Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda – a respondent driven sampling survey

Abstract

Background Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda. Methods Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence. Results Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67–78%) met symptom criteria for PTSD, 57% (95% CI: 51–63%) for depression, and 65% reported thoughts of ending one’s life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01). Conclusions Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.

Prevalence of depression in Uganda: A systematic review and meta-analysis

“…Both diagnostic and screening tools were used to assess depression among different populations in Uganda ( Table 1 ). The tools used included: (i) Depression sub-section of the Hopkins Symptom Checklist (DHSCL) ( n = 34, 26.8%) [ 35 , 55 , 61 , 63 , 65 – 68 , 71 , 73 , 74 , 79 – 82 , 84 , 92 , 100 , 108 , 110 , 111 , 113 , 125 , 135 , 136 , 138 , 140 , 141 , 144 , 147 , 151 , 155 , 166 ], (ii) Patient Health Questionnaire (PHQ) ( n = 33, 26.0%) [ 16 , 21 , 32 , 34 , 36 , 37 , 52 , 86 , 88 – 90 , 93 , 98 , 99 , 101 , 102 , 112 , 116 – 118 , 120 – 123 , 126 – 128 , …”

“…Depression was screened or diagnosed in the following study groups in Uganda: (i) individuals living with HIV ( n = 43) [ 15 , 34 , 60 , 64 , 68 , 70 – 73 , 79 , 81 , 82 , 85 – 91 , 93 – 96 , 98 – 105 , 112 – 114 , 117 , 119 , 123 , 127 , 128 , 130 , 132 , 133 , 136 , 141 – 143 , 145 , 148 – 150 , 160 ], (ii) females only ( n = 25) [ 16 , 31 , 35 , 52 , 59 , 73 , 79 , 97 , 113 , 116 , 134 , 139 , 144 , 158 , 166 , 170 ], including seven studies among pregnant or postpartum women [ 53 , 59 , 73 , 97 , ...…”

Why local concepts matter: Using cultural expressions of distress to explore the construct validity of research instruments to measure mental health problems among Congolese women in Nyarugusu refugee camp

“…Available data show a high burden of IPV and mental health problems in humanitarian settings. In line with these global findings, a strong correlation between experiences of IPV and worse mental health outcomes has also been found among Congolese refugee women (Familiar et al, 2021;Morof et al, 2014;Sipsma et al, 2015). This study uses data collected from Congolese survivors of IPV living in Nyarugusu Refugee Camp, Tanzania-a population and humanitarian context with high documented burden of IPV and associated mental health problems (Greene et al, 2016;Johnson et al, 2010;Lugova et al, 2020;Norman & Niehuus, 2015;Schmitt et al, 2021;Tankink et al, 2010).…”

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda

“…Sexual violence is particularly likely to lead to poor mental health (Cortina & Kubiak, 2006 ; Kessler et al, 2017 ). Although much of the literature on Congolese refugees has focused on the impacts of rape on women (Ainamani et al, 2020 ; Familiar et al, 2021 ), population-based research with conflict-affected people in DRC (Johnson et al, 2010 ) indicated that 23.6% of males had also experienced sexual violence. For this reason, in addition to the number of conflict-related PTEs, we looked specifically at the association between sexual violence and distress for both males and females.…”