Browsing by Author "Kunwar, D"
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Publication Anxiety and Depression during COVID-19 Pandemic among Medical Students in Nepal(Kathmandu University, 2020) Risal, A; Shikhrakar, S; Mishra, S; Kunwar, D; Karki, E; Shrestha, B; Khadka, S; Holen, AABSTRACT Background Medical students’ psychological response to societal lockdown during the COVID-19 pandemic has not been studied much. Objective To assess levels of anxiety and depression among medical students during initial stages of COVID-19 pandemic in Nepal and relate their distress to relevant variables. Method A cross-sectional study with online questionnaire was conducted among medical students at different colleges in Nepal. Hospital Anxiety and Depression Scale (HADS) detected ‘anxiety’ and ‘depression’. The covariates were explored by logistic regression analyses. Result A total 416 medical students [mean age: 22.2 (2.1); males 57.7%, females 42.3%] participated. HADS-anxiety scores [mean: 7.1(4.3)] were significantly and positively correlated with HADS-depression [mean: 5.9 (4.1)] (r=0.695; p < 0.001). Point prevalence of total HADS caseness (HADS-T) was 26.7%. Specific HADS-defined caseness were: anxiety (HADS-A) 11.8%, depression (HADS-D) 5.5%, and comorbid anxiety and depression (HADS-cAD) 9.4%. All four types of caseness were significantly more prevalent among students with a history of mental problems (AOR=4.7, 3.2, 2.6, and 3.2 respectively). HADS-T was higher among those with a concurrent physical illness (AOR=2.4). HADS-T, HADS-A and HADS-D scores were higher among the age group > 22 years (AOR= 2.2, 2.5 and 4.4 respectively). HADS-cAD was almost three- times higher among those with a possible COVID-19 exposure (AOR=2.8). Conclusion A significant number of medical students in Nepal suffered from high levels of anxiety and depression during the COVID-19 shut-down. The students in the higher (> 22 years) age group, those with past mental disorders, possible COVID-19 exposure, and concurrent physical illness showed elevated levels of anxiety and/or depression. KEY WORDS COVID-19, Medical students, Pandemic, Psychological distress, Self-quarantinePublication Association between Thyroid Dysfunction and Common Mental Disorders (Anxiety and Depression): A university hospital-based cross-sectional study(Kathmandu University, 2025) Shrestha, B; Upadhaya, SK; Shrestha, M; Regmi, S; Kunwar, D; Risal, AABSTRACT Background Anxiety and depression have been frequently reported to be associated with thyroid dysfunctions. Many symptoms of anxiety and depression overlap with thyroid disorders sometimes masking the diagnosis. Objective To look for association between thyroid diseases and newly diagnosed case of anxiety or depression in out-patient department. Method It was a hospital based descriptive, cross-sectional study conducted in a period of six months after ethical approval from institutional review committee with participants aged 18-65 years, who wished to give consent for the study and investigations. Cases of anxiety and depression was diagnosed as per the International Classification of Diseases-10, clinical description and diagnostic guideline and self-administered proforma was used for demographic profile. Sample analysis and comparison of different groups in the study was done using chi-square test; p-value < 0.05 was considered for statistical significance. Result Anxiety disorders was higher in individuals with normal thyroid function (54.5%), and depression appeared to be more common among individuals with abnormal thyroid function (60.9%); it did not have any statistical significance. Conclusion Depressive disorders were common among thyroid disorder patients. Further study is needed to examine the relationship between thyroid disorder and common mental disorders to help improve mental health outcomes. KEY WORDS Anxiety, Common mental disorders, Depression, Thyroid diseasesPublication Comparative Study of Different Anti Craving Medication for Alcohol Dependence and Their Effect on Relapse Rate(Kathmandu University, 2025) Kunwar, D; Risal, AABSTRACT Background Alcohol use disorder is a chronic medical condition with a multifactorial aetiology. Food and drug administration approved treatment options for alcohol dependence syndrome includes: Naltrexone, Acamprosate, and Disulfiram and Topiramate as an off label drug. The lack of data specific to the Nepalese population pose significant challenges. Objective To fill that gap by assessing the effectiveness of Naltrexone, Disulfiram, Topiramate and Acamprosate in relapse prevention Method Hospital based cohort study conducted over a period of two months. The total 128 participants were divided into four groups randomly. Patients in the Naltrexone group were prescribed a 50 mg tablet once daily, patients in Topiramate group was given 25 mg up to 100 mg. Acamprosate group, 333 mg one tablet three times a day was given and Disulfiram group received 250 mg once a day and followed up for four weeks. The association between alcohol consumption and sociodemographic characteristics was assessed using Chi-square test. The Statistical Package for Social Science software (IBM SPSS Statistics 21, Chicago, USA) was used for analysis. Result Out of 128 participants 23.4% relapsed in 12 weeks follow up. Naltrexone, Topiramate, Disulfiram, and Acamprosate all were equally effective in preventing relapse and there was no statistically significant differences identified among these medications regarding relapse prevention in our study. Conclusion This study contributes important new data on the efficacy of Acamprosate in the treatment of alcohol dependence in Nepalese population. The study also support for use of pharmacotherapy for relapse prevention. KEY WORDS Alcohol dependence, Anti-craving drugs, Relapse preventionPublication Depression, Alcohol Use, Antiretroviral Therapy Adherence and HIV Status