Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis

Prevalence and associated factors of depression among refugees in East Africa: a systematic review and meta-analysis

INTRODUCTION

Depression is a common and debilitating mental health issue among refugees in East Africa, who face numerous challenges. However, there is a lack of systematic reviews and meta-analyses that have explored the pooled prevalence and associated factors of depression among refugees in East Africa. This study aims to investigate the pooled prevalence of depression and its associated factors among refugees living in East Africa.

METHODS

A systematic search was conducted across several databases, including PubMed/MEDLINE, CINAHL, ScienceDirect, African Journals of Online (AJOL), and Google Scholar. The quality of the included studies was assessed using a Joanna Briggs Institute (JBI) quality appraisal tool. Statistical analysis was carried out using STATA-17 software packages, and a meta-analysis was conducted using a random-effects model. Heterogeneity among the studies was assessed using the I2 statistic. Publication bias was evaluated using the DOI plot, Luis Furuya Kanamori (LFK) index, and Egger's test. For associated factors of depression, effect sizes (odds ratio) with 95% confidence intervals were analyzed.

RESULT

A total of eight studies involving 6,388 participants were included in this systematic review and meta-analysis, all of which were assessed to have a low risk of bias. The pooled prevalence of depression was 50.60%, with a 95% CI (35.49%, 65.71). Regarding factors associated with depression; being female [(OR = 2.01; 95% CI (1.06, 3.82)], having poor social support [OR 5.88; 95% CI (2.53, 13.67)], and experienced eight or more traumatic events [OR = 3.31;95% CI (1.74, 6.31) were positively associated factors with depression.

CONCLUSION

The pooled prevalence of depression among refugees in East Africa was found to be significantly high. Female participants, poor social support, and experienced eight or more traumatic events were factors affecting depression among refugees in East Africa. Therefore, policymakers and health personnel in East Africa should prioritize addressing the needs of female participants, individuals with poor social support, and those who have experienced eight or more traumatic events.

Sociodemographic factors associated with trajectories of depression among urban refugee youth in Kampala, Uganda: A longitudinal cohort study

Background

There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.

Methods

We conducted a longitudinal cohort study with refugee youth aged 16-24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.

Results

Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: "sustained low depression level" (n = 803, 71.9%) and "sustained high depression level" (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.

Conclusions

The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.

Gender-based violence and its determinants among refugees and internally displaced women in Africa: systematic review and meta-analysis

BACKGROUND

Gender-based violence is a serious public health concern and affects a large number of women and girls in humanitarian emergencies. Despite this, there is a dearth of the summary data to address the issue. Therefore, this study aimed to assess the estimated pooled magnitude and factors associated with gender-based violence among refugees and internally displaced women in Africa.

METHODS

PubMed/MEDLINE, Google Scholar, African Journals OnLine, PsycINFO, and EMBASE were among the databases that were used to search the primary articles. The reviewed papers were articles that evaluated the prevalence and contributing variables of gender-based violence against refugees and internally displaced women in Africa. We extracted the data using a Microsoft Excel spreadsheet, which we exported into Stata version 14 for further analysis. The I2 test was applied to identify statistical heterogeneity. We used a random effect meta-analysis methodology because of the heterogeneity. A funnel plot and Egger's weighted regression test were used to examine publication bias.

RESULTS

This systematic review and meta-analysis reviewed 17 primary studies with a total of 6,161 refugees and internally displaced women in Africa. The findings of this study revealed that the estimated pooled prevalence of gender-based violence among refugees and internally displaced women was determined to be 48.20% (95% CI: 39.28, 57.12). Young age (AOR = 3.68, CI: 2.63, 5.14), alcohol consumption (AOR = 2.53, CI: 1.56, 4.11), and having no social protection (AOR = 3.21, CI: 2.22, 4.63) were factors significantly associated with gender-based violence.

CONCLUSIONS AND RECOMMENDATIONS

The present study showed that almost half of refugees and internally displaced women residing in Africa were survivors of gender-based violence. Younger women, alcohol users, and those without social protection were more likely to experience gender-based violence. Therefore, it is recommended that accessible information about the consequences of gender-based violence and early intervention for survivors be provided, taking these factors into consideration.

