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Haim-Nachum S, Lazarov A, Zabag R, Martin A, Bergman M, Neria Y, Amsalem D. Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety. Eur J Psychotraumatol 2024; 15:2370174. [PMID: 38985020 PMCID: PMC11238652 DOI: 10.1080/20008066.2024.2370174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.
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Affiliation(s)
- Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Reut Zabag
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Andrés Martin
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Maja Bergman
- New York State Psychiatric Institute, New York, NY, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Doron Amsalem
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Ngamaba KH, Lombo LS, Makopa IK, Webber M, Liuta JM, Madinga JN, Mampunza SMM, Heap C. Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo. NPJ MENTAL HEALTH RESEARCH 2024; 3:9. [PMID: 38609473 PMCID: PMC10956021 DOI: 10.1038/s44184-023-00051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/20/2023] [Indexed: 04/14/2024]
Abstract
In the Democratic Republic of the Congo (DRC), the prevalence of mental health issues could be greater than in other low-income and middle-income countries because of major risk factors related to armed conflicts and poverty. Given that mental health is an essential component of health, it is surprising that no systematic evaluation of mental health in the DRC has yet been undertaken. This study aims to undertake the first systematic review of mental health literacy and service provision in the DRC, to bridge this gap and inform those who need to develop an evidence base. This could support policymakers in tackling the issues related to limited mental health systems and service provision in DRC. Following Cochrane and PRISMA guidelines, a systematic (Web of Science, Medline, Public Health, PsycINFO, and Google Scholar) search was conducted (January 2000 and August 2023). Combinations of key blocks of terms were used in the search such as DRC, war zone, mental health, post-traumatic stress disorder (PTSD), anxiety, depression, sexual violence, war trauma, resilience, mental health systems and service provision. We followed additional sources from reference lists of included studies. Screening was completed in two stages: title and abstract search, and full-text screening for relevance and quality. Overall, 50 studies were included in the review; the majority of studies (n = 31) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence. Different instruments were used to measure participants' mental health such as the Hopkins Symptoms Checklist (HSCL-25), The Harvard Trauma Questionnaire, Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7), and Positive and Negative Symptoms Scale (PANSS). Our study found that wartime sexual violence and extreme poverty are highly traumatic, and cause multiple, long-term mental health difficulties. We found that depression, anxiety, and PTSD were the most common problems in the DRC. Psychosocial interventions such as group therapy, family support, and socio-economic support were effective in reducing anxiety, depression, and PTSD symptoms. This systematic review calls attention to the need to support sexual violence survivors and many other Congolese people affected by traumatic events. This review also highlights the need for validating culturally appropriate measures, and the need for well-designed controlled intervention studies in low-income settings such as the DRC. Better public mental health systems and service provision could help to improve community cohesion, human resilience, and mental wellbeing. There is also an urgent need to address wider social issues such as poverty, stigma, and gender inequality in the DRC.
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Affiliation(s)
- Kayonda Hubert Ngamaba
- International Centre for Mental Health Social Research, Social Policy and Social Work, School for Business and Society, University of York, Heslington, York, YO10 5DD, UK.
| | - Laddy Sedzo Lombo
- Centre Spécialisé dans la Prise en charge Psychosociale en Santé Mentale (CSPEMRDC), Université Chrétienne de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Israël Kenda Makopa
- Neuropsychiatre et Addictologue Centre Spécialisé dans la Prise en charge Psychosociale en Santé Mentale (CSPEMRDC), Université Chrétienne de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Martin Webber
- International Centre for Mental Health Social Research, Social Policy and Social Work, School for Business and Society, University of York, Heslington, York, YO10 5DD, UK
| | - Jack M Liuta
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Joule Ntwan Madinga
- WHO Country Office DRC & Medical Parasitology and Epidemiology, Faculty of Medicine, University of Kikwit, Kikwit, Democratic Republic of Congo
| | - Samuel Ma Miezi Mampunza
- Faculte de Medicine University of Kinshasa & Université Protestante au Congo (UPC), Kinshasa, Democratic Republic of Congo
| | - Cheyann Heap
- International Centre for Mental Health Social Research, Social Policy and Social Work, School for Business and Society, University of York, Heslington, York, YO10 5DD, UK
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Biluala F, Kayembe HC, Batumbo D, Kapour G, Mumbanza F, Bokabo E, Longo-Mbenza B, Zinga B. Magnitude and factors associated with sexual re-victimization among adolescent girls and young women in Kinshasa, Democratic Republic of the Congo: a retrospective multicenter study. Reprod Health 2023; 20:179. [PMID: 38057905 DOI: 10.1186/s12978-023-01710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Adolescent girls and young women are more exposed to sexual violence. A significant proportion of victims of sexual abuse are victims of sexual re-victimization. However, information on the burden of sexual re-victimization among AGYW in contexts other than conflict-affected areas in the Democratic Republic of the Congo (DRC) is limited. The aim of this study was to assess the magnitude of sexual re-victimization among AGYW and to identify associated risk factors in the capital, Kinshasa. METHODS We conducted a retrospective multicenter cohort study in which sexual violence records between 2015 and 2020 were used to extract and analyze victims' sociodemographic and behavioral characteristics and profiles of sexual violence perpetrated. Multivariate logistic regression models were employed to identify factors associated with sexual re-victimization using the adjusted odds ratio (AOR) with its 95% confidence interval (95% CI) and p value < 0.05. RESULTS We found that 74 (31%) of the 241 AGYW included in this study had experienced sexual re-victimization. Sexual re-victimization was associated with being older (> 19 years), sexually active, and living in a single-parent family, and with perpetrator types, particularly intimate partners and family members. CONCLUSIONS Our findings provide tools for developing and implementing targeted prevention and intervention programs to reduce sexual violence in general and sexual re-victimization in particular.
