Table 1: Socio-demographic characteristics of the respondents
n=384
Variable
|
frequency (f)
|
Percentage (%)
|
Age
|
|
|
20 to 40 years
|
84
|
21.9
|
41 to 60 years
|
277
|
72.1
|
˃60
|
23
|
6.0
|
Mean±SD
|
47.51±9.28
|
|
Sex
|
|
|
Male
|
1
|
0.3
|
Female
|
383
|
99.7
|
Ethnicity
|
|
|
Brahmin/Chhetri
|
152
|
39.6
|
Janajati
|
34
|
8.9
|
Madeshi
|
174
|
45.3
|
Muslim
|
14
|
3.6
|
Dalit
|
10
|
2.6
|
Religion
|
|
|
Hindu
|
366
|
95.3
|
Buddhist
|
2
|
0.5
|
Muslim
|
14
|
3.6
|
Christian
|
2
|
0.5
|
Education
|
|
|
Literate only
|
106
|
27.6
|
Primary
|
48
|
12.5
|
Secondary
|
104
|
27.1
|
SLC
|
108
|
28.1
|
Bachelor and above
|
18
|
4.7
|
Occupation
|
|
|
FCHVs with Service
|
9
|
2.3
|
FCHVs with Business
|
10
|
2.6
|
only FCHVs
|
365
|
95.1
|
Type of Family
|
|
|
Nuclear
|
255
|
66.5
|
Joint
|
129
|
33.5
|
Marital status
|
|
|
Married
|
381
|
99.2
|
Unmarried
|
3
|
0.8
|
Personal habit
|
|
|
Relax
|
381
|
99.2
|
Tense
Place of Residence
Urban
Rural
|
3
200
184
|
0.8
58.1
47.9
|
Table 1 showed that nearly third-fourth (72.1%) of respondents were aged 40 to 60 years of age and 21.9% of respondents were aged 20 to 40 years. The mean age was 47.5 years whereas only 6.0% of respondents were aged above 60 years. Almost of the (99.7%) respondents were Female whereas only 0.3 % was male. Less than half (45.3%) of the respondents were Madhesi and more than one-third (39.6%) of respondents were Brahmin and Chhetri. Only 2.6% of Respondents were Dalit. Most of them (95.3%) of respondents were Hindu whereas 0.5% of respondents were Buddhist and Christian. More than one-fourth (28.1%) of the respondent’s education level was SLC whereas only 4.7% of respondents' education level was Bachelor and above. almost (95.1%) of the respondent's occupations were only FCHVs whereas only 2.3% of the respondents were FCHVs with did service. Two-thirds (66.4%) of the respondents had nuclear families whereas only 33.5% had a joint family. Similarly almost of the respondents were married whereas 0.8 % were unmarried.
Table 1 B: Socio-demographic Characteristics of Respondents
n=384
Variable
|
Frequency (f)
|
Percentage (%)
|
Personal habit
|
|
|
Relax
|
381
|
99.2
|
Tense
|
3
|
0.8
|
Social network
|
|
|
Use properly
|
371
|
96.6
|
Not use properly
|
13
|
3.4
|
Family support
|
|
|
Supportive
|
377
|
98.2
|
Not supportive
|
7
|
1.8
|
Workplace Climate
|
|
|
Favorable
|
380
|
99.0
|
Unfavorable
|
4
|
1.0
|
working environment
|
|
|
Supportive
|
373
|
97.1
|
Unsupportive
|
11
|
2.9
|
Policy
|
|
|
Favorable
|
381
|
99.2
|
Unfavorable
|
3
|
0.8
|
Table 2 revealed that almost (99.2%) of respondents were looked relaxed whereas only 0.8% of respondents were looked tense. Similarly, most of (96.6%) the respondents had a proper social network. Likewise almost (98.2%) of the respondents had supportive families whereas only 1.8% of the respondent’s families had unsupportive. Almost (99.0%) of the respondents had favorable working environments whereas only 2.9% of respondents had unfavorable working environments. Similarly almost (99.2 %) of respondents had expressed unfavorable policy for them whereas only 0.8% of respondents had expressed unfavorable policy for them.