Association between sexual violence and depression is mediated by perceived social support among female university students in the kingdom of Eswatini

BACKGROUND

Gender-based violence is a tool that primarily functions to maintain gendered power hierarchies. Manifestations of gender-based violence, sexual assault and street harassment have been shown to have significant effects on mental wellbeing in the global North, however there is little research centering the experiences and consequences of gendered harassment in the Africa region.

METHODS

We analyzed a cross-sectional random sample of 372 women attending a major university in Eswatini in 2017 to measure the prevalence of street harassment among female university students and assess the relationship between experiences of sexual assault, sexualized street harassment, and mental health outcomes in this population.

RESULTS

We found that in the previous 12 months, women reported experiencing high levels of sexual assault (20%), street harassment (90%), and depression (38%). Lifetime sexual assault, past 12 months sexual assault, and street harassment were all significantly associated with symptoms of depression. We created a structural model to test hypothesized causal pathways between street harassment, previous experiences of sexual assault, and symptoms of depression, with social support as a potential mediator. We found that a history of sexual violence significantly mediated the association between street harassment and depression, and that social support mediated a large proportion of the association between both forms of gender-based violence and depression.

CONCLUSION

Sexualized street harassment is associated with increased depressive symptomology for nearly all women, however the effects are especially pronounced for women who have previous experiences of sexual violence. Sexualized street harassment functions as a tool to maintain gendered power hierarchies by reminding women of ongoing threat of sexual violence even in public spaces. Social support and solidarity among women is a potentially important source of resiliency against the physical and mental harms of all forms of gender based violence.

Prevalence, predictors, and economic burden of mental health disorders among asylum seekers, refugees and migrants from African countries: A scoping review

BACKGROUND

Asylum seekers, migrants, and refugees from African countries may have significant health needs, resulting in economic implications for receiving countries around the world. The risk of mental illness is higher in these communities because of factors like violence, deprivation, and post-immigration challenges.

OBJECTIVE

The purpose of this study was to examine the literature to determine the prevalence, predictors, and economic impacts of mental health (MH) disorders among asylum seekers, migrants, and refugees from African countries.

DESIGN AND METHODS

In this scoping review, we followed the guidelines from PRISMA and CoCoPop. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS) was used to assess study quality for cross-sectional studies, while an appraisal list was used for qualitative studies based on the Critical Appraisal Skills Programme (CASP). Inclusion criteria included peer-reviewed articles published in English, and articles based on official reports from credible institutions and organizations. Among the exclusion criteria were publications that were not peer reviewed or had not been sourced by credible sources, publications that did not meet the study topic or language criteria, mixed populations (including Africans and non-Africans), and research abstracts, reviews, news articles, commentary on study protocols, case reports, letters, and guidelines.

DATA SOURCES

A systematic search was carried out in Medline (via PubMed), EMBASE, APA PsycINFO, Web of Science and EBSCO, to identify relevant articles that were published between 1 January 2000 and 31 January 2024.

RESULTS

A total of 38 studies met the inclusion criteria, including 22 from African countries and three qualitative studies. In terms of number of countries contributing, Uganda was the largest (n = 7), followed by Italy (n = 4). The most studied conditions, using multiple diagnostic tools, were Post-Traumatic Stress Disorder (PTSD, n = 19) and depression (n = 17). These studies all revealed elevated rates of mental health disorders among these groups, and these were related to migration, refugee-related factors, and traumatic events. Most of these groups are dominated by young males. There is, however, a prominent presence of minors and women who have suffered a variety of forms of violence, in particular sexual violence. Furthermore, mental illnesses, such as PTSD and depression, are not only persistent, but can also be transmitted to children. In accordance with our inclusion criteria, our review found only one study that examined the economic impact of MH disorders in these groups, leaving a significant knowledge gap. According to this randomized controlled trial, intervention to reduce psychological impairment can help young people stay in school, improve their quality-adjusted life year (QALY), and earn an incremental cost-effectiveness ratio (ICER) of $7260 for each QALY gained.