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Affiliation(s)
- Fifiya Biluala
- Master of Ecology and Governance of Infectious Diseases, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Harry César Kayembe
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, B.P.: 834, Kinshasa, Democratic Republic of the Congo.
| | - Doudou Batumbo
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, B.P.: 834, Kinshasa, Democratic Republic of the Congo
| | - Germain Kapour
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, B.P.: 834, Kinshasa, Democratic Republic of the Congo
| | - Félicitée Mumbanza
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, B.P.: 834, Kinshasa, Democratic Republic of the Congo
| | - Eric Bokabo
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, B.P.: 834, Kinshasa, Democratic Republic of the Congo
| | - Benjamin Longo-Mbenza
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Berthe Zinga
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Xianguo Q, Hui C, Xin S, Jing F, Zijian W, Zhenyu N, Yong G. The prevalence of sexual violence against African women: a systematic review and meta-analysis. Afr Health Sci 2023; 23:117-127. [PMID: 38357142 PMCID: PMC10862609 DOI: 10.4314/ahs.v23i3.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background High rates of sexual violence ratios in low-income countries are recognized as a global public health problem. The incidence of violence against African women has been increasing. However, no study has systematically summarized the global prevalence of sexual violence against African woman. Methods We conducted a comprehensive search of PubMed, Embase and Web of Science, databases from their inception through January 2021 for pertinent studies on reporting the prevalence of sexual violence against African women. We included observational studies. The prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study level characteristics were estimated through subgroup analysis and meta-regression. Results A total of 9 cross-sectional studies were included (a total of 9,030 participants). The pooled sexual violence rate was 0.33 (95% CI = 0.23-0.42). Subgroup analyses found that there was a higher rates of sexual violence against pregnant woman in east Africa (0.41, 95% CI = 0.24-0.58), pregnant (0.42, 95% CI = 0.05-0.80), and interview (0.40, 95% CI = 0.01-0.78). The analysis found that the major sexual violence types were the physical violence (0.19, 95% CI = 0.07-0.31), psychological violence (0.36, 95% CI = 0.11-0.61), sexual assault (0.25, 95% CI = 0.02-0.47). Conclusions Nearly one out of every three (33%) African woman around the world has been a victim of sexual violence in their life. This current study investigated the status and characteristics of sexual violence against women, which could provide an important reference for the African health care provider. Assessing this problem against African women helps government officials, policy makers, program designers and non-governmental organizations to design prevention and controlling strategies.
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Affiliation(s)
- Qu Xianguo
- Zhejiang University School of Medicine, Affiliated Hangzhou First People's Hospital
| | - Cao Hui
- Beijing Vocational College of Labour and Social Security, Department of Labor Economics and Management
| | - Shen Xin
- Huazhong University of Science and Technology, Department of Social Medicine and Health Management
| | - Feng Jing
- Huazhong University of Science and Technology, Department of Social Medicine and Health Management
| | - Wang Zijian
- Guangxi University of Science and Technology, School of Arts and Communication
| | - Niu Zhenyu
- Shihezi University, Department of Public Health and Preventive Medicine
| | - Gan Yong
- Huazhong University of Science and Technology, Department of Social Medicine and Health Management
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Wondie Y, Zeleke WA, Melesse M. In between the lines of the narrative map: Phenomenological analysis of war rape victims in Amhara Regional State, Ethiopia. PLoS One 2023; 18:e0289106. [PMID: 37506073 PMCID: PMC10381033 DOI: 10.1371/journal.pone.0289106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Research conducted in the last four decades on rape and other forms of sexual violence shows that they are not only the result of transgression behaviors of some people but have been used as strategic, systemic, and calculated tools of war, ethnic cleansing, and genocide. Examining the nature and effect of wartime rape and sexual violence based on their distinctive features, context, and historical background is essential for research and service providers. This paper explores the lived experiences of sexual violence and gang rape victims during the North Ethiopian war in Amhara Region, Ethiopia. Data were collected from three girls and women survivors using a trauma and socio-culturally informed phenomenological approach. The finding shows that participants experienced a broad and complex range of psychological, physiological, emotional, and relational suffering after the rape. The result also shed light on some risk factors such as lack of awareness of the effect of traumatic events, stigma related to rape, and lacks victim protective legislation risk their journey to healing. The paper further discussed individual and community mental health responses for victims of war rape in culturally responsive and resource-poor settings.
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Affiliation(s)
- Yemataw Wondie
- Department of Psychology, University of Gondar, Gondar, Ethiopia
| | - Waganesh A Zeleke
- Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Mekides Melesse
- Department of Psychology, University of Gondar, Gondar, Ethiopia
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Gebremichael MW, Gebremariam B, Mitiku M, Hadush Z, Tesfay B, Gerezgiher A, Alemu MG. Rape survivors' experience in Tigray: a qualitative study. BMC Womens Health 2023; 23:372. [PMID: 37443028 PMCID: PMC10347821 DOI: 10.1186/s12905-023-02502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION As consequences of war, women and girls are the most likely segment of society to be impacted by violence. War also affects the critical facilities and makes the situation worse as victims cannot get the vital basic services. According to media and unpublished reports, Tigrayan women have been victimized by gang rape and sexual violence. Furthermore, there is substantive evidence of intentional destruction and vandalization of health facilities due to the one-year-old-armed conflict. This study aimed to explore experiences of rape survivors in areas hit by armed conflict in the Tigray region of Ethiopia. METHODS In this qualitative study, a phenomenological study design was employed among Tigrayan sexual assault survivors in a war-ravaged of Tigray. Survivors were selected purposively and included in the study for an in-depth interview. An interview guide was used to collect the data. Audio records from the in-depth interviews in Tigrigna were transcribed verbatim and then translated into English for analysis. Atlas-ti 7 software was used to code the interview transcripts of the qualitative data, and categorizations and thematizing of the codes were done. Direct quotes were used to describe categories or themes. RESULTS Ten women who were survivors of sexual violence and rape related to the war in Tigray participated in the interview. The age of the women ranged between 16 and 30 years with a mean age of 21.7. Among the participants, five were teenagers, six were single and/or economically dependent on their family or husband, and two did not attend any school and were not able to read and write. This study has generated five major thematic areas: (1) infliction of long-lasting trauma on children (2) effects of the rape (3) means of escaping from rape and killings (4) home remedies as means of life saving in war affected areas, and (5) beyond rape. CONCLUSIONS Rape in war-stricken Tigray has been widespread which includes teenagers and it caused immense psychological and physical damage to the survivors and their families. Damage of critical facilities such as the absence of safe houses for survivors and health services was an added complexity to the victims of rape. Hence, a coordinated effort by the government of Tigray and international partners is required to heal, support and rehabilitate the victims and rebuild the damaged health institutions and reequip the health facilities.
