Evaluation of psychological support for victims of sexual violence in a conflict setting: Results from Brazzaville, Congo

Epicentre, Paris, France.
International Journal of Mental Health Systems (Impact Factor: 1.06). 05/2009; 3(1):7. DOI: 10.1186/1752-4458-3-7
Source: PubMed


Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo.
Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville.
The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment).
We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings.

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    • "These include income enhancement and gender training, [44,45] male-targeted, community-based training sessions to address GBV and HIV risk behaviors, [46] training sessions with participatory learning and communications skills, [44,45] and community mobilization (trial underway) [47]. Though still few in number, research to inform evidence-based response efforts has been implemented in humanitarian settings, including studies of psychological support interventions for rape survivors, [48] community-led mobile clinic and psychological support services for male and female survivors of GBV, [37] and support of women and families through economic empowerment by village-led microfinance (trial underway) [49]. The dearth of data on evidence-based prevention and response for GBV in humanitarian settings sets a research agenda to develop a base with which to inform programming to provide the most effective and efficient responses in times of limited resources. "
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    ABSTRACT: Background High levels of gender-based violence (GBV) persist among conflict-affected populations and within humanitarian settings and are paralleled by under-reporting and low service utilization. Novel and evidence-based approaches are necessary to change the current state of GBV amongst these populations. We present the findings of qualitative research, which were used to inform the development of a screening tool as one potential strategy to identify and respond to GBV for females in humanitarian settings. Methods Qualitative research methods were conducted from January-February 2011 to explore the range of experiences of GBV and barriers to reporting GBV among female refugees. Individual interview participants (n=37) included female refugees (≥15 years), who were survivors of GBV, living in urban or one of three camps settings in Ethiopia, and originating from six conflict countries. Focus group discussion participants (11 groups; 77 participants) included health, protection and community service staff working in the urban or camp settings. Interviews and discussions were conducted in the language of preference, with assistance by interpreters when needed, and transcribed for analysis by grounded-theory technique. Results Single and multiple counts of GBV were reported and ranged from psychological and social violence; rape, gang rape, sexual coercion, and other sexual violence; abduction; and physical violence. Domestic violence was predominantly reported to occur when participants were living in the host country. Opportunistic violence, often manifested by rape, occurred during transit when women depended on others to reach their destination. Abduction within the host country, and often across borders, highlighted the constant state of vulnerability of refugees. Barriers to reporting included perceived and experienced stigma in health settings and in the wider community, lack of awareness of services, and inability to protect children while mothers sought services. Conclusions Findings demonstrate that GBV persists across the span of the refugee experience, though there is a transition in the range of perpetrators and types of GBV that are experienced. Further, survivors experience significant individual and system barriers to disclosure and service utilization. The findings suggest that routine GBV screening by skilled service providers offers a strategy to confidentially identify and refer survivors to needed services within refugee settings, potentially enabling survivors to overcome existing barriers.
    Full-text · Article · Jun 2013 · Conflict and Health
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    • "Psychological support, delivered by a psychologist, included offering a safe environment for sharing of experiences and expression of distress, active listening, normalizing reactions, work on coping strategies and development of future plans. Pre- and post-test comparisons of 59 women participating in at least 2 sessions (median 3) showed a decrease in ratings of severe impairment (from 22 participants with severe impairment pre-intervention, to 3 and 2 participants at end of treatment and 1 to 2 year follow-up respectively, p = .04) [38]. "
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    ABSTRACT: Sexual and other forms of gender-based violence are common in conflict settings and are known risk factors for mental health and psychosocial wellbeing. We present findings from a systematic review of the academic and grey literature focused on the effectiveness of mental health and psychosocial support interventions for populations exposed to sexual and other forms of gender-based violence in the context of armed conflicts. We searched the Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PubMed/ Medline, psycINFO, and PILOTS, as well as grey literature to search for evaluations of interventions, without date limitations. Out of 5,684 returned records 189 full text papers were assessed for eligibility. Seven studies met inclusion criteria: 1 non-randomized controlled study; 3 non-controlled pre- post-test designs; 1 retrospective cohort with a matched comparison group; and 2 case studies. Studies were conducted in West and Central Africa; Albania; UK and USA, included female participants, and focused on individual and group counseling; combined psychological, medical, social and economic interventions; and cognitive behavioral therapy (two single case studies). The seven studies, while very limited, tentatively suggest beneficial effects of mental health and psychosocial interventions for this population, and show feasibility of evaluation and implementation of such interventions in real-life settings through partnerships with humanitarian organizations. Robust conclusions on the effectiveness of particular approaches are not possible on the basis of current evidence. More rigorous research is urgently needed.
    Full-text · Article · Jun 2013 · World psychiatry: official journal of the World Psychiatric Association (WPA)
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    • "These issues remain to be studied and are a clear direction for future research. Clinical evaluations of patients who were able to follow early short term psychotherapy could be conducted to examine their status in the future as it was done in the Congo Brazzaville (Hustache et al., 2009). We believe that a psychodynamic approach is a valuable therapeutic intervention in areas a¡ected by collective violence.We hope that this paper can stimulate e¡orts to do more research on the e¡ectiveness of psychotherapeutic approaches in such settings. "
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    ABSTRACT: Since the beginning of Al Aqsa Intifada, Palestinian children and adults living in the occupied Palestinian territory have been exposed to stressful events on a daily basis. As a result, some individuals develop severe and chronic reactive psychological syndromes. The nongovernmental organisation Médecins Sans Frontières (MSF) provides medical and psychological support to them, using psychodynamic psychotherapy adapted to the Palestinian culture and to the low intensity conflict context. This article presents data from 1773 children and adults who received treatment by psychotherapists between November 2000 and January 2006, in the Gaza strip and the West Bank. Nearly half of the patients were children between 4 and 14 years. The three main diagnoses were a) anxiety disorder other than posttraumatic stress disorder (PTSD) or acute stress, b) mood disorder, and c) PTSD. The psychotherapy included a median of six sessions over a period of around 11 weeks. At the evaluation at the end of therapy almost 80% of all patients had improved. These observations suggest that brief psychodynamic psychotherapy could have positive effects on the psychological wellbeing of Palestinians, even in difficult circumstances (war context) and within an Arab culture. The authors argue that this type of individual psychological support can be a useful complement to a psychosocial approach at the community level.
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