CONCLUSION

Asylum seekers, migrants, and refugees from African countries are likely to experience MH needs, according to this scoping review. As well as posing persistent challenges, these disorders can also be transmissible to offspring. In addition to longitudinal studies of these groups, economic impact studies of mental illnesses are necessary.

Gender-based violence in the context of armed conflict in Northern Ethiopia

BACKGROUND

Gender-based violence (GBV) particularly against women is unfortunately common during armed conflicts. No rigorous and comprehensive empirical work has documented the extent of GBV and its consequences that took place during the two years of devastating armed conflict in Northern Ethiopia. This study aims to assess GBV and its consequences in war-torn areas of northern Ethiopia.

METHODS

We used a qualitative method augmented by quantitative method to enroll research participants. We conducted in-depth interviews to characterize the lived experiences of GBV survivors. All interviews were conducted confidentially. The data were collected to the point of data saturation. All interviews were transcribed verbatim into local language, translated into English, and analyzed using a thematic analysis approach. We also used reports from healthcare facilities and conducted a descriptive analysis of the demographic characteristics of study participants.

RESULTS

One thousand one hundred seventy-seven persons reported GBV to healthcare providers. The qualitative study identified several forms of violence (sexual, physical, and psychological). Gang rape against women including minors as young as 14 years old girls was reported. Additionally, the perpetrators sexually violated women who were pregnant, and elderly women as old as 65 years, who took refuge in religious institutions. The perpetrators committed direct assaults on the body with items (e.g., burning the body with cigarette fire) or weapons, holding women and girls as captives, and deprivation of sleep and food. GBV survivors reported stigma, prejudice, suicide attempts, nightmares, and hopelessness. GBV survivors dealt with the traumatic stress by outmigration (leaving their residences), seeking care at healthcare facilities, self-isolation, being silent, dropping out of school, and seeking counseling.

CONCLUSION

GBV survivors were subjected to multiple and compounding types of violence, with a wide range of adverse health consequences for survivors and their families. GBV survivors require multifaceted interventions including psychological, health, and economic support to rehabilitate them to lead a productive life.

"When you leave your country, this is what you're in for": experiences of structural, legal, and gender-based violence among asylum-seeking women at the Mexico-U.S. border

BACKGROUND

Recent U.S. immigration policy has increasingly focused on asylum deterrence and has been used extensively to rapidly deport and deter asylum-seekers, leaving thousands of would-be asylum-seekers waiting indefinitely in Mexican border cities, a large and growing proportion of whom are pregnant and parenting women. In the border city of Tijuana, Mexico, these women are spending unprecedented durations waiting under unsafe humanitarian conditions to seek safety in the U.S, with rising concerns regarding increases in gender-based violence (GBV) among this population during the COVID-19 pandemic. Given existing gaps in evidence, we aimed to describe the lived experiences of GBV in the context of asylum deterrence policies among pregnant and parenting asylum-seeking women at the Mexico-U.S. border.

METHODS

Within the community-based Maternal and Infant Health for Refugee & Asylum-Seeking Women (MIHRA) study, we conducted semi-structured qualitative interviews with 30 asylum-seeking women in Tijuana, Mexico between June and December 2022. Eligible women had been pregnant or postpartum since March 2020, were 18-49 years old, and migrated for the purposes of seeking asylum in the U.S. Drawing on conceptualizations of structural and legal violence, we conducted a thematic analysis of participants' experiences of GBV in the context of asylum deterrence policies and COVID-19.

RESULTS

Pregnant and parenting asylum-seeking women routinely faced multiple forms of GBV perpetuated by asylum deterrence policies at all stages of migration (pre-migration, in transit, and in Tijuana). Indefinite wait times to cross the border and inadequate/unsafe shelter exacerbated further vulnerability to GBV. Repeated exposure to GBV contributed to poor mental health among women who reported feelings of fear, isolation, despair, shame, and anxiety. The lack of supports and legal recourse related to GBV in Tijuana highlighted the impact of asylum deterrence policies on this ongoing humanitarian crisis.