Table 3: Respondent’s response on different variables of Depression Anxiety Stress
Variable
|
Did not apply to me at all (f) %
|
Apply to me some degree (f) %
|
Apply to me considerable degree (f) %
|
Apply to me very much (f) %
|
I found it hard to wind wound
|
147 (38.3)
|
197 (51.3)
|
21 (5.5)
|
19 (4.9)
|
It was aware of dryness of mouth
|
167 (43.5)
|
172 (44.8)
|
27 (7.0)
|
18 (4.7)
|
I couldn’t seem to experience any positive feeling at all
|
190 (49.5)
|
144 (37.5)
|
30 (7.8)
|
20 (5.2)
|
I experienced breathing difficulty
|
201(52.3)
|
138 (35.9)
|
29 (7.6)
|
16 (4.2)
|
I found it difficult to work up the initiative to do things
|
200 (52.1)
|
139 (36.2)
|
27 (7.0)
|
18 (4.7)
|
I tended to over-react to situations
|
199 (51.8)
|
138 (35.9)
|
27 (7.0)
|
20 (5.2)
|
I experienced trembling (e.g. in the hands)
|
207 (53.9)
|
133 (34.6)
|
28 (7.3)
|
16 (4.2)
|
I felt that I was using a lot of nervous energy
|
206 (53.6)
|
129 (33.6)
|
29 (7.6)
|
20(5.2)
|
I was worried about situations in which I might panic and make a fool of myself
|
201 (52.3)
|
132 (34.4)
|
34 (8.9)
|
17 (4.4)
|
I felt that I had nothing to look forward to
|
210 (54.7)
|
131 (34.1)
|
24 (6.3)
|
19 (4.9)
|
I found myself getting agitated
|
210 (54.7
|
132 (34.4)
|
23 (6.0)
|
19 (4.9)
|
I found it difficult to relax
|
218 (56.8)
|
122 (31.8)
|
25 (6.5)
|
19 (4.9)
|
I felt down-hearted and blue
|
208 (54.2)
|
129 (33.6)
|
28 (7.3)
|
19 (4.9)
|
I was intolerant of anything that kept me from getting on with what I was doing
|
210 (54.7)
|
122 (31.8)
|
32 (8.3)
|
20 (5.2)
|
I felt I was close to panic
|
213 (55.5)
|
123 (32.0)
|
33 (8.6)
|
15 (3.9)
|
I was unable to become enthusiastic about anything
|
213 (55.5)
|
125 (32.6)
|
30 (7.8)
|
16 (4.2)
|
I felt I wasn’t worth much as a person
|
220 (57.3)
|
121 (31.5)
|
26 (6.8)
|
17 (4.4)
|
I felt that I was rather touchy
|
210 (54.7)
|
126 (32.8)
|
31 (8.1)
|
17 (4.4)
|
I was aware of the action of my heart in the absence of physical exertion
|
219 (57.0)
|
121 (31.5)
|
26 (6.8)
|
18 (4.7)
|
I felt scared without any good reason
|
217 (56.5)
|
127 (33.1)
|
23 (6.0)
|
17 (4.4)
|
I felt that life was meaningless
|
218 (56.8)
|
123 (32.0)
|
24 (6.3)
|
19 (4.9)
|
Table 3 illustrated that in terms of, I found it hard to wind wound, more than half (51.3%) of respondents agree to apply to me some degree whereas more than one-third (38.3%) of respondents were agreed to apply to did not apply to me at all. in terms of, it was aware of dryness of mouth, less than half of respondents (44.8%) were agreed with applying to me some degree whereas (4.7%) of respondents were agreed with applying to me very much. Similarly in terms of, I couldn’t seem to experience any positive feeling at all, nearly half of the respondents (49.5%) agreed that did not apply to me at all whereas only (5.2%) of respondents agreed that apply to me very much. In terms of, I experienced breathing difficulty, more than (51.8%) of respondents agreed that did not apply to me at all whereas only 4.2% of respondents agreed with applying to me very much. In terms of, I found it difficult to work up the initiative to do things more than half (52.1%) of respondents agreed that did not apply to me at all-in terms of, I experienced trembling (e.g. in the hands) more than half (53.9%) of the respondents agreed that did not apply to me at all whereas only 7.3% of respondents were agreed with applying to me a considerable degree. In terms of, I felt that I was using a lot of nervous energy, more than half (53.6%) of the respondents agreed that did not apply to me at all whereas only 5.2% of respondents were