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Affiliation(s)
| | | | - Mengistu Mitiku
- College of Health Sciences, Mekelle University, P.O.Box: 1871, Mekelle City, Tigray, Ethiopia
| | - Znabu Hadush
- College of Health Sciences, Mekelle University, P.O.Box: 1871, Mekelle City, Tigray, Ethiopia
| | - Bisrat Tesfay
- College of Health Sciences, Mekelle University, P.O.Box: 1871, Mekelle City, Tigray, Ethiopia
| | - Alemseged Gerezgiher
- Institute of Population Studies, Mekelle University, Mekelle City, Tigray, Ethiopia
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Mossie TB, Mekonnen Fenta H, Tadesse M, Tadele A. Mapping the disparities in intimate partner violence prevalence and determinants across Sub-Saharan Africa. Front Public Health 2023; 11:1188718. [PMID: 37448663 PMCID: PMC10337829 DOI: 10.3389/fpubh.2023.1188718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Objective This study aimed to map disparities in prevalence and associated factors across countries in Sub-Saharan Africa. Methods We used National Demographic and Health Survey (DHS) data from 26 countries in the region with 114,340 participants. Women and girls in the reproductive age group of 15 to 49 years were included in the study. To map disparities across countries and their provinces, we employed the kriging interpolation technique. We used STATA for data management. Result The prevalence of physical, emotional and sexual IPV in Sub-Saharan Africa was 30.58, 30.22, and 12.6% respectively, and at least one form of IPV was 42.62%. Disparities were observed across the countries and provinces in each country. Younger age, secondary-level education and above, moderate participation in decision-making, not working out of home, not afraid of the spouse, rich (wealth index), not having a child, high maternal literacy, and rural residence relatively decreased the odds of IPV. The husbands' lower education, alcohol consumption, and high controlling behavior increased the probability of IPV. Conclusion The prevalence of Intimate Partner Violence in Sub-Saharan Africa is the highest in the world, a signal that the global agenda to end all forms of violence against women will be difficult to achieve. There is a large gap across countries and provinces in each country. Area-specific intervention packages that focus on modifiable factors should be strengthened.
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Affiliation(s)
- Tilahun B. Mossie
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Haile Mekonnen Fenta
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Meseret Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Animut Tadele
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
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Li L, Shen X, Zeng G, Huang H, Chen Z, Yang J, Wang X, Jiang M, Yang S, Zhang Q, Li H. Sexual violence against women remains problematic and highly prevalent around the world. BMC Womens Health 2023; 23:196. [PMID: 37101173 PMCID: PMC10134525 DOI: 10.1186/s12905-023-02338-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Sexual violence is far more prevalent in most societies than is usually suspected in daily life. However, no study has systematically summarized the global prevalence rate and the major outcomes of sexual violence against women. METHODS We directed a wide-raging search in the PubMed, Embase, and Web of Science, catalogs since the beginning to December 2022 for relevant reports about the incidence of sexual fighting touching females. The occurrence frequency was assessed with a random-effects model. The heterogeneity was estimated with I 2 values. Differences by research features were assessed over subgroup evaluation and meta-regression. RESULTS A total of 32 cross-sectional studies were included (a total of 19,125 participants). The pooled sexual violence rate was 0.29 (95% CI = 0.25-0.34). Subgroup analyses found that there was a higher rate of sexual violence against women in 2010-2019 period (0.33, 95% CI = 0.27-0.37), developing countries (0.32, 95% CI = 0.28-0.37), and interview (0.39, 95% CI = 0.29-0.49). The analysis found that more than half of women (0.56, 95% CI = 0.37-0.75) had post-traumatic stress disorder (PTSD) after experiencing sexual violence, and only a third of women considered seeking support (0.34, 95% CI = 0.13-0.55). CONCLUSIONS Nearly one out of every three (29%) women around the world has been a victim of sexual violence in their life. This current study investigated the status and characteristics of sexual violence against women, which could provide an important reference for police and emergency health services management.
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Affiliation(s)
- Liqing Li
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China.
| | - Xin Shen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guohua Zeng
- School of Economics and Management, Jiangxi University of Science and Technology, Ganzhou, Jiangxi, China
| | - Hongwei Huang
- Department of Health Management Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhensheng Chen
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Jiayi Yang
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Xiaofang Wang
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Ming Jiang
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Sule Yang
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Qi Zhang
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Honglang Li
- School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China.
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Onyinyechi Maduakolam I, Joy Onome A, Sunday Ede S, Chisom Favour O. Knowledge and Experience of Sexual Violence among Female Adolescents in Public Schools in Enugu State during the Covid-19 Pandemic. JOURNAL OF CHILD SEXUAL ABUSE 2023; 32:204-224. [PMID: 36815550 DOI: 10.1080/10538712.2023.2181902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/27/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Sexual violence among female adolescents is a pervasive problem. This is even worse in periods of unrest such as the COVID-19 pandemic, which heighten the vulnerability of these female adolescents' victims to the potential perpetrators of sexual violence. This study assessed the knowledge and experience of sexual violence amongst female adolescents in public schools in Enugu State, Nigeria, during the COVID-19 pandemic. Three hundred twenty-five adolescents (aged 10-19 years with a mean age of 12.8 ±2.8) female school students were purposively recruited in this cross-sectional study to complete a scale designed to measure the knowledge and experience of sexual violence among female adolescents. Findings showed a high (90.8%) knowledge level of sexual violence among adolescents. The majority of the perpetrators were their uncles (40.4%) and cousins (28.6%). Among 9.8% of the participants who had forced to have sex, about two-thirds (65.6%) have been raped 2 to 5 times. A significant difference was noted only between the respondent's class levels and their knowledge of sexual violence (p < .05) with higher classes having better knowledge. Female adolescents showed a good knowledge level about sexual violence, which might explain the low prevalence of sexual violence in the sample population. The study also provides evidence that females are most at risk of sexual violence from closer relations during times of crisis. Thus, these study findings add evidence to the literature that would guide policymakers, health, and social workers toward making campaigns and interventions that would prevent female adolescent sexual violence.
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Affiliation(s)
| | | | | | - Okoh Chisom Favour
- David Umahi Federal University of Health Sciences, University of Southampton, Uburu, UK
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Schneider KE, Allen ST, Winiker AK, White RH, O’Rourke A, Sherman SG, Grieb SM. Overdose Experiences among People Who Inject Drugs in West Virginia: Personal Loss, Psychological Distress, Naloxone, and Fentanyl. Subst Use Misuse 2022; 58:22-26. [PMID: 36371695 PMCID: PMC10124002 DOI: 10.1080/10826084.2022.2136489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As overdose remains a major public health concern in the United States, it is important to understand the experiences people who inject drugs (PWID) have with overdose. Past experiences during such emergencies are an important determinant of future behavior, including help seeking, which can be lifesaving. Methods: We explored experiences with overdose, using data from 21 in-depth interviews collected from PWID in a rural county in West Virginia (Cabell County). We used an iterative, modified constant comparison approach to synthesize resulting interview data. Results: Participants reported pervasive experiences with overdose, including through their own personal overdose experiences, witnessing others overdose, and losing loved ones to overdose fatalities. Experiencing emotional distress when witnessing an overdose was common among our participants. Many participants reported regularly carrying naloxone and using it to reverse overdoses. Multiple participants described believing the myth that people grow immune to naloxone over time. Concerns about the presence of fentanyl in drugs were also common, with many participants attributing their own and others' overdoses to fentanyl. Conclusions: Our findings have important implications for naloxone access and education, as well as policies and practices to encourage help seeking during overdose events among rural PWID. Participant concerns about fentanyl in the drug supply highlight the need for access to drug checking technologies.