CONCLUSION

Asylum deterrence policies undermine the health and safety of pregnant and parenting asylum-seeking women at the Mexico-U.S. border. There is an urgent need to end U.S. asylum deterrence policies and to provide respectful, appropriate, and adequately resourced humanitarian supports to pregnant and parenting asylum-seeking women in border cities, to reduce women's risk of GBV and trauma.

Psychosocial effects of gender-based violence among women in Vhembe district: A qualitative study

Background

The phenomenon of gender-based violence is a pertinent social problem in South Africa. The fear of reporting gender-based violence contributes to its continuation, marginalisation and silencing of victims.

Objectives

The study sought to explore the psychosocial effects of gender-based violence among women in Vhembe district.

Methods

An exploratory phenomenological research design was used and sampling was performed purposively from a population of women who experienced gender-based violence in a low-resource, rural setting of Vhembe district. Semi-structured telephonic interviews were used as the main method of data collection after permissions and informed consent were sought for conducting the study. Thematic content analysis was applied to convert the participants' statements into a meaningful framework to derive the findings.

Results

A total of 15 participants aged from 19 to 35 years participated in the study. Their psychosocial experiences of gender-based violence were depression, worthlessness, social isolation and anger directed towards children.

Conclusion

This research confirms that gender-based violence remains one of the most challenging problems associated with mental health problems in Vhembe district. It affirms the need to focus on awareness in rural areas afflicted by patriarchal attitudes, norms and stereotypes. Gender-based violence should to be viewed as human rights violation for victims' protection.

Contribution

The study contributes to the body of knowledge on the experiences of gender-based violence among marginalised women from rural areas.

Factors contributing to the high prevalence of intimate partner violence among south Sudanese refugee women in Ethiopia

BACKGROUND

Intimate partner violence is a universally occurring form of violence against women which is perpetrated by a husband or other intimate partner. It is a common public health problem during humanitarian crisis. Despite this, little is known about the problem among South Sudanese refugee women in Ethiopia.

OBJECTIVE

This study aimed to determine the prevalence of intimate partner violence and identify its contributing factors among married refugee women in Pinyudo refugee camp, Gambella, Ethiopia in 2021.

METHODS

A community-based cross-sectional study was conducted from March to June 2021. A random sample of 406 refugee women was included in the study. A structured, pretested, and interviewer-administered questionnaire was used to collect the data. Data were entered into epi-data version 3.1 and exported to SPSS version 22 for analysis. Multivariable logistic regression was run to identify factors associated with intimate partner violence. Statistical significance was affirmed using Adjusted Odds Ratio with its 95% Confidence Interval at a p-value ≤ 0.05.

RESULTS

A total of 406 married refugee women participated in the study making a response rate of 96.2%. The overall prevalence of intimate partner violence in the past 12 months was 48.3% 95% CI= (43.6-53.2). Low-income contribution [AOR = 2.4, 95% CI: 1.2-5.5], and attitudinal acceptance [AOR = 2.1, 95%CI: 1.2-3.8] were significantly associated with the problem.

CONCLUSION

The prevalence of intimate partner violence is alarmingly high as half of participating women reported facing the problem in the year preceding the study. Low-income contribution and attitudinal acceptance were associated with a higher probability of experiencing violence. The government, humanitarian organizations, and other stakeholders should enable refugee women to generate income. There should be continuous women empowerment and behavioral interventions to improve refugee women's attitudes towards intimate partner violence.

Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence

North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women's exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women's exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.

Women's mental health and climate change Part II: Socioeconomic stresses of climate change and eco-anxiety for women and their children

Climate change is a significant public health crisis that is both rooted in pre-existing inequitable socioeconomic and racial systems and will further worsen these social injustices. In the face of acute and slow-moving natural disasters, women, and particularly women of color, will be more susceptible to gender-based violence, displacement, and other socioeconomic stressors, all of which have adverse mental health outcomes. Among the social consequences of climate change, eco-anxiety resulting from these negative impacts is also increasingly a significant factor in family planning and reproductive justice, as well as disruptions of the feminine connection to nature that numerous cultures historically and currently honor. This narrative review will discuss these sociologic factors and also touch on ways that practitioners can become involved in climate-related advocacy for the physical and mental well-being of their patients.

