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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 livi...
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Background
Finding work is an important priority for many refugees in the initial years following settlement in a host country. Difficulties in finding work could conceivably both contribute to and be a consequence of symptoms of posttraumatic stress disorder (PTSD) and psychological distress commonly reported by refugees.PurposeWe sought to determ...
Citations
... A systematic review and meta-analysis found that the pooled prevalence of depression in Uganda is approximately 30.2%, with refugees experiencing the highest rates at 67.63% (4,5). Experiences of sexual and physical violence, along with the SAVA syndemic (substance use, violence, and HIV/AIDS), further increase vulnerability to depression (6,7). The lack of adequate healthcare access is a significant barrier to addressing mental health issues among these groups. ...
Introduction
In the post-COVID-19 era, depressive disorders among youth have risen significantly, creating an urgent need for accessible, cost-effective mental health interventions. This study adapts Group Support Psychotherapy into Tele-Support Psychotherapy (TSP) via mobile phones. It aims to evaluate its feasibility, acceptability, effectiveness, and cost-efficiency in addressing mild to moderate depression among youth in central Uganda.
Methods and analysis
This study will use a mixed-methods approach, starting with a qualitative phase to adapt Group Support Psychotherapy into Tele-Support Psychotherapy (TSP) via mobile phones. Guided by ecological theories and the Unified Theory of Acceptance and Use of Technology (UTAUT), focus group discussions and interviews with youth, mental health professionals, and stakeholders will inform the development of a youth-tailored call platform integrated into Rocket Health Africa's telehealth services. Data will be analyzed using grounded theory and MAXQDA Analytics Pro 2022 to guide intervention adaptation. An open-label randomized controlled trial will enroll 300 youth (15–30 years) with mild to moderate depression from Kampala, Uganda, to evaluate Tele-Support Psychotherapy (TSP). Participants will be randomized to TSP with standard mental health services (SMHS) or SMHS alone. Primary outcomes include feasibility and acceptability, with secondary outcomes assessing cost-effectiveness, depressive symptom changes, and social support. Intention-to-treat analysis using structural equation modeling will evaluate treatment effects, complemented by qualitative insights into implementation barriers and facilitators.
Discussion
This study protocol develops and evaluates Tele-Support Psychotherapy (TSP) for youth depression in resource-limited settings, addressing mental health gaps exacerbated by COVID-19. Using user-centered design and mixed methods, it explores TSP's feasibility, adaptability, and cost-effectiveness while addressing barriers like technology literacy, laying the groundwork for accessible digital mental health solutions.
Trial Registration
PACTR202201684613316.
... For instance, a study conducted by Thapa and Hauff in Nepal demonstrated that there is a signi cant correlation between disability and mental health deterioration (symptoms of anxiety, depression, and post-traumatic stress disorder as consequences of violence during armed con icts) [21], which is a similar to the relationship found in this study. As stated by Familiar et al., this correlation could be established and consolidated by multiple reasons, including rape, lack of shelter, lack of food or water, and other traumatic factors [22]. Another explanation may be that health professionals fail to recognize the mental health disorders that a ict disabled victims of armed con icts as well as the limited access to medical assistance in the areas affected by the con ict [23]. ...
Background
The Black communities who inhabit the Colombian Pacific Coast experience high risk levels due to the persistence of an armed conflict and the presence of a variety of illegal armed groups. Likewise, in comparison to the rest of the country, these communities face poor health conditions, a higher prevalence of preventable diseases, and a lower life expectancy at birth. This study was aimed at identifying the impact of violence on the health of the Afro-Colombian population from Tumaco (Narino, Colombia).
Methods
A cross-sectional observational study was conducted applying a survey to 280 victims of the armed conflict. A bivariate analysis was carried out using chi square test and Odds Ratio, together with a logistic regression.
Results
Most of the victims were young low-income women, who are at a higher risk of suffering from depression, injuries or poisonings caused by environmental pollution, malaria, and cardiovascular diseases as a consequence of their exposure to violent events. The most important effect of violence on the population’s health is the difficulty in completing their academic formation, and the determinants of violence that most strongly affect their health are housing conditions and unsatisfied basic needs.
