Abstract
Abstract
Objective
To assess the prevalence and factors associated with depression, anxiety and stress among wives of international migrant workers in Ward 5 of Gauradaha municipality, Jhapa, Nepal.
Design
Community-based cross-sectional study.
Setting
Ward 5 of Gauradaha Municipality, Jhapa, Nepal.
Participants
A total of 179 wives of international migrant workers, aged 20–49 years, whose husbands had been away for at least 6 months.
Outcome measures
Depression, anxiety and stress were assessed using the Depression, Anxiety and Stress Scale (DASS-21). Descriptive statistics, χ2/Fisher’s exact test and multivariable logistic regression analyses were performed.
Results
The prevalence of depression, anxiety and stress was 54.7%, 53.1% and 60.9%, respectively. In multivariable analysis, frequency of remittance, debts incurred and daily communication with husbands were significantly associated with depression, anxiety and stress. Additionally, the wives’ occupation was significantly associated with anxiety.
Conclusions
More than half of the wives of international migrant workers experience depression, anxiety and stress. Interventions promoting financial security, facilitating regular communication with migrant spouses and providing occupation-related support may improve mental health outcomes in this population. These findings highlight the need for targeted policies and community programmes to support families left behind by international migrant workers in Nepal.
Keywords: MENTAL HEALTH; Depression & mood disorders; Anxiety disorders; Stress, Psychological
STRENGTHS AND LIMITATIONS OF THIS STUDY.
One of the few community-based studies in Nepal focusing on the mental health of wives of international migrant workers.
Used probability sampling, enhancing representativeness of the study population.
Applied validated instruments (DASS-21) to measure depression, anxiety and stress, showing high reliability.
Cross-sectional design limits the ability to determine causal relationships.
Conducted in a single ward, which may limit generalisability to other settings.
Introduction
Mental wellness is characterised by self-awareness, the ability to manage everyday stressors, the capacity to work effectively and efficiently, and the capacity to give back to the community.1 Mental disorders are one of the leading causes of the global health burden. A mental disorder is defined by a notable decline in an individual’s cognitive abilities, emotional control or behavioural patterns, which significantly impacts their functioning. Approximately 970 million individuals worldwide, equating to one in eight people, are affected by a mental disorder, with anxiety and depressive disorders the most common.2
Globalisation brings opportunities for individuals to move from one place of the world to another. A ‘migrant worker’ is a person who migrates from one country to another (or who has migrated from one country to another) with a view to being employed other than on his own account, and includes any person regularly admitted as a migrant for employment.3 Approximately 3.6% of the world’s population, equivalent to 281 million individuals, is international migrants, of which 169 million are migrant workers.4 The foremost cause of international migration from low and middle-income countries is the search for enhanced employment opportunities.
Approximately 4 million Nepalese individuals are working overseas, roughly 20% of the total employed population. The majority of these migrants are male, comprising around 80%, while females account for 20%.5 The Gulf Cooperation Council (GCC) countries (Qatar, Saudi Arabia, United Arab Emirates, Kuwait, Bahrain and Oman) and Malaysia are the primary destinations, constituting approximately 85% of the total labour migrants.6 Labour migration not only impacts the lives of workers and their families but also plays a crucial role in Nepal’s economy, with one-quarter of the country’s Gross Domestic Product coming from remittances.6
Numerous global studies have found several adverse consequences for the families left behind, including negative mental health outcomes for both migrants and their spouses. For instance, a study in Bangladesh reported elevated rates of depression and anxiety among wives of migrant workers.7 Similar mental health challenges have been observed in the Philippines, where spouses experienced loneliness, stress and increased household responsibilities due to partner migration.8 Research from Sri Lanka also highlighted higher prevalence of common mental disorders among women whose husbands migrated for work.9 These studies indicate that separation from their spouses, lack of companionship, increased household responsibilities and financial stress can contribute to mental health issues among the wives of migrant workers.
In Nepal, the Koshi Province has the highest number of migrant workers, accounting for more than one-fifth of the national total. Jhapa district ranks second among the top five districts of origin. Despite the high migration rates, there is limited research on the mental health of wives left behind, particularly in this region.7 This gap underscores the need to investigate the psychological well-being of these women. Therefore, focusing on Ward 5, the most populous ward within Gauradaha Municipality, this study aims to assess depression, anxiety and stress among wives of international migrant workers in a context where migration is prevalent yet under-researched.