among HIV-infected from Multiple Antiretroviral Therapy Clinics in Nepal(Kathmandu University, 2019) Kunwar, D; Shrestha, B; Risal, A; Kunwar, R; Khadka, SABSTRACT Background Depression and alcohol use disorder are very common among people living with HIV infection, these disorders are not only common among HIV patients but also associated with antiretroviral therapy (ART) non adherence, morbidity and mortality. Objective The objective of our study is to study the prevalence of Depression, Alcohol use, and ART treatment adherence. Method This is a analytical cross-sectional study. Total of 221 participants were included in the study. Convenient method of sampling was used to collect the data from three district Kathmandu, Lalitpur and Kavre ART (Antiretroviral treatment) clinics. Beck Depression Inventory (BDI) was used for the assessment of depression, Alcohol use disorders identification test (AUDIT) was used for alcohol related problems and Visual analogue scale (VAS) was used for treatment adherence. Chi square test and multiple linear regression analysis were conducted for testing bivariate and multivariate relationship of sociodemographic and clinical factors with depression and treatment adherence. Result The 40% participants found to have depression. Variables associated with depression significantly after multiple regression analysis were employment (p value=0.04) and mode of transmission (p value= 0.003). More than half, 56% of the participant’s CD4+ cells count was <500 per cubic millimetre and 71% participant’s viral load was undetectable. Clinical variables mode of transmission (pvalue=0.000), duration of illness (p value=0.03) and duration of treatment (p value=0.01) were significantly associated with depression. ART treatment adherence was significantly associated with CD4 cell (p value=0.02) and viral load (p value= 0.05). Conclusion Depression is very prominent among HIV positive patients. Low CD4+ cell count and high viral load has been seen among patients who are not adherent to antiretroviral treatment. It is suggested that clinicians should carefully assess the possibility of depressive symptoms in their patients on ART treatment. KEY WORDS Antiretroviral therapy, Adherence, Depression, HIV-infectionPublication Does Work-related Stress among Doctors Deserve a Public Debate?(Kathmandu University, 2023) Kunwar, DNAPublication Effectiveness of Mannheim Peritonitis Index in Predicting the Morbidity and Mortality of Patients with Hollow Viscus Perforation(Kathmandu University, 2018) Karki, OB; Hazra, NK; Timilsina, B; Kunwar, DABSTRACT Background Peritonitis due to hollow viscus perforation is one of common surgical emergency. Its accurate diagnosis and management is a challenge to every surgeon. This led to the development of disease severity grading systems that would aid in management and appropriately predict possible outcome. Objective Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the morbidity and mortality in patients with peritonitis due to hollow viscus perforation. Method Prospective study of 126 patients operated for perforation peritonitis in Manipal College of Medical Sciences, Pokhara, Nepal from May 2015 to April 2018. Mannheim Peritonitis Index score was calculated for each patient. Data was analysed for predicting mortality and morbidity using SPSS 20. Pearson’s Chisquare was used as a statistical test and considered as significant difference if p ≤ 0.05. Result Perforated appendix (35.7%), peptic ulcer perforation (31%) and truma (19%) were common causes of perforation peritonitis. Mean score was 18.55. The overall mortality and morbidity was 9% and 43% respectively with Mannheim Peritonitis Index scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 0%, 14%, and 46% respectively. Presence of generalized peritonitis, organ failure at time of admission, type of intra peritoneal exudate carried more significance in predicting the mortality and morbidity in the post op period than other variables. Conclusion Mannheim Peritonitis Index is a simple and specific scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management. KEY WORDS Mannheim peritonitis index, Morbidity, Mortality, Perforation peritonitisPublication Quality of Life (QOL) of Patients Diagnosed with Alcohol Dependence Syndrome Presenting to a Tertiary Care Centre(Kathmandu University, 2025) Kunwar, D; Risal, AABSTRACT Background Among many factors behind the declined health, alcohol dependence plays a crucial role. It has been a significant problem in many countries and around the world. Objective To find out the detrimental quality of life of people dependent on alcohol. Method This was a hospital based cross-sectional study conducted within six months. The study participants were both male and female alcohol dependents taking treatment in de-addiction centers of Kathmandu University School of Medical Sciences. The mean (± SD) of the total and domain specific quality of life score were calculated. Bivariate analysis was done by comparing mean by using independent sample t test. Result The total sample comprised of 300, out of them 85.3% were males and remaining 14.7% were females. Among them 63.3% were using alcohol for more than 22 years, 40% were dependent on alcohol for 13 years and above, and 59.3% were using other substance. In terms of association, variables sex, education and demography were found to be statistically significant. Conclusion This study highlights the impact of alcohol on individuals’ quality of life. Contrary to some previous research, this study did not find significant relationships between age, marital status, comorbidities, and duration of alcohol use with quality of life. Holistic approach could lead to better outcomes for individuals with alcohol dependence syndrome. KEY WORDS Alcohol dependence, Quality of life, Tertiary care centerPublication Publication Screening for Postpartum Depression and