Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2018

Open Access 01-12-2018 | Research article

Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide

Authors: Hawkar Ibrahim, Verena Ertl, Claudia Catani, Azad Ali Ismail, Frank Neuner

Published in: BMC Medicine | Issue 1/2018

Login to get access

Abstract

Background

In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi’s ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. The aim of this study is to determine the mental health of women and girl survivors of these events in relation to enslavement and experiences with genocide-related events, as well as perceived social rejection in their community.

Methods

Between February and July 2017, trained local assessors interviewed a sample of 416 Yazidi women and girls (65 of whom had survived sexual enslavement), aged between 17 and 75 years, and living in internally displaced person camps in the Kurdistan Region of Iraq. Post-traumatic stress disorder (PTSD) and depression symptoms were assessed using validated Kurdish versions of standard instruments. Scales for trauma exposure and perceived rejection were developed for the purpose of this study.

Results

Participants reported a high number of traumatic events. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable DSM-5 PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health. In addition, among formerly enslaved girls and women, perceived social rejection in their community mediated the relationship between traumatic enslavement events and depression symptoms.

Conclusions

In a context of maximum adversity, enslavement and war-related events contribute to high levels of PTSD and depression. Perceived social rejection seems to play a role in the relationship between trauma exposure and mental health among abducted genocide survivors. Providing psychosocial support and treatment for Yazidi people is essential and urgently required.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Human Rights Watch. Flawed Justice – Accountability for ISIS Crimes in Iraq. 2017.
4.
Amnesty International. Escape from Hell: Torture and Sexual Slavery in Islamic State Captivity in Iraq. London: Amnesty International; 2014.
5.
Cetorelli V, Sasson I, Shabila N, Burnham G. Mortality and kidnapping estimates for the Yazidi population in the area of Mount Sinjar, Iraq, in August 2014: A retrospective household survey. Plos Med. 2017;14:e1002297.CrossRefPubMedPubMedCentral
6.
Independent International Commission of Inquiry on the Syrian Arab Republic. They Came to Destroy: ISIS Crimes Against the Yazidis. Geneva: Independent International Commission of Inquiry on the Syrian Arab Republic; 2016.
7.
Rugema L, Mogren I, Ntaganira J, Gunilla K. Traumatic episodes experienced during the genocide period in Rwanda influence life circumstances in young men and women 17 years later. BMC Public Health. 2013;13:1235.CrossRefPubMedPubMedCentral
8.
Roth M, Neuner F, Elbert T. Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide. Int J Ment Health Syst. 2014;8:12.CrossRefPubMedPubMedCentral
9.
Barel E, Van IJzendoorn MH, Sagi-Schwartz A, Bakermans-Kranenburg MJ. Surviving the holocaust: a meta-analysis of the long-term sequelae of a genocide. Psychol Bull. 2010;136:677–98.CrossRefPubMed
10.
Heim L, Schaal S. Rates and predictors of mental stress in Rwanda: investigating the impact of gender, persecution, readiness to reconcile and religiosity via a structural equation model. Int J Ment Health Syst. 2014;8:37.CrossRefPubMedPubMedCentral
11.
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA. 2009;302:537.CrossRefPubMed
12.
Schaal S, Elbert T. Ten years after the genocide: trauma confrontation and posttraumatic stress in Rwandan adolescents. J Trauma Stress. 2006;19:95–105.CrossRefPubMed
13.
Weine SM, Becker DF, TH MG, Laub D, Lazrove S, Vojvoda D, Hyman L. Psychiatric consequences of ‘ethnic cleansing’: clinical assessments and trauma testimonies of newly resettled Bosnian refugees. Am J Psychiatry. 1995;152:536–42.CrossRefPubMed
14.
Dworkin J, Prescott M, Jamal R, Hardawan SA, Abdullah A, Galea S. The long-term psychosocial impact of a surprise chemical weapons attack on civilians in Halabja, Iraqi Kurdistan. J Nerv Ment Dis. 2008;196:772–5.CrossRefPubMed
15.
Bolton P, Michalopoulos L, Ahmed AMA, Murray LK, Bass J. The mental health and psychosocial problems of survivors of torture and genocide in Kurdistan, northern Iraq: a brief qualitative study. Torture. 2013;23:1–14.PubMed
16.
Ahmad A, Sofi MA, Sundelin-Wahlsten V, Von Knorring AL. Posttraumatic stress disorder in children after the military operation ‘Anfal’ in Iraqi Kurdistan. Eur Child Adolesc Psychiatry. 2000;9:235–43.CrossRefPubMed
17.
Hall BJ, Bonanno GA, Bolton PA, Bass JK. A longitudinal investigation of changes to social resources associated with psychological distress among Kurdish torture survivors living in northern Iraq. J Trauma Stress. 2014;27:446–53.CrossRefPubMed