Methods
Study design and setting
A community-based cross-sectional study was conducted to assess depression, anxiety and stress among wives of international migrant workers. Ethical approval was obtained from the Institutional Review Committee of Chitwan Medical College (CMC-IRC/080/081-073). Data were collected between 1 January and 1 July 2024 in Ward 5 of Gauradaha Municipality, Jhapa, Nepal.
Study participants
The study population included wives of international migrant workers whose husbands had migrated to Malaysia or the six GCC countries (Qatar, Saudi Arabia, United Arab Emirates, Kuwait, Bahrain and Oman) for 6 months or more. Women aged below 20 years or above 49 years were excluded from the study to focus on the reproductive and early-middle adult age range, which represents the majority of wives of migrant workers and aligns with prior studies assessing mental health in this population.10
Sample size calculation
The minimum sample size was calculated using standard formulae for cross-sectional studies based on a 95% confidence interval and 5% margin of error, with reference to a previous study reporting 79% prevalence of depression among left-behind wives of migrant workers in Chitwan, Nepal.10 Considering the finite population of 441 eligible participants in Ward 5 of Gauradaha Municipality and adjusting for a 10% non-response rate, the final sample size was determined to be 179 participants as shown in online supplemental table 1.
Sampling procedure
Online supplemental figure 1 shows the sampling procedure where simple random sampling was used to select participants. Ward 5 of Gauradaha Municipality, comprising 14 registered Tole Bikash Samitis, served as the study site. A comprehensive list of eligible participants was prepared in collaboration with local committee representatives. Participants were then randomly selected using a random number table in MS Excel. On the day of data collection, committee representatives assisted in reaching participants’ homes.
Data collection
Depression, anxiety and stress were assessed using the Nepali version of the Depression Anxiety Stress Scales (DASS-21),11 a validated self-report questionnaire widely used to measure psychological distress. The tool consists of 21 items, with seven items per subscale (depression, anxiety, stress), each scored on a 4-point Likert scale from 0 (‘not at all’) to 3 (‘most of the time’) as per table 1. Subscale scores were summed and multiplied by two to obtain final scores. For analysis, scores were dichotomised: the normal range indicated absence, while mild to extremely severe scores were categorised as presence of depression, anxiety or stress. Reliability in this study was confirmed with a Cronbach’s alpha of 0.95.
Table 1. Level of depression anxiety stress−21 score tool11.
| Depression | Anxiety | Stress | |
|---|---|---|---|
| Normal | 0–9 | 0–7 | 0–14 |
| Mild | 10–13 | 8–9 | 15–18 |
| Moderate | 14–20 | 10–14 | 19–25 |
| Severe | 21–27 | 15–19 | 26–33 |
| Extremely severe | 28+ | 20+ | 34+ |
Table 1 shows that the final Depression Anxiety Stress (DAS) score was categorized into two categories. If the score was within the normal range, it indicated the absence of DAS, and scores ranging from mild to extremely severe were categorized as presence of DAS.The final Depression Anxiety Stress (DAS) score was categorized into two categories. If the score was within the normal range, it indicated the absence of DAS, and scores ranging from mild to extremely severe were categorized as presence of DAS.
Data were collected through face-to-face interviews using standardised questionnaires, which consisted of two parts:
Part 1: sociodemographic characteristics of participants and migration-related characteristics of their husbands.
Part 2: depression, anxiety and stress scale–21 Items (DASS-21) to assess mental health outcomes.
Before interviews, verbal and written informed consent was obtained, and participants were informed about the study purpose, procedures, confidentiality and dissemination of results.
Key variables
Outcome Variable: Depression, Anxiety and Stress measured using DASS-21.11
Independent variables: sociodemographic characteristics (age, education, occupation, etc), migration-related characteristics of husbands (duration of migration, frequency of remittance, communication frequency, debts incurred).
Data management and analysis
After data collection, all responses were thoroughly checked, edited and coded. Data were entered into Epidata V.3.1 and exported to IBM SPSS V.20 for analysis.
