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

Human Rights Center, University of California, Berkeley, 460 Stephens Hall, No. 2300, Berkeley, CA 94720-2300, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 29.98). 08/2010; 304(5):544-52. DOI: 10.1001/jama.2010.1065
Source: PubMed

ABSTRACT 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.
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.
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.
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 cut-off score of 1.75.
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 (P < .001). Anxiety symptom scores were higher for respondents in the northern prefectures than those in the south (t = 2.54, P = .01).
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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: People seeking to understand the scope and scale of violence in the Central African Republic over the past two years have cited a variety of social grievances centring on the political manipulation of religion, belonging, and access to opportunities. Without denying that these factors have played a role, this article argues that the violence must be understood in the context of social practices of violence that long predate the war, especially in light of the diffuse and non-centralized mode of organization through which the ongoing war has played out. The article focuses on the prevalence of popular punishment and vengeance, which have long histories as elements of statecraft in the CAR and have become even more widespread amid the generalized insecurity and anomie that have set in over the past few decades. The article presents evidence of the workings of popular punishment from the intra-family level to that of the crowd and quartier, in both rural and urban locales. Though people have important reservations about popular punishment, they also see vengeance as an important tool for enforcing a circumscribed mode of empathy and a minimum set of standards for social behaviour. These experiences in the CAR suggest that those wishing to understand how wartime mobilization happens must consider not just fighters' grievances but also people's conceptions of the practical and symbolic efficacy of vengeance and popular punishment as elements of politics and the management of threats.
    African Affairs 01/2014; 114(454):52-71. DOI:10.1093/afraf/adu079 · 1.54 Impact Factor
  • Source
    Article: none
  • [Show abstract] [Hide abstract]
    ABSTRACT: Refugees and internally displaced persons are highly vulnerable to sexual violence during conflict and subsequent displacement. However, accurate estimates of the prevalence of sexual violence among in these populations remain uncertain. Our objective was to estimate the prevalence of sexual violence among refugees and displaced persons in complex humanitarian emergencies. We conducted systematic review of relevant literature in multiple databases (EMBASE, CINAHL, and MEDLINE) through February 2013 to identify studies. We also reviewed reference lists of included articles to identify any missing sources. Inclusion criteria required identification of sexual violence among refugees and internally displaced persons or those displaced by conflict in complex humanitarian settings. Studies were excluded if they did not provide female sexual violence prevalence, or that included only single case reports, anecdotes, and those that focused on displacement associated with natural disasters. After a review of 1175 citations 19 unique studies were selected. Data Extraction: Two reviewers worked independently to identify final selection and a third reviewer adjudicated any differences. Descriptive and quantitative information was extracted; prevalence estimates were synthesized. Heterogeneity was assessed using I2. The main outcome of interest was sexual violence among female refugees and internally displaced persons in complex humanitarian settings. The prevalence of sexual violence was estimated at 21.4% (95% CI, 14.9-28.7; I2=98.3%), using a random effects model. Statistical heterogeneity was noted with studies using probability sampling designs reporting lower prevalence of sexual violence (21.0%, 95% CI, 13.2-30.1; I2=98.6%), compared to lower quality studies (21.7%, 95% CI, 11.5-34.2; I2=97.4%). We could not rule out the presence of publication bias. The findings suggest that approximately one in five refugees or displaced women in complex humanitarian settings experienced sexual violence. However, this is likely an underestimation of the true prevalence given the multiple existing barriers associated with disclosure. The long-term health and social consequences of sexual violence for women and their families necessitate strategies to improve identification of survivors of sexual violence and increase prevention and response interventions in these complex settings.
    03/2014; 6. DOI:10.1371/currents.dis.835f10778fd80ae031aac12d3b533ca7
    This article is viewable in ResearchGate's enriched format