Exploring the Impact of a Family-Focused, Gender-Transformative Intervention on Adolescent Girls' Well-Being in a Humanitarian Context

While family functioning interventions show promise for improving adolescent girls' well-being in humanitarian contexts, few programs employ a gender-transformative approach to maximize benefits for adolescent girls. This paper presents findings from a mixed-methods pilot evaluation of a whole-family, gender-transformative intervention conducted with Syrian refugee families in Jordan. The Siblings Support of Adolescent Girls in Emergencies program was implemented with 60 Syrian refugee households in Azraq and Za'atari camps in Jordan. A quantitative survey was administered to 18 households at baseline and endline, and researchers conducted qualitative interviews and focus group discussions with caregivers, paired interviews and participatory discussions with adolescents, and key informant interviews with program mentors. Paired t-tests revealed statistically significant improvements in mental distress, resilience, and gender equitable attitudes in the full sample and for girls only and marginally significant improvements in family functioning. Qualitative findings revealed improvements in four domains of girls' well-being-self-efficacy, self-confidence, pro-social behavior, and mental health-through three primary pathways: family members' increased gender equitable attitudes, healthier intrahousehold communication, and greater affective involvement. Findings from this mixed-methods evaluation point to the potential value in merging gender-transformative and whole-family approaches in humanitarian programming to maximize positive impacts for adolescent girls.

Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

The mental health and well-being of internally displaced female Yazidis in the Kurdistan Region of Iraq: a realist review of psychosocial interventions and the impact of COVID-19

BACKGROUND

Yazidis in the Kurdistan Region of Iraq have been exposed to recurrent traumatic experiences associated with genocide and gender-based violence (GBV). In 2014, ISIS perpetrated another genocide against the Yazidi community of Sinjar. Women and girls were held captive, raped and beaten. Many have been forced into displacement. Rates of post-traumatic stress disorder (PTSD) and suicide are high. Limited research has evaluated interventions delivered to this population.

METHODS

This review explores how the global evidence on psychosocial interventions for female survivors of conflict-related sexual violence applies to the context of the female Yazidi population. We used a realist review to explore mechanisms underpinning complex psychosocial interventions delivered to internally displaced, conflict-affected females. Findings were cross-referenced with eight realist, semi-structured interviews with stakeholders who deliver interventions to female Yazidis in the Kurdistan Region of Iraq. Interviews also allowed us to explore the impact of COVID-19 on effectiveness of interventions.

RESULTS

Seven mechanisms underpinned positive mental health outcomes (reduced PTSD, depression, anxiety, suicidal ideation): safe spaces, a strong therapeutic relationship, social connection, mental health literacy, cultural-competency, gender-matching and empowerment. Interviews confirmed relevance and applicability of mechanisms to the displaced female Yazidi population. Interviews also reported increased PTSD, depression, suicide and flashbacks since the start of the COVID-19 pandemic, with significant disruptions to interventions.

CONCLUSION

COVID-19 is just one of many challenges in the implementation and delivery of interventions. Responding to the mental health needs of female Yazidis exposed to chronic collective violence requires recognition of their sociocultural context and everyday experiences.

Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria

BACKGROUND

Valid measures of sexual violence stigma that can be readily incorporated into program monitoring and evaluation systems are needed to strengthen gender-based violence (GBV) services in humanitarian emergencies. This study sought to assess the psychometric properties, construct validity, and measurement invariance of sexual violence stigma scales among female Somali GBV survivors in Kenya and Syrian GBV survivors in Jordan to identify an abbreviated scale that could be used across humanitarian contexts.