Descriptive statistics were used to summarise participant characteristics and outcome measures. Associations between independent variables and outcomes were assessed using χ2 or Fisher’s exact test. Multivariable logistic regression analysis was performed to identify factors associated with depression, anxiety and stress. ORs) with 95% CIs were reported.
For regression analysis, some categories were combined (eg, occupation, age, number of children, years of marriage, years of separation) to ensure sufficient sample size in each group, improve model stability and enhance interpretability of results. This approach was carefully considered to minimise potential bias while maintaining meaningful comparisons.
Ethics statement
The study received approval from the Institutional Review Committee of Chitwan Medical College (CMC-IRC/080/081-073). Written and verbal informed consent was obtained from all participants, and confidentiality of data was maintained throughout the study.
Results
Table 2 shows the highest proportion of respondents fell within the age group of 20–29, comprising 46.4% of the sample, followed by 30–39 (35.8%) and 40–19 (17.9%). The mean (SD) age of the respondents was 31.2±SD = 31.2 ± 7.8 years. Regarding religion, Hinduism represents the majority (86.6%), with smaller percentages identifying as Buddhist (1.7%), Islam (2.2%), and other religions (9.5%). Ethnicity data reveal significant proportions belonging to Chhetri (34.6%) and Janajati (29.1%) ethnic groups. Other groups, including Brahmin, Dalit, Muslim and Madheshi, constituted the remaining 36.3%. Educational status varied, with the majority completing secondary education (52.5%), followed by primary education (27.9%), while a small proportion were illiterate (2.2%). Housewives constituted the largest occupational group (67.6%), while public service had the lowest representation (0.6%). Family type was categorised into nuclear (35.8%) and joint families (64.2%). The majority of respondents were married for 6 to 10 years, comprising 30.7% of the total. The lowest number of respondents was those who had been married for 15 years and above, accounting for only 17.3% of the total with the median duration being 10 years. A significant majority of respondents had two or more children (69.8%), and the mean number of children was found to be 1.9. Regarding duration of husband’s migration, the majority of participants (84.9%) reported that their husbands had been away for 1 to 3 years, with a median duration of 2 years.
Table 2. Sociodemographic characteristics (n=179).
| Sociodemographic characteristics | Category | Frequency (%) |
|---|---|---|
| Age group | ||
| 20–29 | 83 (46.4) | |
| 30–39 | 64 (35.8) | |
| 40–49 | 32 (17.9) | |
| Mean±SD=31.2±7.8 years | ||
| Religion | ||
| Hindu | 155 (86.6) | |
| Buddhist | 3 (1.7) | |
| Islam | 4 (2.2) | |
| Kirat | 17 (9.5) | |
| Ethnicity | ||
| Brahmin | 29 (16.2) | |
| Chhetri | 62 (34.6) | |
| Dalit | 18 (10.1) | |
| Janajati | 52 (29.1) | |
| Muslim | 4 (2.2) | |
| Madhesi | 14 (7.8) | |
| Educational status | ||
| Illiterate | 4 (2.2) | |
| Literate | 175 (97.8) | |
| Level of education (n=175) | ||
| Informal | 27 (15.4) | |
| Primary | 50 (28.6) | |
| Secondary | 94 (53.7) | |
| Bachelor’s and above | 4 (2.3) | |
| Occupation | ||
| Housewife | 121 (67.6) | |
| Public service | 1 (0.6) | |
| Private service | 13 (7.3) | |
| Business | 15 (8.4) | |
| Family type | ||
| Nuclear | 64 (35.8) | |
| Joint | 115 (64.2) | |
| Years of marriage | ||
| Up to 5 years | 48 (26.8) | |
| 6 to 10 years | 55 (30.7) | |
| 11 to 15 years | 45 (25.1) | |
| 15 years and above | 31 (17.3) | |
| Median (IQR)=10 (5–14), Min/Max=2/28 | ||
| Number of children | ||
| One child | 54 (30.2) | |
| Two or more children | 125 (69.8) | |
| Mean±SD=1.9±0.8 | ||
| Duration of husband’s migration | ||
| ≤3 years | 152 (84.9) | |
| >3 years | 27 (15.1) | |
| Median (IQR)=2 (2–3), Min/Max=1/9 | ||
Table 3 shows that the largest portion of migrant workers were situated in Malaysia (27.9%), followed closely by Saudi Arabia (24.6%) and Qatar (22.9%) with Oman (0.6%), constituting smaller percentages of the overall distribution. Regarding occupation, labourers constituted the largest percentage (34.1%), followed by technicians (17.9%), with cook/chefs representing the smallest percentage (1.1%). The majority of migrant workers (77.1%) had been away for 3 years or less, while a smaller proportion (22.9%) had been away for more than 3 years. In terms of remittance frequency, the highest percentage of migrants (60.3%) sent money back home once a month, while the lowest percentage (1.1%) had not sent any remittances yet. Most respondents (59.2%) find remittances insufficient. A considerable proportion (26.8%) of migrants had incurred debts for migration, while the majority (73.2%) had not. Communication with husband appeared frequent, with 68.2% reporting daily communication and 31.8% at least once a week.