18.
Tekin A, Karadağ H, Süleymanoğlu M, Tekin M, Kayran Y, Alpak G, et al. Prevalence and gender differences in symptomatology of posttraumatic stress disorder and depression among Iraqi Yazidis displaced into Turkey. Eur J Psychotraumatol. 2016;7:28556.CrossRefPubMed
19.
Ceri V, Özlü-Erkilic Z, Özer Ü, Yalcin M, Popow C, Akkaya-Kalayci T. Psychiatric symptoms and disorders among Yazidi children and adolescents immediately after forced migration following ISIS attacks. Neuropsychiatrie. 2016;30:145–50.CrossRefPubMedPubMedCentral
20.
21.
Reid-Cunningham AR. Rape as a weapon of genocide. Genocide Stud Prev. 2008;3:279–96.CrossRef
22.
Longombe AO, Claude KM, Ruminjo J. Fistula and traumatic genital injury from sexual violence in a conflict setting in eastern Congo: case studies. Reprod Health Matters. 2008;16:132–41.CrossRefPubMed
23.
Tompkins TL. Prosecuting rape as a war crime: speaking the unspeakable. Notre Dame Law Rev. 1995;70:845–90.
24.
Lončar M, Medved V, Jovanović N, Hotujac L. Psychological consequences of rape on women in 1991-1995 war in Croatia and Bosnia and Herzegovina. Croat Med J. 2006;47:67–75.PubMedPubMedCentral
25.
Ba I, Bhopal RS. Physical, mental and social consequences in civilians who have experienced war-related sexual violence: a systematic review (1981-2014). Public Health. 2017;142:121–35.CrossRefPubMed
26.
Hoffman YSG, Grossman ES, Shrira A, Kedar M, Ben-Ezra M, Dinnayi M, et al. Complex PTSD and its correlates amongst female Yazidi victims of sexual slavery living in post-ISIS camps. World Psychiatry. 2018;17:112–3.CrossRefPubMedPubMedCentral
27.
Kelly JT, Betancourt TS, Mukwege D, Lipton R, VanRooyen MJ. Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study. Confl Health. 2011;5:25.CrossRefPubMedPubMedCentral
28.
Duroch F, McRae M, Grais RF. Description and consequences of sexual violence in Ituri province, Democratic Republic of Congo. BMC Int Health Hum Rights. 2011;11:5.CrossRefPubMedPubMedCentral
29.
Amone-P’Olak K, Lekhutlile TM, Ovuga E, Abbott RA, Meiser-Stedman R, Stewart DG, et al. Sexual violence and general functioning among formerly abducted girls in northern Uganda: the mediating roles of stigma and community relations - the WAYS study. BMC Public Health. 2016;16:64.CrossRefPubMedPubMedCentral
30.
Albutt K, Kelly J, Kabanga J, VanRooyen M. Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo. Disasters. 2017;41:211–27.CrossRefPubMed
31.
Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68:748–66.CrossRefPubMed
32.
Siriwardhana C, Ali S, Roberts B, Stewart R. A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants. Confl Health. 2014;8:13.CrossRefPubMedPubMedCentral
33.
Shishehgar S, Gholizadeh L, DiGiacomo M, Green A, Davidson PM. Health and socio-cultural experiences of refugee women: an integrative review. J Immigr Minor Heal. 2017;19:959–73.CrossRef
34.
King DW, Taft C, King LA, Hammond C, Stone ER. Directionality of the association between social support and posttraumatic stress disorder: a longitudinal Investigation. J Appl Soc Psychol. 2006;36:2980–92.CrossRef
35.
Barnes JB, Nickerson A, Adler AB, Litz BT. Perceived military organizational support and peacekeeper distress: A longitudinal investigation. Psychol Serv. 2013;10:177–85.CrossRefPubMed
36.
Wagner B, Keller V, Knaevelsrud C, Maercker A. Social acknowledgement as a predictor of post-traumatic stress and complicated grief after witnessing assisted suicide. Int J Soc Psychiatry. 2012;58:381–5.CrossRefPubMed
37.
Nietlisbach G, Maercker A. Social cognition and interpersonal impairments in trauma survivors with PTSD. J Aggress Maltreat Trauma. 2009;18:382–402.CrossRef
38.
Sommer J, Hinsberger M, Weierstall R, Holtzhausen L, Kaminer D, Seedat S, et al. Social acknowledgment of violent experiences and its role in PTSD and appetitive aggression among high-risk males in South Africa. Clin Psychol Sci. 2016;5:166–73.CrossRef
39.
Mueller J, Moergeli H, Maercker A. Disclosure and social acknowledgement as predictors of recovery from posttraumatic stress: a longitudinal study in crime victims. Can J Psychiatr. 2008;53:160–8.CrossRef
40.
Kohli A, Perrin NA, Mpanano RM, Mullany LC, Murhula CM, Binkurhorhwa AK, et al. Risk for family rejection and associated mental health outcomes among conflict-affected adult women living in rural eastern Democratic Republic of the Congo. Health Care Women Int. 2014;35:789–807.CrossRefPubMed
41.
Amone-P’Olak K, Ovuga E, Jones PB. The effects of sexual violence on psychosocial outcomes in formerly abducted girls in northern Uganda: the WAYS study. BMC Psychol. 2015;3:46.CrossRefPubMedPubMedCentral
42.
Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. Validation and calibration of the posttraumatic stress disorder checklist for DSM-5 (PCL-5) with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry. 2018 (in press).
43.
Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane T. The Life Events Checklist for DSM-5 (LEC-5). National Center for PTSD. 2013. National Center for PTSD. www.​ptsd.​va.​gov. Accessed 9 Feb 2018.
44.
Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. 2013. Instrument available from the National Center for PTSD at www.​ptsd.​va.​gov
45.
Hesbacher PT, Rickels K, Morris RJ, Newman H, Rosenfeld H. Psychiatric illness in family practice. J Clin Psychiatry. 1980;41:6–10.PubMed
46.
Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. 2nd ed. New York: Guilford Press; 2018.
47.
Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002;7:422–45.CrossRefPubMed
48.
49.
Mlodoch K. Fragmented memory, competing narratives: the perspective of women survivors of the Anfal operations in Iraqi Kurdistan. In: Tejel J, Sluglett P, Bocco R, Bozarslan H, editors. Writing the Modern History of Iraq: World Scientific; 2012. p. 205–26. https://​doi.​org/​10.​1142/​9789814390576_​0014.
50.
Suarez EB. The association between post-traumatic stress-related symptoms, resilience, current stress and past exposure to violence: a cross sectional study of the survival of Quechua women in the aftermath of the Peruvian armed conflict. Confl Health. 2013;7:21.CrossRefPubMedPubMedCentral
51.
Johnson K, Scott J, Rughita B, et al. Association of sexual violence and human rights violations with physical and mental health in territories of the eastern Democratic Republic of the Congo. JAMA. 2010;304:553–62.CrossRefPubMed
52.
Stevanović A, Frančišković T, Vermetten E. Relationship of early-life trauma, war-related trauma, personality traits, and PTSD symptom severity: a retrospective study on female civilian victims of war. Eur J Psychotraumatol. 2016;7:30964.CrossRefPubMed
53.
54.
Ibrahim H, Hassan CQ. Post-traumatic stress disorder symptoms resulting from torture and other traumatic events among Syrian Kurdish refugees in Kurdistan region, Iraq. Front Psychol. 2017;8:241.CrossRefPubMedPubMedCentral
55.
Muftić LR, Finn MA. Health outcomes among women trafficked for sex in the United States: a closer look. J Interpers Violence. 2013;28:1859–85.CrossRefPubMed
56.
Ovuga E, Oyok TO, Moro EB. Post traumatic stress disorder among former child soldiers attending a rehabilitative service and primary school education in northern Uganda. Afr Health Sci. 2008;8:136–41.PubMedPubMedCentral
57.
Betancourt TS, Brennan RT, Rubin-Smith J, Fitzmaurice GM, Gilman SE. Sierra Leone’s former child soldiers: a longitudinal study of risk, protective factors, and mental health. J Am Acad Child Adolesc Psychiatry. 2010;49:606–15.PubMedPubMedCentral
58.
59.
Winkler N, Ruf-Leuschner M, Ertl V, Pfeiffer A, Schalinski I, Ovuga E, et al. From war to classroom: PTSD and depression in formerly abducted youth in Uganda. Front Psychiatry. 2015;6:2.CrossRefPubMedPubMedCentral
60.
Umubyeyi A, Mogren I, Ntaganira J, Krantz G. Intimate partner violence and its contribution to mental disorders in men and women in the post genocide Rwanda: findings from a population based study. BMC Psychiatry. 2014;14:315.CrossRefPubMedPubMedCentral
61.
Rugema L, Mogren I, Ntaganira J, Krantz G. Traumatic episodes and mental health effects in young men and women in Rwanda, 17 years after the genocide. BMJ Open. 2015;5:e006778.CrossRefPubMedPubMedCentral
62.
Amone-P’Olak K, Lekhutlile TM, Ovuga E, Abbott RA, Meiser-Stedman R, Stewart DG, et al. Sexual violence and general functioning among formerly abducted girls in northern Uganda: the mediating roles of stigma and community relations--the WAYS study. BMC Public Health. 2016;16:64.CrossRefPubMedPubMedCentral
63.
Amone-P’Olak K, Elklit A, Dokkedahl SB. PTSD, mental illness, and care among survivors of sexual violence in northern Uganda: findings from the WAYS study. Psychol Trauma. 2018;10(3):282–9.CrossRefPubMed
64.
Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014;140:921–48.CrossRefPubMed
65.
Metadata
Title
Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide
Authors
Hawkar Ibrahim
Verena Ertl
Claudia Catani
Azad Ali Ismail
Frank Neuner
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-018-1140-5

Other articles of this Issue 1/2018

BMC Medicine 1/2018 Go to the issue

Research article

Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study

Commentary

Avoiding rash decisions about zoster vaccination: insights from cost-effectiveness evidence

Research article

Prevalence, risk factors and behavioural and emotional comorbidity of acute seizures in young Kenyan children: a population-based study

Research article

Investigating spillover of multidrug-resistant tuberculosis from a prison: a spatial and molecular epidemiological analysis

Research article

Abortion-related emergency department visits in the United States: An analysis of a national emergency department sample

Research article

Adult height and risk of 50 diseases: a combined epidemiological and genetic analysis