Latent class analysis of violence against adolescents and psychosocial outcomes in refugee settings in Uganda and Rwanda

Abstract

BackgroundLittle 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.MethodsSurveys 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.ResultsIn 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.ConclusionsThe 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.

A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps

“…As expected, higher exposure to violence related to war, within the family, and in the community was associated with higher levels of PTSD symptoms and internalizing problems. This is consistent with a large body of evidence documenting the detrimental mental health impact of traumatic experiences [2,56], child maltreatment [20,40,57] and community violence [27,28] for refugee and non-refugee children and adolescents across various socioeconomic and cultural settings. Studies conducted within a socio-ecological framework have shown how violence on more distal ecological levels, e.g., structural and community violence, adversely affects children's adjustment both directly and indirectly by increasing violence within the more proximal family context [58][59][60].…”

“…All but two families were willing to participate in the study. The research team, consisting of Tanzanian master-level psychologists and trained research assistants from the refugee community residing in the camps, conducted structured 20 54.9 (119) More than 20 8.7 (19) clinical interviews individually with each parent and child in Swahili, the lingua franca in Tanzania and the refugee camps, or in Kirundi, the native language of Burundians.…”

“…Recent studies found that refugee parents' mental health problems stemming from exposure to war trauma and post-migration stressors were associated with greater levels of harsh parenting, which were in turn related to children's emotional and behavioral problems [18,19]. Adolescents living in refugee camps in Uganda and Rwanda who reported higher exposure to physical, verbal, and sexual abuse also reported higher levels of anxiety and depression symptoms [20]. High-quality friendships, in contrast, have been shown to be an important protective factor for the mental health of children and adolescents facing adversity [21,22].…”

Maltreatment in childhood and intimate partner violence: A latent class growth analysis in a South African pregnancy cohort

“…Optimal number of classes were determined based on multiple statistical criteria, including Akaike Information Criterion (AIC) and sample size adjusted Bayesian Information Criterion (ssaBIC) as well as sufficient class size ( Muthen & Muthen, 2000 ). To ensure a meaningful class size and allow clinically relevant interpretation, we excluded any models where the smallest class was fewer than 30 women, similar to other studies ( Meyer, Yu, Hermosilla, & Stark, 2017 ; Olson, Choe, & Sameroff, 2017 ; Solomon et al, 2018 ). To investigate associations of maternal maltreatment in childhood (by subtype) with LCGA and LCA class membership for IPV, we utilised the bias-adjusted 3-step approach, which takes into account inaccuracy of class assignment ( Asparouhov & Muthén, 2014 ; Feingold, Tiberio, & Capaldi, 2014 ).…”

Pushing the Limits of Child Participation in Research: Reflections from a Youth-Driven Participatory Action Research (YPAR) Initiative in Uganda

“…Violence against children, especially in the global South, has recently emerged as a major priority for donors, UN agencies and governments. Academics and policymakers alike have called to end violence against children globally (Kyegombe et al, 2015;Meyer et al, 2017;Miller et al, 2018;Ministry of Gender, Labour and Social Development, 2018;Namy et al, 2017;Stark et al, 2013;Svevo-Cianci et al, 2011). Ending violence against children (VAC) has been prioritized in recent global development initiatives including the incorporation of VAC as one of the targets within Goal 16 of the Sustainable Development Goals on ending all forms of abuse, exploitation, trafficking and VAC by 2030 (https:// www.un.org/sustainabledevelopment/gender-equality/).…”