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Affiliation(s)
- Kristin E. Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Allison O’Rourke
- DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington, DC 20052, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Suzanne M. Grieb
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
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Albezreh S, Anastario M, Ulibarrí BJ, Naimer K, Johnson K, McHale T, Mishori R, Macias-Konstantopoulos WL, Olson R, Nelson BD. Multiyear, Multisectoral Training Program in Kenya to Enhance Medical-Legal Processes in Response to Sexual and Gender-Based Violence. Violence Against Women 2022; 28:3311-3330. [PMID: 35938230 PMCID: PMC9727116 DOI: 10.1177/10778012221099984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Sexual and gender-based violence (SGBV) leads to severe sequelae for individuals and communities. Lack of cross-sector coordination inhibits effective medical-legal support and justice for survivors. Multisectoral trainings for health, legal, and law enforcement professionals on survivor-centered SGBV care were conducted in Kenya during 2012-2018. Evaluation utilized objective structured clinical examinations, standardized patients, knowledge assessments, and interviews. A total of 446 professionals participated in 18 trainings. Mean knowledge scores increased from 75.6% to 84.7% (p < .001). Thirty interviews revealed improved survivor confidentiality, increased specialized hospital care, more comprehensive forensic care, and greater cross-sector collaboration. Participants reported survivors feeling more comfortable pursuing legal action and increased perpetrator convictions.
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Affiliation(s)
- Salma Albezreh
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Mike Anastario
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Billy J. Ulibarrí
- Department of Sociology, The University of Texas Rio Grande Valley, Brownsville, TX, USA
| | | | | | | | - Ranit Mishori
- Physicians for Human Rights, New York, NY, USA,Georgetown University School of Medicine, Washington, DC, USA
| | - Wendy L. Macias-Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Rose Olson
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Brett D. Nelson
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA,Brett D. Nelson, Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA.
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12
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Lakin DP, Murray SM, Lasater ME, Kaysen D, Mataboro A, Annan J, Bolton P, Bass JK. The end of the trial: Perspectives on cognitive processing therapy from community-based providers in the Democratic Republic of Congo. J Trauma Stress 2022; 35:269-277. [PMID: 34644432 PMCID: PMC9903302 DOI: 10.1002/jts.22734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/14/2021] [Accepted: 06/16/2021] [Indexed: 01/27/2023]
Abstract
Despite calls forincreased mental health programming in low-resource and humanitarian contexts and effectiveness trials of psychotherapy in these settings, little research exists on the extent to which providers and recipients continue to practice skills learned during trials of these programs. To understand if and how providers continued to use mental health intervention skills without ongoing institutional support following the completion of randomized controlled trials (RCTs), we analyzed data from semistructured interviews with six of seven providers who participated in an RCT of cognitive processing therapy (CPT) in the Democratic Republic of Congo 7 years prior. Provider interviews revealed continued knowledge of and, in some cases, the practice of core CPT skills as well as efforts to keep meeting with women in the community and a strong desire to learn new skills. Although financial limitations sometimes prohibited providers from formally convening CPT groups with women in need, participants maintained knowledge and skill use. Providers also reported feeling more valued in their communities, and they continued providing services beyond the planned intervention period despite a lack of ongoing support. In addition, participants described a strong desire to continue psychosocial interventions for trauma and learn more about this type of intervention. Reframing the evaluation of psychological interventions as program development and maintaining a strong working relationship with community partners may allow for increased sustainability of mental health services beyond the end of academic research studies in low-resource contexts.
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Affiliation(s)
- Daniel P. Lakin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Molly E. Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, California, USA
| | - Amani Mataboro
- Action Kivu, Bukavu, South Kivu, Democratic Republic of Congo
| | - Jeannie Annan
- International Rescue Committee, New York, New York, USA
| | - Paul Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Judith K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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13
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Murray SM, Lasater ME, Guimond MF, Poku O, Musci R, Al-Fataftah M, Kasina L, Lwambi M, Salaimeh A, Falb K. Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria. Confl Health 2021; 15:96. [PMID: 34952621 PMCID: PMC8709979 DOI: 10.1186/s13031-021-00431-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Sarah M. Murray
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Molly E. Lasater
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Marie-France Guimond
- grid.420433.20000 0000 8728 7745Airbel Impact Lab, International Rescue Committee, New York, NY USA
| | - Ohemaa Poku
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Rashelle Musci
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Manal Al-Fataftah
- Women Protection and Empowerment Program, International Rescue Committee, Amman, Jordan
| | - Lilian Kasina
- Design Monitoring and Evaluation Unit, International Rescue Committee, Nairobi, Kenya
| | - Mercy Lwambi
- Women’s Protection and Empowerment Program, International Rescue Committee, Nairobi, Kenya
| | - Asma Salaimeh
- Monitoring, Evaluation, Accountability and Learning Unit, International Rescue Committee, Amman, Jordan
| | - Kathryn Falb
- grid.420433.20000 0000 8728 7745Airbel Impact Lab, International Rescue Committee, Washington, DC USA
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Samantha G, Bartels Susan A, Sabine L, Heather S. A cross-sectional study of community perceptions of stigmatization amongst women affected by UN-peacekeeper perpetrated sexual exploitation and abuse. BMC Public Health 2021; 21:2295. [PMID: 34922504 PMCID: PMC8684182 DOI: 10.1186/s12889-021-12221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sexual exploitation and abuse (SEA) by UN peacekeepers perpetrated against local women and girls is a concern in the Democratic Republic of Congo (DRC). While stigma associated with sexual and gender-based violence is well documented more broadly, little is known about stigma associated with peacekeeper-perpetrated SEA. Methods The aim of this study was to examine how the degree of exposure to SEA affects community perceptions of a woman or girl’s (1) social status (public stigma) and (2) institutional support in her community (structural stigma). Two poisson regression models with robust variance estimation were constructed utilizing community survey data of SEA experiences from eastern DRC (n = 2867) to quantify these associations. Relevant demographic variables were assessed for confounding and effect modification. Results The prevalence of public and structural stigma were 62.9 and 19.3% respectively across the sample. A positive relationship was demonstrated between level of exposure of SEA and diminished social status in which women and girls experiencing moderate levels of SEA were at the greatest risk of public stigmatization after adjusting for confounding (RR: 1.94; CI: 1.66–2.26). Similarly, a positive relationship between exposure to SEA and inadequate institutional support was shown for female narrators wherein women and girls experiencing a high degree of SEA were 6.53 times as likely to receive inadequate support (RR: 6.53; CI: 3.63, 11.73). This contrasted with male narrated stories for whom there was no significant association between the SEA exposure level and institutional support. Conclusions Women/girls with high exposure levels to UN peacekeeper-perpetrated SEA are at the highest risk of public and structural stigmatization, which should be more routinely considered when conceptualizing the consequences of SEA in peacekeeping contexts. The frequent occurrence of both public and structural stigma, coupled with the varying perceptions by sex, demonstrates the need for a multi-faceted approach for stigma reduction.