Table 3. Migration-related characteristics of participant’s husband (n=179).
| Migration-related characteristics | Category | Frequency (%) |
|---|---|---|
| Destination country | ||
| Malaysia | 50 (27.9) | |
| Bahrain | 5 (2.8) | |
| Kuwait | 13 (7.3) | |
| Oman | 1 (0.6) | |
| Qatar | 41 (22.9) | |
| Saudi Arabia | 44 (24.6) | |
| UAE | 25 (14) | |
| Occupation | ||
| Technician | 32 (17.9) | |
| Labourer | 61 (34.1) | |
| Driver | 25 (14) | |
| Security guard | 24 (13.4) | |
| Hotel worker | 22 (12.3) | |
| Cook/chef | 2 (1.1) | |
| Shop/supermarket worker | 13 (7.3) | |
| Interval of return | ||
| ≤3 years | 138 (77.1) | |
| >3 years | 41 (22.9) | |
| Frequency of remittance | ||
| Once a month | 108 (60.3) | |
| Every 3 month | 66 (36.9) | |
| Once in every 6 months | 3 (1.7) | |
| Not sent yet | 2 (1.1) | |
| Adequacy of remittance | ||
| Sufficient | 73 (40.8) | |
| Insufficient | 106 (59.2) | |
| Debts incurred for migration | ||
| Yes | 48 (26.8) | |
| No | 131 (73.2) | |
| Communication with husband | ||
| At least once a day | 122 (68.2) | |
| At least once a week | 57 (31.8) |
Table 4 shows that Depression was present in 54.7% of respondents. Anxiety and stress were present in 53.1% and 60.9%, respectively. In terms of depression, 45.3% of respondents fell within the normal range, while 7.8% experienced mild symptoms, 21.8% moderate, 11.7% severe and 13.4% extremely severe symptoms. Regarding anxiety, 46.9% indicated normal levels, with 6.1% experiencing mild symptoms, 8.9% moderate, 12.3% severe and 25.7% extremely severe symptoms. Additionally, for stress, 39.1% displayed normal levels, 6.7% mild symptoms, 14.0% moderate, 13.4% severe and 26.8% extremely severe symptoms.
Table 4. Distribution of participants according to levels of depression, anxiety and stress (n=179).
| Variables | Normal frequency (%) | Mild frequency (%) | Moderate frequency (%) | Severe frequency (%) | Extremely severe frequency (%) |
|---|---|---|---|---|---|
| Depression* | |||||
| Absence | 81 (45.3) | ||||
| Presence | 14 (7.8) | 39 (21.8) | 21 (11.7) | 24 (13.4) | |
| Anxiety* | |||||
| Absence | 84 (46.9) | ||||
| Presence | 11 (6.1) | 16 (8.9) | 22 (12.3) | 46 (25.7) | |
| Stress* | |||||
| Absence | 70 (39.1) | ||||
| Presence | 12 (6.7) | 25 (14.0) | 24 (13.4) | 48 (26.8) |
Depression: Normal=0–9, Mild=10–13, Moderate=14–20, Severe=21–27, Extremely severe=28+.
Anxiety: Normal=0–7, Mild=8–9, Moderate=10–14, Severe=15–19, Extremely severe= 20+.
Stress: Normal=0–14, Mild=15–18, Moderate=19–25, Severe=26–33, Extremely severe=34+.
Cut-off scores.