agreed with applying to me very much. In terms of, I was worried about situations in which I might panic and make a fool of me, 52.3% of the respondents agreed that did not apply to me at all whereas only 4.4% were agreed with applying to me very much. In terms of, I felt that I had nothing to look forward to 54.7% of the respondents agreed that did not apply to me at all whereas only 4.9% were agreed with applying to me very much. In terms of, I found myself getting agitated, more than half (54.7%) of the respondents agreed that did not apply to me at all whereas only 4.9% were agreed with applying to me very much. In terms of, I found it difficult to relax, 56.8% of the respondents agreed that did not apply to me at all whereas only 6.5% were agreed with applying to me a considerable degree. In terms of, I felt down-hearted and blue, 54.2% of the respondents agreed that did not apply to me at all whereas only 7.3% were agreed with applying to me a considerable degree. In terms of, I was intolerant of anything that kept me from getting on with what I was doing, 54.7% of the respondents agreed that did not apply to me at all whereas only 8.3% were agreed with applying to me a considerable degree. In terms of, I felt I was close to panic, 55.5% of the respondents agreed that did not apply to me at all whereas only 8.6% were agreed with applying to me a considerable degree. In terms of, I was unable to become enthusiastic about anything, 55.5% of the respondents agreed that did not apply to me at all whereas only 7.8% were agreed with applying to me a considerable degree. In terms of, I felt I wasn’t worth much as a person, 57.3% of the respondents agreed that did not apply to me at all whereas only 6.8% were agreed with applying to me a considerable degree. In terms of, I felt that I was rather touchy, 54.7% of the respondents agreed that did not apply to me at all whereas only 8.1% were agreed with applying to me the considerable degree. In terms of, I was aware of the action of my heart in the absence of physical exertion, 57.0% of the respondents agreed that did not apply to me at all whereas only 6.8% were agreed with applying to me a considerable degree. In terms of, I felt scared without any good reason, 56.5% of the respondents agreed that did not apply to me at all whereas only 6.0% were agreed with applying to me a considerable degree. In terms of, I felt that life was meaningless, 56.8% of the respondents agreed that did not apply to me at all whereas only 6.3% were agreed with applying to me for a considerable degree.
Table 4: Prevalence of level of Depression Anxiety Stress of respondents
n=384
Variables
|
Frequency (f)
|
Percentage (%)
|
Level of Anxiety
|
|
|
Normal
Mild
|
194
8
|
50.5
2.1
|
Moderate anxiety
|
23
|
6.0
|
Severe anxiety
Extremely Severe
|
23
136
|
6.6
35.5
|
Level of Stress
|
|
|
Normal
Mild
|
226
18
|
58.9
4.7
|
Moderate Stress
|
90
|
23.4
|
Severe stress
Extremely Severe
|
6
44
|
1.6
11.4
|
Level of Depression
|
|
|
Normal
Mild
|
204
20
|
53.1
5.2
|
Moderate depression
|
29
|
7.6
|
Severe depression
Extremely Severe
|
83
48
|
21.6
12.5
|
Table 4 showed that half (50.5 %) of respondents had no anxiety and the prevalence of extremely severe levels of anxiety was 35.5 % of the respondent (FCHVs) whereas only 6.0% of respondents were moderate anxiety. Likewise, the prevalence of stress was 23.4% of moderate level of stress and 1.6 were the severe level of stress of respondents. Similarly, the prevalence of depression was 21.6% of respondents were a severe level of depression whereas only 7.6% of respondents had a moderate level of depression.
