{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:01:39Z","timestamp":1787508099559,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T00:00:00Z","timestamp":1555372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: In 2015, a 7.8 magnitude earthquake struck Nepal, causing unprecedented damage and loss in the mountain and hill regions of central Nepal. The aim of this study was to investigate the association between healthcare access and utilization, and post-disaster mental health symptoms. Methods: A cross-sectional study conducted with 750 disaster-affected individuals in six districts in central Nepal 15 months post-earthquake. Anxiety and depression were measured through the Depression, Anxiety and Stress Scale (DASS-21). Healthcare utilization questions examined types of healthcare in the communities, utilization, and approachability of care providers. Univariate analyses, ANOVAs and Tobit regression were used. Results: Depression and anxiety symptoms were significantly higher for females and individuals between 40\u201350 years old. Those who utilized a district hospital had the lowest anxiety and depression scores. Participants who indicated medical shops were the most important source of health-related information had more anxiety and depression than those who used other services. Higher quality of healthcare was significantly associated with fewer anxiety and depressive symptoms. Conclusions: Mental health symptoms can last long after a disaster occurs. Access to quality mental health care in the primary health care settings is critical to help individuals and communities recover immediately and during the long-term recovery.<\/jats:p>","DOI":"10.3390\/ijerph16081369","type":"journal-article","created":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T03:02:01Z","timestamp":1555470121000},"page":"1369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Investigating the Aftershock of a Disaster: A Study of Health Service Utilization and Mental Health Symptoms in Post-Earthquake Nepal"],"prefix":"10.3390","volume":"16","author":[{"given":"Tara","family":"Powell","sequence":"first","affiliation":[{"name":"School of Social Work, University of Illinois Urbana\u2014Champaign, 1010 W. Nevada St., Urbana, IL 61801, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Ju","family":"Li","sequence":"additional","affiliation":[{"name":"Americares, 88 Hamilton Avenue, Stamford, CT 06902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Sociology, University of Washington, Seattle, WA 98195-3340, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Ettari","sequence":"additional","affiliation":[{"name":"Americares, 88 Hamilton Avenue, Stamford, CT 06902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anish","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Social Science Baha, 345 Ramchandra Marg, Battisputali, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Peterson","sequence":"additional","affiliation":[{"name":"Americares, 88 Hamilton Avenue, Stamford, CT 06902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niva","family":"Shakya","sequence":"additional","affiliation":[{"name":"Americares Nepal, Dhobighat 4, Lalitpur, State 3, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3389\/fbuil.2015.00008","article-title":"The 2015 Gorkha Nepal Earthquake: Insights from Earthquake Damage Survey","volume":"1","author":"Goda","year":"2015","journal-title":"Front. 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