Table 5 presents the association of sociodemographic and migration-related characteristics of participants’ husbands with depression, anxiety and stress among the wives of migrant workers. Younger women (20–29 years) had lower prevalence of depression (44.6%), anxiety (41.0%), and stress (48.2%) compared with older women aged 40–49 years, where the prevalence reached 78.1%, 75.0%, and 81.2%, respectively (p<0.01). Religion and ethnicity were not significantly associated with the three outcomes. However, occupation, family type, years of marriage and number of children were strongly linked with mental health outcomes. Housewives and women engaged in agriculture reported substantially higher rates of depression (61.3%), anxiety (60.7%) and stress (67.3%) compared with those in other occupations (all p<0.001). Similarly, women from joint families, those married for more than 10 years and those with two or more children had significantly higher prevalence of depression, anxiety and stress (all p<0.01).
Table 5. Association between Depression, Anxiety and Stress and sociodemographic characteristics, migration-related characteristics of participants’ husbands (n=179).
| Sociodemographic characteristics | Depression n (%) | P value | Anxiety n (%) | P value | Stress n (%) | P value |
|---|---|---|---|---|---|---|
| Age group | ||||||
| 20–29 | 37 (44.6) | 34 (41.0) | 40 (48.2) | |||
| 30–39 | 36 (56.2) | 0.005* | 37 (57.8) | 0.003* | 43 (67.2) | 0.002* |
| 40–49 | 25 (78.1) | 24 (75.0) | 26 (81.2) | |||
| Religion‡ | ||||||
| Hindu | 84 (54.2) | 0.705 | 81 (52.3) | 0.579 | 94 (60.6) | 0.862 |
| Other than Hindu | 14 (58.3) | 14 (58.3) | 15 (62.5) | |||
| Ethnicity‡ | ||||||
| Brahmin/Chhetri | 49 (53.8) | 0.805 | 44 (48.4) | 0.198 | 53 (58.2) | 0.460 |
| Others | 49 (55.7) | 51 (58.0) | 56 (63.6) | |||
| Educational status | ||||||
| Illiterate | 3 (75.0) | 0.628† | 2 (50.0) | 1.000† | 2 (50.0) | 0.645 † |
| Literate | 95 (54.3) | 93 (53.1) | 107 (61.1) | |||
| Occupation‡ | ||||||
| Housewife/agriculture | 92 (61.3) | <0.001* | 91 (60.7) | <0.001* | 101 (67.3) | <0.001* |
| Others | 6 (20.7) | 4 (13.8) | 8 (27.6) | |||
| Family type | ||||||
| Nuclear | 26 (40.6) | 0.05* | 26 (40.6) | 0.013* | 28 (43.8) | <0.001* |
| Joint | 72 (62.6) | 69 (60.0) | 81 (70.4) | |||
| Years of marriage‡ | ||||||
| ≤10 years | 47 (45.6) | 0.004* | 42 (40.8) | <0.001* | 51 (49.5) | <0.001* |
| >10 years | 51 (67.1) | 53 (69.7) | 58 (76.3) | |||
| Number of children | ||||||
| 1 child | 19 (35.2) | 0.001* | 17 (31.5) | <0.001* | 20 (37.0) | <0.001* |
| 2 or more children | 79 (63.2) | 78 (62.4) | 89 (71.2) | |||
| Duration of husband’s migration | ||||||
| ≤3 years | 78 (51.3) | 0.029* | 73 (48.0) | 0.001* | 87 (57.2) | 0.017* |
| >3 years | 20 (74.1) | 22 (81.5) | 22 (81.5) | |||
| Migration related characteristics | ||||||
| Destination country‡ | ||||||
| Malaysia | 29 (58.0) | 31 (62.0) | 0.136 | 36 (72.0) | 0.058 | |
| GCC countries | 69 (53.5) | 0.586 | 64 (49.6) | 73 (56.6) | ||
| Occupation ‡ | ||||||
| Labourer | 50 (82.0) | <0.001* | 47 (77.0) | <0.001* | 52 (85.2) | <0.001* |
| Other than labourer | 48 (40.7) | 48 (40.7) | 57 (48.3) | |||
| Interval of return | ||||||
| ≤3 years | 71 (51.4) | 0.104 | 65 (47.1) | 0.003* | 78 (56.5) | 0.028* |
| >3 years | 27 (65.9) | 30 (73.2) | 31 (75.6) | |||
| Frequency of remittance | ||||||
| Monthly | 39 (36.1) | <0.001* | 35 (32.4) | <0.001* | 44 (40.7) | <0.001* |
| Other than monthly | 59 (83.1) | 60 (84.5) | 65 (91.5) | |||
| Adequacy of remittance | ||||||
| Sufficient | 15 (20.5) | <0.001* | 16 (21.9) | <0.001* | 19 (26.0) | <0.001* |
| Insufficient | 83 (78.3) | 79 (74.5) | 90 (84.9) | |||
| Debts incurred | ||||||
| Yes | 37 (77.1) | <0.001* | 33 (68.8) | 0.011* | 38 (79.2) | 0.002* |
| No | 61 (46.6) | 62 (47.3) | 71 (54.2) | |||
| Communication with husband | ||||||
| At least once a day | 44 (36.1) | 0.001* | 43 (35.2) | <0.001* | 57 (46.7) | <0.001* |
| At least once a week | 54 (94.7) | 52 (91.2) | 52 (91.2) |
Denotes Significant at p<0.05.