METHODS

We administered measures of sexual violence stigma to 209 female survivors of sexual violence aged 15 and older in Kenya and Jordan. Exploratory factor analysis was used to assess the underlying latent structure, and Item Response Theory was used to estimate item difficulty and discrimination parameters to guide efforts to shorten the scales. Differential item functioning (DIF) by site was assessed using Multiple Indicators, Multiple Causes models. Construct validity of the sexual violence stigma scales was assessed by estimating correlations with functional impairment, depression, and disability.

RESULTS

The sexual violence stigma measure exhibited distinct factor structures among Somali and Syrian GBV survivors. Among Somali survivors, a two-factor model with separate felt (10 items) and enacted (4 items) stigma constructs was identified, with scales for both domains exhibiting good internal consistency (Cronbach's alpha = 0.93 and 0.88, respectively). In Jordan, a single factor solution was uncovered for a 15-item stigma scale with good internal consistency (alpha = 0.86). The shortened core sexual stigma scale consisting of the 4 items that did not exhibit DIF had a Cronbach's alpha of 0.82 in Kenya and 0.81 in Jordan. The felt stigma scale in Kenya, the full stigma scale in Jordan, and abbreviated core stigma scales in both countries were meaningfully correlated with depression, while correlations with functional impairment were weaker and inconsistent across scales.

CONCLUSIONS

An abbreviated core set of invariant perceived and internalized sexual violence stigma items demonstrated evidence of construct validity in two diverse settings. The ability of this measure to be efficiently administered as a part of routine program monitoring and evaluation activities, with the potential addition of items from a measurement bank to improve contextual relevance, can facilitate improvements in the delivery and quality of gender-based violence programs in humanitarian emergencies.

Health and Lifestyle, Safety, Relationship and Personality Factors Influence Gender, Sex and Sexuality Issues among Youth—A Case Record Analysis from Youth Mental Health Promotion Clinics in Karnataka, India

Promoting positive identity and seeking early support for gender, sex and sexuality (GSS) issues among youth is vital. Understanding and addressing factors associated withGSS among them is critical. We assessed four-year case records (January 2017–December 2020) of all first visit youth mental health promotion clinic (YMHPC) clients (15–35 years) for factors associated with GSS issues in Karnataka. Overall, prevalence of GSS issues was 1.8% (189/10,340). Increased risk of GSS issues was observed among clients reporting suicidality (AOR = 4.27, 95% CI = 2.70–6.74) and relationship issues (AOR = 3.63, 95% CI = 2.36–5.57), followed by issues of safety (AOR = 2.56, 95% CI = 1.72–3.81), personality (AOR = 2.48, 95% CI = 1.60–3.85), health and lifestyle (AOR = 2.27, 95% CI = 1.77–4.19), smokers (AOR = 2.30, 95% CI = 1.24–4.27), and those who felt depressed (AOR = 2.10, 95% CI = 1.43–3.09) and worthless (AOR = 2.08, 95% CI = 1.28–3.39). Clients aged 21–25 years (AOR = 1.80,95% CI = 1.27–2.54), male (AOR = 1.72, 95% CI = 1.20–2.46) and who had been married (AOR = 2.32, 95% CI = 1.51–3.57) had a higher risk of GSS issues than those aged 15–20 years and other counterparts, respectively. Clients who drank alcohol (AOR = 0.49, 95% CI = 0.30–0.81) had reduced risk of GSS issues. The findings re-iterate the importance of early recognition of factors (essential precursors) of GSS issues among youth. The study highlights the importance of promoting awareness and improving primordial prevention of possible GSS issues in later life. This study has important implications on youth mental health promotion programs, especially in countries like India.

Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees

Purpose of Review

The number of refugees across the globe continues to grow, leaving a large proportion of the global population in a vulnerable state of health. However, the number of robust clinical interventions has not kept apace. This paper provides a general review of literature on the trauma and violence that refugees face, the impact on health outcomes, and some of the promising models for clinical intervention.

Recent Findings

Refugees experience a cycle of trauma, violence, and distress that begins before migration and continues during migration and after resettlement. It has been challenging to develop robust clinical interventions due to the cumulative and cyclic effects of trauma, as well as the unique experiences of trauma that each refugee community and each refugee individual faces.