Table 5: Association between anxiety and selected demographic variables (Bivariate analysis)
n=384
Variable
|
Level of Anxiety
|
Unadjusted OR
|
CI
|
p-Value
|
|
Normal
|
Anxiety
|
|
|
|
Age
|
|
|
|
|
|
20 to 40 years
|
40
|
44
|
0.862
|
0.531-1.399
|
0.547
|
41 to 60 year
|
154
|
146
|
|
|
|
Ethnicity
|
|
|
|
|
|
Bramin/ Chhetri
|
85
|
67
|
0.699
|
0.463-1.054
|
0.087
|
Other castes
|
109
|
123
|
|
|
|
Religion
|
|
|
|
|
|
Hindu
|
|
|
1.022
|
0.397-2.633
|
0.964
|
Others
|
|
|
|
|
|
Occupation
|
|
|
|
|
|
Service & FCHVs
|
14
|
5
|
2.878
|
1.016-8.154
|
0.047 ⃰
|
Business & FCHVs
|
180
|
185
|
|
|
|
Types of Family
|
|
|
|
|
|
Nuclear
|
128
|
127
|
0.962
|
0.630-1.470
|
0.858
|
Joint
|
66
|
63
|
|
|
|
Marital Status
|
|
|
|
|
|
Married
|
193
|
188
|
0. .962
|
0. .630-1.470
|
0. 858
|
Unmarried
|
1
|
2
|
|
|
|
Social network
|
|
|
|
|
|
Good
|
187
|
184
|
2.595
|
0.497-13.540
|
0.258
|
Bad
|
7
|
6
|
|
|
|
Place of Residence
|
|
|
|
|
|
Urban
|
117
|
83
|
1.959
|
1.305-2.940
|
0.001 ⃰
|
Rural
|
77
|
107
|
|
|
|
Co-morbidities
|
|
|
|
|
|
Yes
|
145
|
137
|
1.020
|
0.956-1.088
|
0.559
|
No
|
49
|
53
|
|
|
|
Table 5 revealed that association between anxiety and selected demographic variable. There is significant association between anxiety and occupation of (p=0.047; OR=2.878; CI=1.016-8.154) and place of residence (p=0.001; OR=1.959; CI=1.305-2.940). The anxiety level is increased 2.878 times more in service with FCHVs then business with FCHVs and others. Likewise the FCHVs who lived in urban area are 1.959 times more chance to develop stress then FCHVs who lived in rural area. Similarly there is no association between age (p=0.547; OR=0.862; CI=0.531-1.399); ethnicity (p=0.087; OR=0.699; CI=0.463--1.054); religion (p=0.964; OR=0.1.022; CI=0.397-2.633) ; types of family (p=0.858; OR=0.962; CI=0.630-1.470); marital status (p=0.258; OR=2.595; CI=0.497-13.540); social network (p=0.559; OR=1.020; CI=0.956-1.088) and co-morbidities.
Table 6: Association between Stress and selected demographic variables (Bivariate analysis)
n=384
Variables
|
Level of Stress
|
Unadjusted OR
|
CI
|
p-Value
|
no stress
|
stress
|
Age
|
|
|
|
|
|
20 to 40 years
|
47
|
37
|
0.859
|
0.527-1.400
|
0.541
|
41 to 60 year
|
179
|
121
|
|
|
|
Ethnicity
|
|
|
|
|
|
Brahmin/Chhetri
|
97
|
55
|
1.408
|
0.925-2.143
|
0.110
|
Other castes
|
129
|
103
|
|
|
|
Religion
|
|
|
|
|
|
Hindu
|
217
|
149
|
1.456
|
0.565-3.755
|
0.437
|
Others
|
9
|
9
|
|
|
|
Education
|
|
|
|
|
|
below SLC
|
95
|
118
|
1.104
|
0.940-1.297
|
0.229
|
Above SLC
|
59
|
94
|
|
|
|
Occupation
|
|
|
|
|
|
Service & FCHVs
|
15
|
4
|
2.737
|
0.891-8.408
|
0.079
|
Business & FCHVs
|
211
|
154
|
|
|
|
Types of Family
|
|
|
|
|
|
Nuclear
|
149
|
106
|
0.949
|
0.617-1.461
|
0.813
|
Joint
|
77
|
52
|
|
|
|
Marital Status
|
|
|
|
|
|
Married
|
224
|
157
|
0.713
|
0.064-7.936
|
0.783
|
Unmarried
|
2
|
1
|
|
|
|
Social network