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Affiliation(s)
- Gray Samantha
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - A Bartels Susan
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Lee Sabine
- Department of History, University of Birmingham, Birmingham, England
| | - Stuart Heather
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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15
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Patterns of conflict-related trauma exposure and their relation to psychopathology: A person-centered analysis in a population-based sample from eastern DRC. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Severo PP, Furstenau LB, Sott MK, Cossul D, Bender MS, Bragazzi NL. Thirty Years of Human Rights Study in the Web of Science Database (1990-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2131. [PMID: 33671671 PMCID: PMC7926733 DOI: 10.3390/ijerph18042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
The study of human rights (HR) is vital in order to enhance the development of human beings, but this field of study still needs to be better depicted and understood because violations of its core principles still frequently occur worldwide. In this study, our goal was to perform a bibliometric performance and network analysis (BPNA) to investigate the strategic themes, thematic evolution structure, and trends of HR found in the Web of Science (WoS) database from 1990 to June 2020. To do this, we included 25,542 articles in the SciMAT software for bibliometric analysis. The strategic diagram produced shows 23 themes, 12 of which are motor themes, the most important of which are discussed in this article. The thematic evolution structure presented the 21 most relevant themes of the 2011-2020 period. Our findings show that HR research is directly related to health issues, such as mental health, HIV, and reproductive health. We believe that the presented results and HR panorama presented have the potential to be used as a basis on which researchers in future works may enhance their decision making related to this field of study.
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Affiliation(s)
- Priscilla Paola Severo
- Graduate Program in Law, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Leonardo B. Furstenau
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Michele Kremer Sott
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Danielli Cossul
- Department of Psychology, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Mariluza Sott Bender
- Multiprofessional Residency Program in Urgency and Emergency, Santa Cruz Hospital, Santa Cruz do Sul 96810-072, Brazil;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
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17
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Attitudes towards Violence in Adolescents and Youth Intimate Partner Relationships: Validation of the Spanish Version of the EAV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020566. [PMID: 33445428 PMCID: PMC7828076 DOI: 10.3390/ijerph18020566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
The main purpose of the present study was to analyze the psychometric properties of the Attitudes Scale Towards Violence (Escala de Actitudes hacia la Violencia, EAV) in adolescents. The EAV is a questionnaire devoted to assess attitudes towards violence. Additionally, the relationship between EAV and violence manifestations and depressive symptoms was analyzed. The final sample comprised a total of 1248 students in a cross-sectional survey. The EAV, the Modified Conflict Tactics Scale (M-CTS), and the Reynolds Adolescent Depression Scale (RADS) were used. The analysis of the internal structure of the EAV yielded a two-factor structure as the most adequate. The EAV scores showed measurement invariance across gender and age. The McDonald’s Omega was 0.862 and 0.872 for the two hypothesized factors. Furthermore, self-reported attitudes towards violence were associated with violence manifestations both as a victim and as a perpetrator and depressive symptoms. These results support that the EAV is a brief and easy tool to assess self-reported violence attitudes in intimate partner relationships in adolescents from the general population. The assessment of these attitudes, and its associations with violence and depressive manifestations, may help us to enhance the possibility of an early identification of adolescents potentially at risk for suffering violence as a victim or as a perpetrator.
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18
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Verelst A, Bal S, De Schryver M, Say Kana N, Broekaert E, Derluyn I. The Impact of Avoidant/Disengagement Coping and Social Support on the Mental Health of Adolescent Victims of Sexual Violence in Eastern Congo. Front Psychiatry 2020; 11:382. [PMID: 32655422 PMCID: PMC7325965 DOI: 10.3389/fpsyt.2020.00382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 04/16/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Eastern Congo has been affected by armed conflict for decades while the rampant use of sexual violence has left many women and girls dealing with a wide range of consequences of sexual violence. For adolescent victims the psychosocial impact of sexual violence is devastating. However, the role of avoidant/disengagement coping and family support on the mental health impact of sexual violence remains unclear. METHODS The study design was a cross-sectional, population-based survey in which 1,305 school-going adolescent girls aged 11 to 23 participated. Mental health symptoms (IES-R and HSCL-37A), family support (MSPSS), avoidant/disengagement (Kidcope), war-related traumatic events (ACEES), experiences of sexual violence, daily stressors, and stigmatization (ACEDSS) were administered through self-report measures. Hierarchical multiple regression analysis was carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure. RESULTS For girls who did not report sexual violence, avoidant/disengagement coping has a direct negative effect on all psychological symptoms. For victims of sexual violence, when high levels of stigma were reported, avoidant/disengagement coping possibly served as a protective factor, as shown by the interaction effect between avoidance/disengagement coping and stigmatization on mental health outcomes. In victims of sexual violence however, high levels of daily stressors combined with avoidant/disengagement strategies showed a strong increase in posttraumatic stress symptoms. Interestingly, the mental health impact of sexual violence was not mitigated by support by family members. For girls who reported a nonconsensual sexual experience without labelling it as rape and at the same time testified to have a lot of family support, there was a positive association between stressors (daily stressors, stigma, and war-related trauma) and posttraumatic stress symptoms. CONCLUSIONS These results of this study underwrite to the importance of looking beyond the straightforward negative impact of avoidant/disengagement coping strategies on mental health in adolescent victims of sexual violence. While avoidant/disengagement coping can have a negative impact on psychosocial well-being on adolescent victims of sexual violence, in case of high levels of stigmatization it can as well protect them from posttraumatic stress or anxiety. Furthermore these findings speak to the importance of exploring the diversified relationship between risk and protective factors, such as avoidant/disengagement coping strategies and family support, that shape the mental health impact of sexual violence in adolescent victims.
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Affiliation(s)
- An Verelst
- Centre for Children in Vulnerable Situations, Department of Social Work and Social Pedagogy, Ghent University, Gent, Belgium
| | - Sarah Bal
- Ghent University Hospital, Ghent University, Gent, Belgium
| | | | - Nanc Say Kana
- Centre for Children in Vulnerable Situations, Department of Social Work and Social Pedagogy, Ghent University, Gent, Belgium
| | - Eric Broekaert
- Department of Special Needs Education, Ghent University, Gent, Belgium
| | - Ilse Derluyn
- Centre for Children in Vulnerable Situations, Department of Social Work and Social Pedagogy, Ghent University, Gent, Belgium
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Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, Chiliza B, Koenen KC. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003090. [PMID: 32413027 PMCID: PMC7228043 DOI: 10.1371/journal.pmed.1003090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA. METHODS AND FINDINGS The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies. CONCLUSIONS In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.