Associated Factors among Women who Deliver at a University Hospital, Nepal(Kathmandu University, 2015) Kunwar, D; Corey, E K; Sharma, P; Risal, AABSTRACT Background Postpartum depression (PPD) is a neglected area of maternal health care in developing countries like Nepal; not only in the treatment aspect, but also, in the areas of research. However, it is important to identify and treat postpartum depression because it can have grave consequences for both the mother and her children. Objective To determine the screening prevalence and risk factors of postpartum depression, among women who deliver at university hospital Nepal. Method This is a cross-sectional study investigating the relationship between postpartum depression and various factors. A total of 100 postpartum women who presented to a Dhulikhel hospital for delivery were interviewed on days 2-3 after delivery. The mothers were administered Edinburgh Postnatal Depression Scale (EPDS) as well as a proforma that included questions about the known risk factors (sociodemographic and sociocultural factors, and mother-related, pregnancy-related, and child related factors). Result The overall screening prevalence of depressive symptoms in the postnatal period (defined as EPDS=>13) was 29 %( 95% CI 20.1%-37.8%). On univariate analysis (chi square test), postpartum depression was significantly associated with pregnancy complications (p<0.01), infant’s health problems (p <0.001) and vaginal delivery (p <0.05). Conclusion Postpartum depression is common among Nepalese women and can be detected early in the postpartum periods; and many psychosocial factors like pregnancy complications, infant’s health problems and vaginal delivery are associated with it. It is recommended that mothers with high risk should be routinely screened for postpartum depression. KEY WORDS Developing countries, hospital delivery, infant welfare, prevalence, risk factorsPublication Study of Adherence Pattern of Antidepressants in Patients with Depression(Kathmandu University, 2017) Shrestha, Manandhar J; Shrestha, R; Basnet, N; Silwal, P; Shrestha, H; Risal, A; Kunwar, DABSTRACT Background Depression is one of the leading psychiatric disorders of the world affecting a person’s mood, physical health and behavior. It is not permanent and is neither a character flaw nor a lack in discipline for a person to be ashamed of. It is a disorder that is reliably diagnosed and successfully treated. Antidepressants are the standard and the most efficacious approach to treating people with depression. However, adherence to treatment is necessary for achieving effectiveness. The result of non- adherence is severe and may cause therapeutic failure resulting in poor quality of life. Objective To determine the medication adherence pattern in patients with depression and assess the factors associated with non-adherence to the prescribed antidepressant therapy. Method Patients meeting the inclusion criteria who were diagnosed with depression were taken for the study. Informed consent was taken from the patients or from their relatives in case of their incapability. They were then interviewed using structured questionnaire. Result Among the 60 patients included in the study, 78% of them were females. Most of the patients 43% (n=26) were prescribed with atypical antidepressants. Less number (37%) of the patients were adherent to the antidepressant therapy. 68% of the females were non adherent. 82% of housewives were not adherent to therapy. Forgetfulness was the main reason for missing dose in majority (50%) of the non- adherent patients. Conclusion Majority of the patients with depression were non-adherent to medication. Forgetfulness was the major reason for missing dose in these patients. KEY WORDS Adherence, Antidepressants, Depression, Non-adherencePublication Study of Depression, Anxiety and Stress among the Medical Students in two Medical Colleges of Nepal(Kathmandu University, 2016) Kunwar, D; Risal, A; Koirala, SABSTRACT Background Medical education is intended to prepare graduates for a promoting health and caring for the sick. Medical students are confronted with significant academic, psychological and existential stressors. There is insufficient information regarding psychological morbidity among Nepalese medical students. Objective To determine the prevalence of depression, anxiety and stress, among the medical students in Nepal, and its association with sociodemographic characteristics. Method A cross-sectional questionnaire based study was conducted including all students from first to fifth year of student using convenience method of sampling from Kathmandu University Medical School (KUSMS), Dhulikhel and Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal. Depression, Anxiety and stress were assessed using Depression Anxiety and Stress Scale (DASS). Additional questions regarding demographic variables were also included in the survey. Data analysis was done on Statistical Package for the Social Sciences SPSS version 16. Result A total of 538 students participated in the study giving a response rate of 89.6%. Aamong them 56.5% were from age group 21-25 years, 42.2% were below 20 years and only 1.3% were above 25 years of age. Among them 52% were female and 48% were male. Our study found that the overall prevalence of depression was 29.9%, anxiety was 41.1% and stress was 27% among all participated medical students. Depression was significantly associated (OR 2.23, 95% CI 1.43-3.47, p<0.001) with living condition (living in hostel or rented house). Conclusion The higher level of psychiatric morbidity depression 29.9%, anxiety 41.1% and stress 27% among undergraduate medical students warrants needs for strategic plans to alleviate depression anxiety and the stressors right from the time they join medical school and has to be continued till they finish the course. KEY WORDS Anxiety, depressive disorder, medical students, Nepal