|
|
|
|
|
|
Good
|
220
|
157
|
0.891
|
.286-2.774
|
0.841
|
Bad
|
6
|
1
|
|
|
|
Place of Residents
|
|
|
|
|
|
Urban
|
117
|
83
|
1.630
|
1.082-2.454
|
0.019 ⃰
|
Rural
|
77
|
107
|
|
|
|
Co-morbidities
|
|
|
|
|
|
Yes
|
164
|
123
|
0.960
|
0.897-1.028
|
0.242
|
No
|
62
|
35
|
|
|
|
Table 6 revealed that association between stress and selected demographic variable. There is association between stress and place of residence (p=0.541; OR=0.859; CI=1.082-2.454). Likewise the FCHVs who lived in urban area are 1.630 times more chance to develop stress then FCHVs who lived in rural area. There is no significant association between stress and age (p=0.541; OR=0.859; CI=0.527-1.400); ethnicity (p=0.019; OR=1.408; CI=0.9252.143); religion (p=0.437; OR=0.1.456; CI=0.565-3.755); education (p=0.229; OR=1.630 ; CI= 0.940-1.297); occupation (p= 0.079; OR=2.737; CI= 0.891-8.408); types of family (p=0.813; OR=0.949; CI=0.617-1.461); marital status (p=0.783; OR=0.713; CI=0.0647-7.936); social network (p=0.841; OR=0.891; CI=0.286-2.774) and co-morbidities (p=0.242; OR=0.960; CI=0.897-1.028).
Table 7: Association between Depression and selected demographic variables (Bivariate analysis)
n=384
Variables
|
Level of Depression
|
Unadjusted OR
|
CI
|
p-Value
|
Non Depressive
|
Depressive
|
Age
|
|
|
|
|
|
20 to 40 years
|
44
|
40
|
963
|
0.593-1.563
|
0.877
|
41 to 60 year
|
160
|
140
|
|
|
|
Ethnicity
|
|
|
|
|
|
Brahmin/ Chhetra
|
62
|
90
|
1.503
|
1.503-2.272
|
0.054
|
Janajati & others
|
114
|
118
|
|
|
|
Religion
|
|
|
|
|
|
Hindu
|
195
|
171
|
1.140
|
0.443-2.938
|
0.786
|
Buddhist
|
9
|
9
|
|
|
|
Level of Education
|
|
|
|
|
|
Below SLC
|
194
|
172
|
.975
|
.768-1.237
|
.832
|
SLC and Above
|
10
|
8
|
|
|
|
Occupation
|
|
|
|
|
|
FCHVs with service
|
14
|
5
|
2.579
|
0.910-7.308
|
0.075
|
FCHVs with Business& other
|
190
|
175
|
|
|
|
Types of Family
|
|
|
|
|
|
Nuclear
|
136
|
119
|
1.025
|
.671-1.567
|
0.908
|
Joint
|
68
|
61
|
|
|
|
Place of Residents
|
|
|
|
|
|
Urban
|
121
|
79
|
1.864
|
1.242-2.797
|
0.003 ⃰
|
Rural
|
83
|
101
|
|
|
|
Status of Co-morbidities
|
|
|
|
|
|
Yes
|
152
|
135
|
0.996
|
0.933-1.064
|
0.912
|
No
|
52
|
45
|
|
|
|
Table 7 revealed that association between depression and selected demographic variable. There is association between depression and place of residence (p=0.003; OR=1.864; CI=1.242-2.797). Likewise the FCHVs who lived in urban area are 1.864 times more chance to develop depression then FCHVs who lived in rural area. There is no significant association between depression and age (p=0.877; OR=1.140; CI=0.593-1.563); ethnicity (p=0.832; OR=1.503; CI=1.503-2.272); religion (p=0.786; OR=0.1.456; CI=0.443-2.938); education (p=0.229; OR= 0.975; CI=0.768-1.237); occupation (p=0.075; OR=2.579; CI=0.910-7.308); types of family (p=0.908; OR=1.025; CI=0.671-1.567); and co-morbidities (p=0.912; OR=0.996; CI=0.933-1.064).