Conclusions
In order to reduce the social inequalities of the victims of armed conflict it is necessary to update and improve the regulatory framework that oversees health, justice, politics, education and agriculture in Colombia. In addition, more studies and policies are required to mitigate the impact of violence on the Black population of the Colombian Pacific region who are young, poor and female.
... 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. ...
Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations.
Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups.
Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males.
Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.
... The effects of violence, from Israel and Gaza to Afghanistan, Cambodia, the Demo cratic Republic of Congo, Iraq, Libya, Syria, Yemen, Myanmar, Nepal, Rwanda, Sri Lanka, Syria, South Sudan, Sudan, and Ukraine, have all been well studied (Familiar et al., 2021;Kienzler & Sapkota, 2020;Razjouyan et al., 2022;Sá et al., 2022). History has supplied un ambiguous evidence of the lasting harm of warfare (Hyseni Duraku et al., 2023;Leshem et al., 2023;Saw et al., 2023;Thomas et al., 2023). ...
The ongoing wars in many regions—such as the conflict between Israel and Hamas—as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by individuals and communities affected by war and violence.
... Although this was a single RDS survey that enrolled both male and female participants, this paper focuses on male DRC refugees only (n = 718); female refugee data have been analysed and published separately (Familiar et al. 2021). ...
... Our population-based survey had enrolled both male and female participants (Familiar et al. 2021) and hence allows for a direct comparison of key characteristics and outcomes. Significantly fewer males (26.2%) reported rapes than females (79.5%), whereas females were more likely to report being raped by government security personnel than by militia members. ...
We conducted a population-based survey in 2013 in Kampala, Uganda, to examine violence and mental health outcomes among self-settled male refugees from the Eastern Democratic Republic of Congo (DRC). Male DRC refugees aged 18+ years were sampled through respondent-driven sampling. Key interview domains included demographics, experiences of sexual and nonsexual violence, social support, PTSD, depression and suicide ideation. Data analysis was weighted to generate population-level estimates. We sampled 718 men (mean age: 33 years), most of whom had lived in North or South Kivu. Nonsexual violence, such as beatings (79.4%) and torture (63.8%), was frequent. A quarter (26.2%) had been raped; 49.9% of rape victims had been raped on multiple occasions, and 75.7% of rape victims had been gang raped. We estimated 52.8% had post-traumatic stress disorder (PTSD); 44.4% reported suicidal ideation. Numerous traumas were significantly (p < 0.05) associated with PTSD such as rape (adjusted odds ratio [aOR] = 1.82), war-related injuries (aOR = 2.90) or having been exposed to >15 traumas (compared to ≤10; aOR = 6.89). Traumata are frequent experiences in this self-settled male refugee population and are often accompanied by adverse mental health outcomes. Screening for trauma and adverse mental health outcomes and providing targeted services are paramount to improve these refugees' lives.
... Respondent-driven sampling became a commonly-used sampling design within public health research to access high-risk marginalized populations such as those with HIV and other vulnerabilities (Johnston et al. 2016). In recent years, RDS methodology has expanded within social science research to study other hard-toreach populations, such as Syrian activist refugees (Khoury 2020), self-settled Congolese refugees in Uganda (Familiar et al. 2021), undocumented Mexican immigrants along the Mexico-California border (Garcini et al. 2017), and a global sample of adolescents in vulnerable urban settings (Decker et al. 2014). These studies have focused on health issues, with an emphasis on mental health and sexual and reproductive health measures. ...
The Central Sahel region has one of the world's fastest-growing populations of internally displaced persons (IDPs). To better understand the risk factors associated with displacement, this study utilized respondent-driven sampling to recruit otherwise hard-to-reach IDPs in remote and urban areas in Burkina Faso, Mali, and Niger. From August to October 2021, 4144 IDPs were surveyed, and nine targeted vulnerability profiles were measured across the domains of gender, health, and protection. The study revealed a high prevalence of risk factors and vulnerability among IDPs, with notable geographic differences. The majority of IDPs fell into at least one category of vulnerability, with health vulnerabilities being the most common. Internally displaced persons reported overlapping vulnerabilities in health, particularly chronic illness, mental health issues, and disability. Women had higher odds of vulnerability than men. Statistically significant associations were site-specific, and some were inconsistent across contexts, highlighting the cross-cutting and pervasive nature of vulnerability among IDPs.