Denotes Fisher’s exact test.
Categories combined as described in the data analysis section.
COR, Crude OR; GCC, Gulf Cooperation Council; Ref, Reference category.
Migration-related factors also showed strong associations. Longer duration of husbands’ migration (>3 years) was associated with higher depression (74.1%), anxiety (81.5%) and stress (81.5%) compared with shorter migration durations. Husbands’ occupation as labourers was associated with markedly higher mental health problems (82.0% depression, 77.0% anxiety, 85.2% stress) compared with non-labourers (all p<0.001). Frequency and adequacy of remittance emerged as important predictors: women receiving remittances less frequently than monthly and those reporting insufficient remittances had significantly higher prevalence of all three outcomes (p<0.001). Similarly, indebtedness and infrequent communication with husbands (once a week compared with daily) were associated with substantially higher levels of depression, anxiety and stress (p<0.01).
Multivariable logistic regression analysis of factors associated with depression
Age, occupation, family type, years of marriage, number of children, years of separation, occupation of participant’s husband, frequency of remittance, adequacy of remittance, debts incurred and communication with husband that exhibited statistically significant association (p<0.05) with depression at 95% CI during bivariate analysis were further subjected to multivariate logistic regression for adjustment of possible confounder. A multicollinearity test was done. None of them had tolerance <0.1 and VIF >10. There was no serious collinearity between predictors of dependent variables as the highest VIF was 3.48.
Table 6 shows that monthly remittances were associated with 81% lower odds of depression (AOR: 0.194, p=0.006). Wives who incurred debts had 8.13 times higher odds of depression (AOR: 8.134, p<0.001), while daily communication with husbands was linked to lower odds of depression (AOR: 0.022, p<0.001).
Table 6. Multivariable logistic regression showing factors associated with depression, anxiety and stress.
| Depression | |||
|---|---|---|---|
| Variables | COR (95% of CI) | AOR (95% of CI) | P value |
| Frequency of remittance | |||
| Monthly | 0.115 (0.055 to 0.240) | 0.194 (0.060 to 0.631) | 0.006* |
| Other than monthly | Ref | Ref | |
| Debts incurred | |||
| Yes | 3.860 (1.813 to 8.217) | 8.134 (2.541 to 26.040) | <0.001* |
| No | Ref | Ref | |
| Communication with husband | |||
| At least once a day | 0.031 (0.009 to 0.106) | 0.022 (0.004 to 0.128) | <0.001* |
| At least once a week or more | Ref | Ref | |
| Anxiety | |||
|---|---|---|---|
| Variables | COR (95% of CI) | AOR (95% of CI) | P value |
| Occupation | |||
| Housewife/agriculture | 9.640 (3.192 to 29.109) | 4.058 (1.053 to 15.637) | 0.042* |
| Others | Ref | Ref | |
| Frequency of remittance |
|||
| Monthly | 0.088 (0.041 to 0.188) | 0.148 (0.051 to 0.433) | <0.001* |
| Other than monthly | Ref | Ref | |
| Debts incurred | |||
| Yes | 2.448 (1.216 to 4.931) | 4.344 (1.515 to 12.454) | 0.006* |
| No | Ref | Ref | |
| Communication with husband |
|||
| At least once a day | 0.052 (0.019 to 0.141) | 0.056 (0.013 to 0.252) | <0.001* |
| At least once a week or more | Ref | Ref |
| Stress | |||
|---|---|---|---|
| Variables | COR (95% of CI) | AOR (95% of CI) | P value |
| Frequency of remittance | |||
| Monthly | 0.063 (0.025 to 0.159) | 0.137 (0.042 to 0.442) | 0.001* |
| Other than monthly | Ref | Ref | |
| Debts incurred | |||
| Yes | 3.211 (1.477 to 6.983) | 3.738 (1.231 to 11.352) | 0.020* |
| No | Ref | Ref | |
| Communication with husband |
|||
| Once a day | 0.084 (0.032 to 0.226) | 0.207 (0.047 to 0.926) | 0.039* |
| At least once a week or more | Ref | Ref |
All VIF <10, Multivariable logistic regression was used. Model fit: Cox & Snell R2=0.499, Nagelkerke R2=0.668, Hosmer and Lemeshow=0.105.
