From ethnography to epigenetics: Mixed methods mental health research in Nepal

Bran­don Kohrt, MD, PhD, Res­i­dent, Depart­ment of Psy­chi­a­try and Behav­ioral Sciences, George Wash­ing­ton Uni­ver­sity Med­ical Cen­ter   Web­site  |  Pub­li­ca­tions  |  Abstract & Bio

Abstract: Inter­dis­ci­pli­nary approaches are cru­cial to answer major ques­tions in global men­tal health research. Dif­fer­ences in lan­guage, ethnopsy­chol­ogy, heal­ing sys­tems, and local biol­ogy con­tribute to vari­a­tion in men­tal health, stress, and resilience across pop­u­la­tions and set­tings. In this ses­sion, I dis­cuss chal­lenges in work­ing across and between dis­ci­plines to study men­tal health in Nepal. I describe the ethno­graphic process used to develop an appro­pri­ate vocab­u­lary and ethnopsy­cho­log­i­cal research model. I explore how com­mon men­tal dis­or­ders and suicide-related behav­iors among civil­ian sur­vivors of the Maoist People’s War can be assessed with epi­demi­o­log­i­cal stud­ies that employ bio­cul­tural meth­ods such as gene-by-environment risk mod­els and cor­ti­sol awak­en­ing pro­files. I dis­cuss how the inter­sec­tion of ethnog­ra­phy and epi­demi­ol­ogy informs psy­chother­a­peu­tic inter­ven­tions for trau­ma­tized groups such as Nepali child sol­diers and Bhutanese refugees. I con­clude by dis­cussing next steps in inter­dis­ci­pli­nary research in Nepal through the incep­tion of a project explor­ing poten­tial epi­ge­netic cor­re­lates of trauma and inter­ven­tion among child sol­diers in Nepal.

Bio: Bran­don Kohrt con­ducts global men­tal health research focus­ing on pop­u­la­tions affected by war-related trauma and chronic stres­sors of poverty, dis­crim­i­na­tion, and lack of access to health­care and edu­ca­tion. He com­pleted med­ical school and a PhD in med­ical anthro­pol­ogy at Emory Uni­ver­sity. He cur­rently is com­plet­ing res­i­dency in gen­eral psy­chi­a­try at The George Wash­ing­ton Uni­ver­sity. He has worked in Nepal for 16 years using a bio­cul­tural devel­op­men­tal per­spec­tive inte­grat­ing epi­demi­ol­ogy, cul­tural anthro­pol­ogy, ethnopsy­chol­ogy, and neu­roen­docrinol­ogy. Since 2000, he has con­ducted a prospec­tive study of adults in rural Nepal exam­in­ing the effects of polit­i­cal trauma, eth­nic dis­crim­i­na­tion, gender-based vio­lence, and poverty on men­tal health. With Tran­scul­tural Psy­choso­cial Orga­ni­za­tion (TPO) Nepal, he designed and eval­u­ated psy­choso­cial rein­te­gra­tion pack­ages for child sol­diers in Nepal. He cur­rently works with The Carter Cen­ter Men­tal Health Liberia Pro­gram devel­op­ing anti-stigma cam­paigns and fam­ily psy­choe­d­u­ca­tion pro­grams. He co-founded the Atlanta Asy­lum Net­work for Tor­ture Sur­vivors, for which he was rec­og­nized by Physi­cians for Human Rights with the Navin Narayan Health and Human Rights Lead­er­ship Award. In 2009, he started a men­tal health clinic for Bhutanese refugees. His research has been pub­lished in JAMA, Lancet, British Jour­nal of Psy­chi­a­try, and Social Sci­ence & Med­i­cine. He was a Laugh­lin Fel­low of the Amer­i­can Col­lege of Psy­chi­a­trists and John Spiegel Fel­low of the Soci­ety for the Study of Psy­chi­a­try and Cul­ture (SSPC). He is cur­rently a board mem­ber of SSPC and tech­ni­cal advi­sor at TPO-Nepal. Dr. Kohrt has con­tributed to numer­ous doc­u­men­tary films includ­ing Returned: Child Sol­diers of Nepal’s Maoist Army. Next year, Dr. Kohrt will join the fac­ulty of the Duke Global Health Insti­tute and the Duke Depart­ment of Psy­chi­a­try and Behav­ioral Sciences.