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Affiliation(s)
- Lauren C. Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Anne Stevenson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sreeja S. Kalapurakkel
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Centre for Global Mental Health, Health Service and Population Research, Department Institute of Psychiatry, Psychology and Neuroscience King’s College, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Boniface Harerimana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Reflective Functioning of Refugee Mothers with Children Born of Conflict-Related Sexual Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082873. [PMID: 32326331 PMCID: PMC7216145 DOI: 10.3390/ijerph17082873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/03/2022]
Abstract
The ability of a parent to step back from their own experiences in order to understand those of their child, reflective functioning (RF), can be impacted by myriad factors. We explored RF among refugee mothers in the context of having a child born of sexual violence (CBSV). A sample of 10 mothers now residing in the Netherlands, both with (n = 5) and without (n = 5) a CBSV, were interviewed, seeking to explore parents’ representations of their children, themselves as parents, and their relationship with their children. After deriving a score of RF, interview narratives were qualitatively analyzed using thematic analysis. An ordinary level of reflective functioning was identified in this sample overall (average score 4.5); which was reduced in the group with CBSV (average score 3.0). Trends within the qualitative analyses indicated that emotion regulation and ambivalence as well as parenting challenges are factors that affect RF capabilities for mothers with CBSV. Wider findings show that the asylum process and mental well-being also impinge on RF capabilities. Experiences of having a CBSV as well as those pertaining to being a refugee appear to interact and impact reflective functioning for some mothers. Further investigation would add weight to this pilot data.
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Anderson K, van Ee E. Mothers with children born of sexual violence: Perceptions of global experts regarding support in social care settings. Health Care Women Int 2018; 40:83-101. [PMID: 30589399 DOI: 10.1080/07399332.2018.1522319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mothers with children born of sexual violence often have complex needs that are seldom adequately addressed in social care settings. The authors' objective was to investigate the current care provisions for these mothers and children, and how these might be enhanced in the future. Twenty-one experts were asked about their current approaches and difficulties in treating this population and to suggest recommendations for improving care. The same group was asked to comment on the relevance and feasibility of implementing suggested options. The authors suggest that a holistic and community embedded approach that can be applied across settings will be most beneficial.
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Affiliation(s)
- Kimberley Anderson
- a Reinier van Arkel Groep , Psychotramacentrum Zuid Nederland , s'-Hertogenbosch, The Netherlands.,b Department for Medical Psychology & Medical Sociology , University of Leipzig , Leipzig , Germany
| | - Elisa van Ee
- a Reinier van Arkel Groep , Psychotramacentrum Zuid Nederland , s'-Hertogenbosch, The Netherlands.,c Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
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22
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Murray SM, Augustinavicius J, Kaysen D, Rao D, Murray LK, Wachter K, Annan J, Falb K, Bolton P, Bass JK. The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: results from a cluster randomized controlled trial. Confl Health 2018; 12:1. [PMID: 29449879 PMCID: PMC5808396 DOI: 10.1186/s13031-018-0142-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo. Methods Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women’s treatment assignment. Linear mixed-effect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment. Results Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen’s D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen’s D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment. Conclusions Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors’ mental health. Trial registration ClinicalTrials.gov NCT01385163. Electronic supplementary material The online version of this article (10.1186/s13031-018-0142-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S M Murray
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - J Augustinavicius
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - D Kaysen
- 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - D Rao
- 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA.,3Department of Global Health, University of Washington, Seattle, WA USA
| | - L K Murray
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - K Wachter
- 4University of Texas, School of Social Work, Austin, TX USA
| | - J Annan
- 5Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY USA.,6Harris School of Public Policy, University of Chicago, Chicago, USA
| | - K Falb
- 5Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY USA
| | - P Bolton
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA.,7Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD USA
| | - J K Bass
- 1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Street, Baltimore, MD 21205 USA
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Scott J, Mullen C, Rouhani S, Kuwert P, Greiner A, Albutt K, Burkhardt G, Onyango M, VanRooyen M, Bartels S. A qualitative analysis of psychosocial outcomes among women with sexual violence-related pregnancies in eastern Democratic Republic of Congo. Int J Ment Health Syst 2017; 11:64. [PMID: 29075319 PMCID: PMC5648419 DOI: 10.1186/s13033-017-0171-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC) and has potentially devastating psychosocial consequences. Previous studies have reported on sexual violence and its impact on the mental health of survivors, but there are few studies conducted among women with sexual violence-related pregnancies (SVRPs). Women with SVRPs may be at greater risk of complex psychosocial outcomes, including social stigmatization. This study aimed to describe psychosocial outcomes among this subgroup of sexual violence survivors in order to inform future interventions. METHODS A mixed methods study was conducted in Bukavu, DRC in 2012 among adult women who self-reported an SVRP and either (1) were currently raising a child from an SVRP (parenting group) or (2) had terminated an SVRP (termination group). This manuscript presents qualitative findings from the mixed methods study. Participants were recruited using respondent-driven sampling and a proportion engaged in semi-structured qualitative interviews conducted by trained female interviewers. Thematic content analysis was conducted and key themes were identified. RESULTS In total, 55 women were interviewed, of whom 38 were in the parenting group and 17 in the termination group. Women with SVRPs experienced a myriad of emotional responses as they navigated their social environments following the SVRPs. Negative reactions, including social stigmatization and/or social rejection, toward women with SVRPs and toward children born from SVRPs were important influences on psychological well-being. Women expressed both internalized emotionality intertwined with externalized experiences in the social environment. Many women demonstrated resilience, or what could be termed post-traumatic growth, identifying avenues of agency to advance the social conditions for women. CONCLUSIONS The findings from the qualitative study, and in particular, the respondents' needs and suggested strategies, may be useful to inform future research, programs, and policies for women with SVRPs in eastern DRC. Future research could move beyond cross-sectional assessments to utilize innovative research methodologies to assess processes of psychological adaptation among women with SVRPs. Multi-dimensional psychosocial programs for women with SVRPs should consider basic needs such as shelter, food, and health care within the broader framework of trauma-informed care. Participatory programming, guided by beneficiaries, could provide further avenues for agency to advance social conditions for women with SVRPs in eastern DRC.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA 02215 USA
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Colleen Mullen
- Department of Psychiatry, One Boston Medical Center Place, Boston Medical Center, Boston, MA 02118 USA
