Association of Exposure to Violence and Potential Traumatic Events With Self-reported Physical and Mental Health Status in the Central African Republic

Abstract

Context For decades, the Central African Republic (CAR) has experienced violence, economic stagnation, and institutional failure. The latest wave of violence erupted in 2001 and continues to this day in some areas. Yet there has been little attention to the conflict and even less research to document and quantify the conflict's human cost. Objective To study levels of violence in CAR, including mortality levels, and the association between exposure to violence and traumatic events with self-reported physical and mental health status. Design, Setting, and Participants Multistage stratified cluster random survey of 1879 adults 18 years or older in selected households conducted in 5 administrative units of CAR (3 in the south, which has been free from recent violence, and 2 in the north, in which violence continues) between October and December 2009. Main Outcome Measures Mortality, morbidity, exposure to potential traumatic events, sense of insecurity, and meeting of symptom criteria for depression and anxiety using the Hopkins Symptom Checklist-25 with a cutoff score of 1.75. Results The crude mortality rate (CMR) was 4.9 deaths (95% confidence interval [CI], 4.6-5.1) per 1000 population per month and self-reported CMR due to violence was 0.8 deaths (95% CI, 0.6-1.0) per 1000 population per month. Thirty-five percent reported their physical health status as being good or very good while 29% described it as bad or very bad. Respondents in northern prefectures reported higher rates of mortality, exposure to trauma, and insecurity and lower levels of physical health and access to health services compared with those in the south. The estimated prevalences of symptoms of depression and anxiety were 55.3% (95% CI, 51.6%-59.0%) and 52.5% (95% CI, 48.1%-56.8%), respectively. Exposure to violence and self-reported physical health were statistically associated with mental health outcomes (PϽ.001). Anxiety symptom scores were higher for respondents in the northern prefectures than those in the south (t=2.54, P=.01). Conclusion A high proportion of adult respondents in CAR reported witnessing or having personally experienced traumatic events over the course of the conflicts, and more than half met symptom criteria for depression and anxiety.

Anxiety: An Evolutionary Approach

“…Langhaug et al, 54 Vinck and Pham, 55 Elbedour et al 56 Higher probability: high rates of violence, unrest and disease mean probability of mortal threat is high in these environments Higher probability: prevalence of physical danger is higher for such women…”

Measurement invariance of the Hopkins Symptoms Checklist: a novel multigroup alignment analytic approach to a large epidemiological sample across eight conflict-affected districts from a nation-wide survey in Sri Lanka

“…The measure has been adapted and translated for use in conflict settings in Asia [11–13], the Middle East [14], Africa [15, 16], and the former Yugoslavia [17, 18]. The HSCL-25 is currently available in a wide range of languages including Arabic [19], Hmong [20], Kiswahili [16], Pashto [14], Farsi, Dari, Bosnian, Somali [9], Vietnamese [21], Swedish [22], Serbo-Croatian, Russian [23], Tibetan [13], Indochinese [24, 25], and Khmer.…”

“…At the same time, other studies focusing on the HSCL in high-income, Anglophone countries have found support for a tripartite factorial model [28, 29] including (in addition to anxiety and depression) a mixed domain of symptoms, variously labelled as “general/mixed distress”, “autonomic anxiety”, and “somatic depression.” Nevertheless, greatest consistency has been found in the association between potentially traumatic events (PTEs) and ongoing adversities typical of post-conflict populations, with the HSCL-25 anxiety and depression scales, respectively, with some minor differences in these relationships between the two symptom domains [9, 15, 30, 31]. …”

Trauma and mental health of medics in eastern Myanmar’s conflict zones: a cross-sectional and mixed methods investigation

“…Studies show an increase in the incidence and prevalence of PTSD, anxiety, and depression among civilian populations as a consequence of war [4-7]. Given the high stress environments and low-resource settings in which they operate, medics are at particular risk for developing such mental health disorders [8].…”