Summary

Trauma-informed care is a critical component of health care. Developing stronger guidelines for trauma-informed care will help clinicians better provide inclusive and equitable care for refugee patients.

Experience of neighbourhood violence and mental distress in Brazilian favelas: a cross-sectional household survey

Background

Living in informal settlements with extensive neighbourhood violence has been shown to be linked with poorer mental health. However, there is little evidence as to whether different levels of personal experiences and fears of neighbourhood violence within such settlements affect mental health. This study assessed such personal experiences and fears of residents in favelas in Brazil. We tested whether variations predict mental health symptoms and quality of life, and whether this is independent of the influence of sociodemographic characteristics and poverty.

Methods

In a population-based survey of adults living in a group of favelas in Rio de Janeiro, Brazil, we assessed: sociodemographic characteristics; extent of personal experiences and fear of neighbourhood violence; mental health symptoms on the Brief Symptom Inventory; and quality of life on the Manchester Short Assessment of Quality of Life. Univariate and multivariate regressions were fit to predict mental health symptoms and quality of life.

Findings

We interviewed 1,211 residents. Both more experiences of neighbourhood violence and more fear of violence predicted higher levels of mental health symptoms and poorer quality of life. In multivariate regression analyses, the associations remained significant after adjusting for the influence of other factors, in particular female gender, younger age, and marked poverty.

Interpretation

Even within a context in which the whole population can be exposed to violence and economic disadvantage, individual variations in the experiences of violence still make a significant difference for mental distress and quality of life. Policies to improve mental health and quality of life of residents in informal settlements need to address risk factors separately, most importantly the personal experiences of violence and poverty.

Funding

Economic and Social Research Council and Arts and Humanities Research Council in the United Kingdom.

Antecedentes

Viver em assentamentos informais, com ampla violência na vizinhança, parece estar associado a piores condições de saúde mental. No entanto, há poucas evidências de que, nestes locais, os diferentes níveis de experiências pessoais e o medo da violência na vizinhança afetem a saúde mental. Este estudo avaliou experiências pessoais e medos de moradores de favelas no Brasil. Testamos se tais variações predizem sintomas de saúde mental e qualidade de vida, e se isso é independente da influência das características sociodemográficas e da pobreza.

Métodos

Com base em um inquérito domiciliar de base populacional, realizado com adultos residentes em um grupo de favelas do Complexo da Maré, Rio de Janeiro, Brasil, foram observadas: características sociodemográficas; a extensão das experiências pessoais de exposição à violência e o medo da violência na vizinhança; sintomas de saúde mental, a partir do Inventário de Sintomas Psicopatológicos (BSI); e qualidade de vida, a partir da escala Manchester Short Assessment of Quality of Life (MANSA). Regressões univariadas e multivariadas foram ajustadas para explicar variações nos sintomas de saúde mental e qualidade de vida.

Resultados

Entrevistamos 1.211 pessoa adultas residentes na Maré. Tanto maiores níveis de exposição a experiências de violência na vizinhança quanto mais medo dessa violência estiveram relacionados a piores níveis de saúde mental (maior número e intensidade de sintomas no BSI) e pior qualidade de vida. Nas análises de regressão multivariada, tais associações permaneceram significativas mesmo após controlarmos pela influência de outros fatores, em particular sexo (feminino), idade (mais jovem) e pobreza acentuada.

Interpretação

Mesmo em um contexto no qual toda a população pode estar exposta à violência e a desvantagens materiais e econômicas, as variações individuais nas experiências de violência ainda assim fazem diferença significativa nas condições de sofrimento mental e qualidade de vida. Políticas para melhorar a saúde mental e a qualidade de vida dos residentes de assentamentos informais, como as favelas, precisam abordar fatores de risco separadamente focando, principalmente, na redução da exposição a experiências pessoais de violência e da pobreza.

Financiamento

Economic and Social Research Council (ESRC) e Arts and Humanities Research Council (AHRC), ambos do Reino Unido.