Part IV: Multivariate analysis between depression, anxiety stress, and socio-demographic variable of FCHVs
Table 8
Association between levels of Anxiety and Socio-demographic variables (Multivariate
Analysis)
n=384
Variables
|
Unadjusted OR
|
adjusted OR
|
CI
|
p-value
|
Ethnicity
|
|
|
|
|
Brahmin/ Chhetri
|
0.699
|
1.562
|
1.021-2.390
|
0.040 ⃰
|
Janajati & others ⁎⁎
|
(Ref)
|
|
|
|
Occupation
|
|
|
|
|
FCHVs with service
|
2.878
|
3.861
|
1.325-11.249
|
0.013 ⃰
|
FCHVs with businesses/others
|
(Ref)
|
|
|
|
Place of resident
|
|
|
|
|
Urban
|
1.959
|
1.959
|
1.470-3.413
|
≤0.001 ⃰
|
Rural
|
(Ref)
|
|
|
|
Table 8 depicts a multivariate analysis between the anxiety and demographic variable. There is significant association between level anxiety and ethnicity of FCHVs (p=0.040; OR=1.562; CI=1.021-2.390), occupation (p=0.013; OR=3.861; CI=1.325-11.249) and place of residence (p≤0.001; OR=1.959; CI=1.470-3.413). The FCHVs who are Brahmin/Chhetri is a 1.562 times more chance to develop anxiety than FCHVs who are Janajati and others. Similarly, FCHVs who did FCHVs with service is a 3.861 times more chance to develop anxiety than FCHVs did FCHVs with Business and others. Likewise, the FCHVs who lived in urban area is 1.959 times more chance to develop stress than FCHVs who lived in the rural area.
Table 9: Association between levels of Stress and Socio-demographic variables (Multivariate analysis)
n=384
Variables
|
Unadjusted OR
|
adjusted OR
|
CI
|
p-value
|
Occupation
|
|
|
|
|
FCHVs with service
|
1.864
|
3.363
|
1.074-10.531
|
0.037٭
|
FCHVs with Business
|
(Ref)
|
|
|
|
Place of resident
|
|
|
|
|
Urban
|
2.579
|
1.817
|
1.193-2.767
|
0.005٭
|
Rural
|
(Ref)
|
|
|
|
Table 9 depicts a multivariate analysis between the stress and demographic variable. There is significant association between level stress and occupation (p=0.037; OR=3.363; CI=1.074-10.531) place of residence (p=0. 005; OR=1.817; CI=1.193-2.767). FCHVs whose occupation FCHVs with service is 3.363 times more chance to develop stress than the FCHVs who are FCHVs, business, and another profession. Similarly, the FCHVs who lived in urban area are 1.817 times more chance to develop stress than FCHVs who lived in rural areas.
Table 10: Association between levels of Depression and Socio-demographic variables (Multivariate analysis)
n=384
Variables
|
Unadjusted OR
|
adjusted OR
|
CI
|
p-value
|
Ethnicity
|
|
|
|
|
Bramin/Chhetri
|
1.503
|
1.630
|
1.065-2.496
|
0.024 ⃰
|
Janajati & others
|
(Ref)
|
|
|
|
Occupation
|
|
|
|
|
FCHVs with service
|
2.579
|
3.371
|
1.158-9.812
|
0.026 ⃰
|
FCHVs with businesses& other
|
(Ref)
|
|
|
|
Place of resident
|
|
|
|
|
Urban
|
1.864
|
2.117
|
1.391-3.222
|
0.001 ⃰
|
Rural
|
(Ref)
|
|
|
|
* Significant association p-value < 0.05; ⁎⁎ Madhesi, Dalit & Muslin
Table 10 depicts a multivariate analysis between the depression and demographic variables. There is significant association between level depression and ethnicity (p=0.024; OR=1.630; CI=1.065-2.496) occupation (p=0. 026; OR=3.371; CI=1.158-9.812) and place of residence (p≤0.001; OR=2.117; OR=1.391-3.222). FCHVs whose ethnicity is Brahmin/Chhetri; have 1.630 times more chance to develop depression than FCHVs who are Janajati & others. FCHVs whose occupation is FCHVs with service; have 3.371 times more chance to develop depression than FCHVs who are FCHVs, Business, and others. Similarly, FCHVs who lived in urban is 2.117 times more chance to develop depression than FCHVs who lived in rural respectively.