... Trauma exposure during migration process increases the risk of psychological and behavioral problems Streel & Schilperoord, 2010;Weaver & Roberts, 2010;Weissbecker et al., 2019). Prior studies with refugee populations showed that sexual trauma significantly increased the risk of depression (Familiar et al., 2021;Hossain et al., 2021), suicidal ideation (J. Y. Kim et al., 2017;Um et al., 2021), and alcohol use disorders (Miranda et al., 2002;Streel & Schilperoord, 2010;Weaver & Roberts, 2010;Weissbecker et al., 2019). ...
North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women’s exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women’s exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.
... Displaced people experience poor mental health from having lived in conflict settings (Meyer et al. 2020). And, once resettled, often live in overcrowded informal settlements with poor sanitation, and high rates of resource insecurity, and violence (Familiar et al. 2021). These conditions directly and indirectly predispose adolescent girls and young women (AGYW) to poor sexual and reproductive health (SRH) outcomes (UNHCR 2019). ...
Adolescent girls and young women (AGYW) in sub-Saharan Africa face a high risk of unintended pregnancy. This risk is compounded in informal settlements, where resources are scarce and access to sexual and reproductive health services is limited. Being a young mother in informal settlements could exacerbate existing experiences of resource scarcity and poor access to sexual and reproductive health services. To explore this, we analyzed the factors associated with motherhood among refugee AGYW in Kampala, Uganda. Between January and March 2018, peer researchers recruited refugee youth aged 15-24 and living in five informal settlements in Kampala to participate in this study. We used a backwards generalized linear model with a log binomial regression to determine if mental health, resource insecurity and sexual and reproductive health variables were associated with motherhood among study participants. Our analysis included 333 AGYW with a mean age of 19.3 years (standard deviation: 2.6). Nearly one-quarter (23 percent; n = 76) of AGYW had children. Having children was associated with greater likelihood of reporting food insecurity (adjusted prevalence ratio [aPR]: 1.96, 95 percent confidence interval [CI]: 1.07-3.61), depressive symptoms (aPR: 2.03, 95 percent CI: 1.09-3.80), and contraception uptake (aPR: 2.37, 95 percent CI: 1.58-3.56) compared to not having children. Mental health and resource insecurity interventions are required for refugee AGYW with children in informal settlements. Sexual and reproductive health services should be promoted to refugee AGYW regardless of motherhood status to prevent unplanned pregnancy.
... 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). ...
There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools—anxiety, depression, and post-traumatic stress disorder—adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local “cultural fit” of globally used tools for measuring mental health in cross-cultural research.
Background:
Sexual violence is a serious public health and human rights problem with both short-term and long-term consequences. This review aims to systematically assess the link between sexual violence and poor mental health among sub-Saharan African women.
Methods:
Systematic review and meta-analyses of observational studies were performed. MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane, Global Health and the University of Melbourne library electronic databases were used to find relevant published literature over 12 years from 2012 to 2024 in sub-Saharan Africa with stringent eligibility criteria. Random effects meta-analyses were used to pool estimates of ORs and 95% CIs. The I2 statistic was used to assess heterogeneity.
Results:
This systematic review and meta-analysis of 76 observational studies included a total of 80 313 participants and found a consistent small-to-medium association between lifetime sexual violence and experiences of poor mental health. The pooled ORs suggest that women who were exposed to sexual violence were more than twice as likely to experience post-traumatic stress disorder (OR 2.75; 95% CI 1.96 to 3.86; I2=73.4%), depression (OR 2.38; 95% CI 2.04 to 2.77; I2=56.6%), anxiety (OR 2.81; 95% CI 1.67 to 4.72; I2=77.2%), common mental disorders (OR 2.12; 95% CI 1.70 to 2.64; I2=0.0%), suicidal behaviour (OR 2.44; 95% CI 1.92 to 3.10; I2=68.0%) and emotional distress (OR 3.14; 95% CI 1.73 to 5.69; I2=79.6%) compared with women who have not experienced sexual violence.
Conclusions:
Exposure to lifetime sexual violence was consistently associated with small to medium effects on poor mental health among women in sub-Saharan Africa. Thus, policy-makers should develop response strategies as well as mental health screening tools for all violence response service delivery points. In addition, health practitioners must prioritise screening for mental health conditions in patients who present with a history of sexual violence.