All VIF <10, Multivariable logistic regression was used. Model fit: Cox & Snell R2=0.458, Nagelkerke R2=0.611, Hosmer and Lemeshow=0.094.
All VIF <10, Multivariable logistic regression was used. Model fit: Cox & Snell R2=0.448, Nagelkerke R2=0.607, Hosmer and Lemeshow=0.213.
Denotes Significant at p<0.05.
AOR, Adjusted OR; COR, Crude OR; Ref, Reference category.
Log odds of depression among wives of international migrant workers are
=2.571–1.638 (Monthly remittance) +2.096 (Debts incurred) −3.830 (Communication once a day).
Multivariable logistic regression analysis of factors associated with anxiety
Age, occupation, family type, years of marriage, number of children, years of separation, occupation of participant’s husband, interval of return, frequency of remittance, adequacy of remittance, debts incurred and communication with husband, that exhibited statistically significant association (p<0.05) with anxiety at 95 percent CI during bivariate analysis, were further subjected to multivariate logistic regression for adjustment of possible confounders. A multicollinearity test was done. None of them had tolerance <0.1 and VIF >10. There was no serious collinearity between predictors of dependent variables as the highest VIF was 3.498.
Table 6 shows that wives in housewife/agriculture occupations had higher odds of anxiety compared with other occupations (AOR: 4.058, p=0.042). Receiving remittances monthly was associated with 85% lower odds of anxiety compared with less frequent remittances (AOR: 0.148, p<0.001). Wives who incurred debts had higher odds of anxiety (AOR: 4.344, p=0.006), while daily communication with husbands was associated with substantially lower odds of anxiety (AOR: 0.056, p<0.001).
Log odds of anxiety among wives of international migrant workers are
=2.434+1.401 (Housewife/agriculture) −1.908 (Monthly remittance) +1.469 (Debts incurred) −2.874 (Communication once a day).
Multivariable logistic regression analysis of factors associated with stress
Age, occupation, family type, years of marriage, number of children, years of separation, occupation of participant’s husband, interval of return, frequency of remittance, adequacy of remittance, debts incurred and communication with husband) that exhibited statistically significant association (p<0.05) with stress at 95% CI during bivariate analysis were further subjected to multivariate logistic regression for adjustment of possible confounders. A multicollinearity test was done. None of them had tolerance <0.1 and VIF >10. There was no serious collinearity between predictors of dependent variables as the highest VIF was 3.498.
Table 6 shows that monthly remittances were associated with 87% lower odds of stress (AOR: 0.137, p=0.001). Wives who incurred debts had 3.74 times higher odds of stress (AOR: 3.738, p=0.020), while daily communication with husbands was linked to 80% lower odds of stress (AOR: 0.207, p=0.039).
Log odds of stress among wives of international migrant workers are
=2.642–1.988 (Monthly remittance +1.318 (Debts incurred) –1.573 (Communication once a day).