- Department of Psychiatric Emergency Services for Cambridge/Somerville, Boston Medical Center, Boston, MA USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, and HELIOS-Hansehospital Stralsund, University of Greifswald, Greifswald, Germany
| | - Ashley Greiner
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM 87131 USA
| | - Monica Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118 USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 190 Pilgrim Road, Boston, MA 02215 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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Assessing the factorial structure and measurement invariance of PTSD by gender and ethnic groups in Sri Lanka: An analysis of the modified Harvard Trauma Questionnaire (HTQ). J Anxiety Disord 2017; 47:45-53. [PMID: 28254549 DOI: 10.1016/j.janxdis.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 02/04/2023]
Abstract
The Harvard Trauma Questionnaire (HTQ) remains the most widely used screening measure for post-traumatic stress disorder (PTSD) in the refugee and post-conflict field. The present study is the first to test the factorial structure and measurement invariance of the HTQ according to DSM-5 criteria across gender and ethnic groups in the ethnically diverse society of post-conflict Sri Lanka. The survey sample included 5136 participants (86% response rate) followed up 12 months after a baseline nationally representative survey undertaken in Sri Lanka in 2014. Exposure to conflict-related traumatic experiences (TEs) generating a trauma count (TC), and symptoms of PTSD were assessed using a modified version of the HTQ adapted to the local context. The final analytic sample included 4260 participants after excluding records with missing data on key variables. We conducted Multigroup Confirmatory Factor Analysis (MG-CFA) to test the four-factor (DSM-5 consistent) and three-factor (DSM-IV-TR) models of PTSD, then assessing measurement invariance of the four factor model by gender and ethnic groups. The three-factor and four-factor DSM-5 model each produced a good fit across the sample as a whole. In addition, there was configural, metric, and scalar invariance for the four-factor model both by gender and ethnicity. The trauma count was directly associated with each of the symptom domains of the four factor model. Our findings provide support for the capacity of the modified HTQ to measure the DSM5 construct of PTSD across gender and key ethnic groupings in Sri Lanka. Confirmation of our findings in other cultures will be important.
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Albutt K, Kelly J, Kabanga J, VanRooyen M. Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo. DISASTERS 2017; 41:211-227. [PMID: 27238379 DOI: 10.1111/disa.12202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Studies report that between 6 per cent and 29 per cent of survivors of sexual violence in eastern Democratic Republic of the Congo (DRC) are rejected by their families and communities. This research project was designed to provide insights into survivors' experiences of stigmatisation and rejection. Surveys were conducted with 310 women as they sought psychosocial services in eastern DRC. In total, 44.3 per cent of women reported suffering rejection after sexual violence. The majority of women felt that their status in the household (58.0 per cent) and community (54.9 per cent) diminished after rape. The odds of rejection were greater among women reporting ongoing displacement, pregnancy owing to sexual violence, worsening family relations, and diminished community status. This work highlights the extremely high levels of loss associated with the war in eastern DRC, particularly among survivors of sexual violence. The rejection of a survivor of rape has concrete and devastating psychosocial consequences.
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Affiliation(s)
- Katherine Albutt
- MD, MPH is a Research Associate at the Harvard Humanitarian Initiative and General Surgery Resident at Massachusetts General Hospital, United States
| | - Jocelyn Kelly
- MS is the Director of the Women in War Program at the Harvard Humanitarian Initiative, United States
| | - Justin Kabanga
- The former Director of the Centre d'Assistance Médico-Psychosociale, Democratic Republic of the Congo
| | - Michael VanRooyen
- MD, MPH is the Director of the Harvard Humanitarian Initiative and Professor of Medicine at Harvard Medical School, United States
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Latent class analysis of violence against adolescents and psychosocial outcomes in refugee settings in Uganda and Rwanda. Glob Ment Health (Camb) 2017; 4:e19. [PMID: 29230315 PMCID: PMC5719474 DOI: 10.1017/gmh.2017.17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/18/2017] [Accepted: 08/04/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about violence against children in refugee camps and settlements, and the evidence-base concerning mental health outcomes of youth in refugee settings in low and middle-income countries is similarly small. Evidence is needed to understand patterns of violence against children in refugee camps, and associations with adverse mental health outcomes. METHODS Surveys were conducted with adolescent refugees (aged 13-17) in two refugee contexts - Kiziba Camp, Rwanda (n = 129) (refugees from Democratic Republic of Congo) and Adjumani and Kiryandongo refugee settlements, Uganda (n = 471) (refugees from South Sudan). Latent Class Analysis was utilized to identify classes of violence exposure (including exposure to witnessing household violence, verbal abuse, physical violence and sexual violence). Logistic regressions explored the association between latent class of violence exposure and symptoms of depression and anxiety. RESULTS In Rwanda, a two-class solution was identified, with Class 1 (n = 33) representing high levels of exposure to violence and Class 2 (n = 96) representing low levels of exposure. In Uganda, a three-class solution was identified: Class 1 (high violence; n = 53), Class 2 (low violence, n = 100) and Class 3 (no violence, n = 317). Logistic regression analyses indicated that latent violence class was associated with increased odds of high anxiety symptoms in Rwanda (AOR 3.56, 95% CI 1.16-0.95), and high v. no violence class was associated with depression (AOR 3.97, 95% CI 1.07-7.61) and anxiety symptoms (AOR 2.04, 95% CI 1.05-3.96) in Uganda. CONCLUSIONS The present results support the existing evidence-base concerning the association between violence and adverse mental health outcomes, while identifying differences in patterns and associations between refugee youth in two different contexts.
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Onyango MA, Burkhardt G, Scott J, Rouhani S, Haider S, Greiner A, Albutt K, Mullen C, VanRooyen M, Bartels S. A Qualitative Analysis of Disclosure Patterns among Women with Sexual Violence-Related Pregnancies in Eastern Democratic Republic of Congo. PLoS One 2016; 11:e0164631. [PMID: 27741262 PMCID: PMC5065222 DOI: 10.1371/journal.pone.0164631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
The Democratic Republic of the Congo (DRC) has experienced nearly two decades of civil conflict in the Eastern regions of North and South Kivu. This conflict has been notorious for the use of sexual violence as a weapon of war, leading in many cases to pregnancy after rape. The objectives of this analysis were: 1) to describe patterns of sexual violence-related pregnancy (SVRP) disclosure; 2) to consider why survivors chose to disclose to particular individuals; and 3) to examine the dialogue around SVRPs between women with SVRPs and their confidants. In South Kivu Province, Democratic Republic of Congo, two sub-groups of sexual violence survivors completed qualitative interviews, those currently raising a child from an SVRP (parenting group, N = 38) and those who had terminated an SVRP (termination group, N = 17). The findings show that a majority of SVRPs were conceived when participants were held in sexual captivity for prolonged periods of time. The SVRPs were disclosed to friends, family members, other sexual violence survivors, community members, spouses, health care providers, or perpetrators. The confidants were most often chosen because they were perceived by the participants as being discreet, trusted, and supportive. The confidants often provided advice about continuing or terminating the SVRP. Trust and discretion are the most important factors determining to whom women with SVRPs disclose their pregnancies. The vital role of confidants in giving support after disclosure cannot be overlooked. Providing opportunities for survivors to safely disclose their SVRPs, including to health care providers, is a necessary first step in allowing them to access safe and comprehensive post-assault care and services.
