The Effect of Social Support on the Relationship between Mental Health and Resilience in Nepali Earthquake Survivors

Background and Purpose: The 7.8 magnitude earthquake, which struck Nepal in 2015 caused widespread devastation to the country.  Over 8,000 people lost their lives, 22,000 were injured and approximately 500,000 homes were destroyed.  Disasters such as the Nepal earthquake can have a long lasting impact on the mental health of survivors, particularly in low-income countries like Nepal.  Research has shown that there is a positive relationship between exposure to natural disasters and common disaster related mental health disorders including post-traumatic stress disorder (PTSD), depression, and anxiety.  Protective factors, however, may buffer the mental health impact of a disaster.  One important protective factor to consider in disaster recovery is perceived social support (PSS).

The World Health Organization (2014) defines mental health as the ability to function well and live as a useful member of society, not just as living with the absence of mental disorders. One way to measure positive mental health is through resilience, which is a complex construct that encompasses the ability of individuals to recover in a variety of ways in the aftermath of a stressful event, such as the 2015 Nepal earthquake.  This study seeks to examine (1) the relationship between common mental disorders and resilience and (2) the moderating effect of PSS.

Methods: Data were collected in August 2016 as part of a longitudinal study on a mental health and psychosocial intervention in the post-earthquake Nepal.  A total of 15 village development communities (VDCs) were selected for participation based on the level of earthquake impact.  Sampling of VDCs was completed using the United Nations Office for the

Coordination of Humanitarian Affairs (OCHA) (22) ratings of the earthquake impact in each VDC and the Probability Proportion to Size (PPS) method.  Households within each VDC were selected using systematic random sampling, until a total of 50 individuals per VDC were surveyed. A total of 660 cases are included in our analyses.  Our independent variables in this study were anxiety, depression, and PTSD. Our dependent variable was resilience.  We tested PSS  as a potential moderating variable. All of the key variables were assessed using continuous measures.  All measures were translated into Nepali to suit language and cultural codes.

We ran OLS regression analyses to  examine the relationships between the three mental disorders and resilience.  We also tested the moderating effect of PSS on the relationships between the three mental disorders and resilience.

Findings: OLS analyses found a statistically significant negative relationship between resilience and anxiety (B=-0.137, p<0.001), depression (B=-0.116, p<0.001), and PTSD (B=-0.065, p=0.337), controlling for other factors. PSS significantly moderated the associations between resilience and each mental disorder: anxiety (B=0.012, p<0.05), depression (B=0.017, p<0.05), and PTSD (B=0.064, p<0.05).

Conclusions and Implications: Our findings suggest that perceived social support does moderate the relationship between common mental disorders and resilience in Nepali earthquake survivors, particularly for PTSD.  These findings suggest that future interventions to strengthen resilience in the aftermath of disasters might seek to increase social support.