Discussions
In this study, the prevalence of depression, anxiety and stress among wives of international migrant workers was 54.7%, 53.1% and 60.9%, respectively. These rates are notably higher than those reported in Bangladesh, Pakistan, China and India.12,16 It is important to note that the studies from Bangladesh and China did not specifically examine wives of international migrant workers; instead, they focused on general women or broader community populations. This difference in study population, in addition to the use of different screening instruments, cut-off points and sample characteristics, may partly explain the observed discrepancies. Cultural attitudes towards mental health, stigma and access to healthcare services may also contribute to variations across countries.17 18 After adjusting for confounders in the multivariable analysis, the associations remained strong, indicating that the observed effects were robust to the influence of other factors.
Regarding remittance frequency, wives who received remittances monthly were less likely to experience depression, anxiety and stress compared with those receiving them less frequently, consistent with findings from Nepal and Sri Lanka.19 20 The Nepalese study by Aryal et al19 similarly reported that irregular remittance transfers and limited financial resources significantly contributed to depressive and anxiety symptoms among left-behind wives. It further emphasised that stable remittance receipt acted as a protective factor, reducing psychological distress. Adjustment in the multivariable model slightly strengthened these associations, suggesting that remittance frequency is an independent predictor of mental health outcomes. Wives who reported debts incurred for migration had significantly higher odds of DAS, with the strongest association observed for depression (AOR: 8.13). This aligns with studies from Sri Lanka and India, highlighting the financial strain imposed by migration-related debts as a risk factor for mental health problems.20 21
Communication with husbands emerged as a protective factor, with wives who communicated at least once daily showing significantly lower odds of DAS. This effect remained strong even after multivariable adjustment, indicating that daily spousal communication independently reduces the risk of depression, anxiety and stress. Occupation was associated only with anxiety; housewives and women engaged in agriculture were more likely to experience anxiety, which may be explained by the physical and emotional burden of household and agricultural responsibilities. Differences in socio-cultural context and gender norms may account for contrasting findings in Pakistan.20
This study has several limitations. The cross-sectional design prevents causal inference between migration-related factors and mental health outcomes. The study was conducted in a single ward of Gauradaha Municipality, limiting generalisability. A relatively small sample required dichotomisation of some variables, potentially reducing data granularity. Mental health outcomes were assessed using a self-reported tool (DASS-21), which may be subject to response or social desirability bias. Sensitive topics like mental health could also have led to underreporting despite assurances of confidentiality. Potential biases and residual confounding should be considered when interpreting the findings.
Overall, these findings highlight the importance of financial stability, debt management and spousal communication in mitigating depression, anxiety and stress among migrant workers’ wives. The multivariable analysis confirms that these associations persist even after adjustment, emphasising their independent role in shaping mental health outcomes. Interventions addressing these factors could improve the psychological well-being of this vulnerable population.
Conclusions
This study found that more than half of the wives of international migrant workers experienced depression, anxiety and stress, highlighting a substantial mental health burden among this population. Key factors associated with these outcomes included frequency of remittance, debts incurred, communication with the husband and, for anxiety specifically, the wife’s occupation. These findings underscore the complex interplay of socioeconomic, relational and occupational factors in shaping the mental health of women left behind by migrant workers, emphasising the urgent need for targeted support mechanisms.
Recommendations
The findings have important implications for both local public health initiatives and national policy. At the local level, municipalities could implement community-based counselling programmes to provide accessible mental health support for wives of migrant workers, addressing issues such as depression, anxiety and stress. Vocational training and skill-development programmes can empower women economically, particularly those engaged in agriculture, through subsidies, sustainable farming training and better access to markets. Stress management and mental health awareness campaigns could further help reduce psychological burden and stigma.
At the policy level, these findings highlight the need for comprehensive strategies to support families affected by international migration. Policymakers could prioritise the development of mental health services tailored for wives of migrant workers, including training of human resources, strengthening psychosocial support systems and integrating mental health awareness into broader public health initiatives. Research and data systems could be enhanced to track mental health trends among this population and inform evidence-based interventions.
Overall, this study reinforces the importance of contextualised, multi-sectoral approaches—combining health, economic and social support—to improve the well-being of families left behind by international migration, ensuring that interventions are both practical and culturally appropriate.
Supplementary material
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2025-101373).
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Not applicable.
Ethics approval: This study involves human participants and was approved by the Chitwan Medical College Institutional Review Committee (CMC-IRC/080/081-073). Participants gave informed consent to participate in the study before taking part.
Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
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