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Affiliation(s)
- Monica Adhiambo Onyango
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, Massachusetts, United States of America
| | - Jennifer Scott
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Department of Obstetrics and Gynecology, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Division of Women’s Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shada Rouhani
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, United States of America
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts, United States of America
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts, United States of America
| | - Colleen Mullen
- Boston Medical Center, Department of Psychiatry, Boston, Massachusetts, United States of America
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts, United States of America
- Queen’s University, Department of Emergency Medicine, Kingston, Canada
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Cardoso LF, Gupta J, Shuman S, Cole H, Kpebo D, Falb KL. What Factors Contribute to Intimate Partner Violence Against Women in Urban, Conflict-Affected Settings? Qualitative Findings from Abidjan, Côte d'Ivoire. J Urban Health 2016; 93:364-78. [PMID: 27000124 PMCID: PMC4835354 DOI: 10.1007/s11524-016-0029-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rapid urbanization is a key driver of the unique set of health risks facing urban populations. One of the most critical health hazards facing urban women is intimate partner violence (IPV). In post-conflict urban areas, women may face an even greater risk of IPV. Yet, few studies have examined the IPV experiences of urban-dwelling, conflict-affected women, including those who have been internally displaced. This study qualitatively examined the social and structural characteristics of the urban environment that contributed to the IPV experiences of women residing in post-conflict Abidjan, Côte d'Ivoire. Ten focus groups were conducted with men and women, both internally displaced (IDPs) and non-displaced. Lack of support networks, changing gender roles, and tensions between traditional gender norms and those of the "modern" city were reported as key contributors to IPV. Urban poverty and with it unemployment, food insecurity, and housing instability also played a role. Finally, IDPs faced heightened vulnerability to IPV as a result of displacement and discrimination. The relationship between economic strains and IPV are similar to other conflict-affected settings, but Abidjan's urban environment presented other unique characteristics contributing to IPV. Understanding these factors is crucial to designing appropriate services for women and for implementing IPV reduction interventions in urban areas. Strengthening formal and informal mechanisms for help-seeking, utilizing multi-modal interventions that address economic stress and challenge inequitable gender norms, as well as tailoring programs specifically for IDPs, are some considerations for IPV program planning focused on conflict-affected women in urban areas.
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Affiliation(s)
- L F Cardoso
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA.
| | - J Gupta
- George Mason University, Department of Global and Community Health, College of Health and Human Services, Fairfax, VA, USA
| | - S Shuman
- La Salle University, Philadelphia, PA, USA
| | - H Cole
- International Rescue Committee, London, UK
| | - D Kpebo
- International Rescue Committee, Abidjan, Côte d'Ivoire
| | - K L Falb
- International Rescue Committee, New York, USA
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Scott J, Rouhani S, Greiner A, Albutt K, Kuwert P, Hacker MR, VanRooyen M, Bartels S. Respondent-driven sampling to assess mental health outcomes, stigma and acceptance among women raising children born from sexual violence-related pregnancies in eastern Democratic Republic of Congo. BMJ Open 2015; 5:e007057. [PMID: 25854968 PMCID: PMC4390729 DOI: 10.1136/bmjopen-2014-007057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Assess mental health outcomes among women raising children from sexual violence-related pregnancies (SVRPs) in eastern Democratic Republic of Congo and stigma toward and acceptance of women and their children. DESIGN Participants were recruited using respondent-driven sampling. SETTING Bukavu, Democratic Republic of Congo in 2012. PARTICIPANTS 757 adult women raising children from SVRPs were interviewed. A woman aged 18 and older was eligible for the study if she self-identified as a sexual violence survivor since the start of the conflict (∼1996), conceived an SVRP, delivered a liveborn child and was currently raising the child. A woman was ineligible for the study if the SVRP ended with a spontaneous abortion or fetal demise or the child was not currently living or in the care of the biological mother. INTERVENTION Trained female Congolese interviewers verbally administered a quantitative survey after obtaining verbal informed consent. OUTCOME MEASURES Symptom criteria for major depressive disorder, post-traumatic stress disorder, anxiety and suicidality were assessed, as well as stigma toward the woman and her child. Acceptance of the woman and child from the spouse, family and community were analysed. RESULTS 48.6% met symptom criteria for major depressive disorder, 57.9% for post-traumatic stress disorder, 43.3% for anxiety and 34.2% reported suicidality. Women who reported stigma from the community (38.4%) or who reported stigma toward the child from the spouse (42.9%), family (31.8%) or community (38.1%) were significantly more likely to meet symptom criteria for most mental health disorders. Although not statistically significant, participants who reported acceptance and acceptance of their children from the spouse, family and community were less likely to meet symptom criteria. CONCLUSIONS Women raising children from SVRPs experience symptoms of mental health disorders. Programming addressing stigma and acceptance following sexual violence may improve mental health outcomes in this population.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ashley Greiner
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hansehospital Stralsund, Stralsund, Germany
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
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Abstract
Child sexual abuse (CSA) is a universal problem with grave life-long outcomes. The estimates vary widely depending on the country under study, the definitions used, the type of CSA studied, the extent of coverage, and quality of data. This study intended to assess the magnitude and the issues related to CSA. We searched databases such as PubMed, Google scholar, web (newspaper reports), and government websites. The relevant data was extracted from these sources for gathering evidence on CSA and secondary data analysis was done. The prevalence of CSA was found to be high in India as well as throughout the world. CSA is an extensive problem and even the lowest prevalence includes a huge number of victims. It also has various adverse effects on the psychological, physical, behavioral, and interpersonal well-being of the victim. Hence, stringent measures should be taken for the prevention and control of this hidden public health issue.
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Affiliation(s)
- Mannat Mohanjeet Singh
- Department of Statistics, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
| | - Shradha S Parsekar
- Department of Statistics, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
| | - Sreekumaran N Nair
- Department of Statistics, Public Health Evidence South Asia, Manipal University, Manipal, Karnataka, India
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