Psychological morbidity in Nepali cross-border migrants in India: A community based cross-sectional study

Background: Since Nepali cross-border migrants can freely enter, work and stay in India, they remain largely undocumented. Majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, predisposing them to psychological distress. We aimed to assess the prevalence and associated factors of psychological morbidity among the Nepali migrants on return from India. Methods: A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using the Poisson regression analysis. Results: The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least primary education (66.6%), and from Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5 % (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR)=2.74), from Terai (aPR=3.29), a religious minority (aPR=3.64), no sick leave (aPR=2.4), with existing health problem (aPR=2.0) and having difficulty in accessing health care (aPR=1.88) were more likely to have a psychological morbidity than others. Conclusion: This study demonstrated that psychological morbidity was prevalent in the study participants, which significantly varied with the individual characteristics, work and health related conditions. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights at workplace are recommended to help reduce psychological morbidity