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Published in: BMC Psychiatry 1/2020

01-12-2020 | Rape | Research article

Gender differences in response to war-related trauma and posttraumatic stress disorder – a study among the Congolese refugees in Uganda

Authors: Herbert E. Ainamani, Thomas Elbert, David Kani Olema, Tobias Hecker

Published in: BMC Psychiatry | Issue 1/2020

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Abstract

Background

The wars in the Democratic Republic of Congo have left indelible marks on the mental health and functioning of the Congolese civilians that sought refuge in Uganda. Even though it is clear that civilians who are exposed to potentially traumatizing events in war and conflict areas develop trauma-related mental health problems, scholarly information on gender differences on exposure to different war-related traumatic events, their conditional risks to developing PTSD and whether the cumulative exposure to traumatic events affects men and women differently is still scanty.

Methods

In total, 325 (n = 143 males, n = 182 females) Congolese refugees who lived in Nakivale, a refugee settlement in the Southwestern part of Uganda were interviewed within a year after their arrival. Assessment included exposure to war-related traumatic events, and DSM-IV PTSD symptom severity.

Results

Our main findings were that refugees were highly exposed to war-related traumatic events with experiencing dangerous flight as the most common event for both men (97%) and women (97%). The overall high prevalence of PTSD differed among women (94%) and men (84%). The highest conditional prevalence of PTSD in women was associated with experiencing rape. The dose-response effect differed significantly between men and women with women showing higher PTSD symptom severity when experiencing low and moderate levels of potentially traumatizing event types.

Conclusion

In conflict areas, civilians are highly exposed to different types of war-related traumatic events that expose them to high levels of PTSD symptoms, particularly women. Interventions focused at reducing mental health problems resulting from war should take the context of gender into consideration.
Literature
1.
go back to reference Veling W, Hall BJ, Joosse P. The association between posttraumatic stress symptoms and functional impairment during ongoing conflict in the Democratic Republic of Congo. J Anxiety Disord. 2013;27(2):225–30.PubMedPubMedCentralCrossRef Veling W, Hall BJ, Joosse P. The association between posttraumatic stress symptoms and functional impairment during ongoing conflict in the Democratic Republic of Congo. J Anxiety Disord. 2013;27(2):225–30.PubMedPubMedCentralCrossRef
2.
go back to reference Ssenyonga J, Owens V, Olema DK. Posttraumatic growth, resilience, and posttraumatic stress disorder (PTSD) among refugees. Procedia - Soc Behav Sci. 2013;82:144–8.CrossRef Ssenyonga J, Owens V, Olema DK. Posttraumatic growth, resilience, and posttraumatic stress disorder (PTSD) among refugees. Procedia - Soc Behav Sci. 2013;82:144–8.CrossRef
3.
go back to reference Silove D. The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework. J Nerv Ment Dis. 1999;187(4):200–7.PubMedCrossRef Silove D. The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework. J Nerv Ment Dis. 1999;187(4):200–7.PubMedCrossRef
4.
go back to reference Steel Z, et al. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet. 2002;360(9339):1056–62.PubMedCrossRef Steel Z, et al. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet. 2002;360(9339):1056–62.PubMedCrossRef
5.
go back to reference Onyut LP, et al. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study. Confl Heal. 2009;3:6.CrossRef Onyut LP, et al. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study. Confl Heal. 2009;3:6.CrossRef
6.
go back to reference Carta MG, et al. Trauma- and stressor related disorders in the tuareg refugees of a cAMP in Burkina Faso. Clin Pract Epidemiol Ment Health. 2013;9:189–95.PubMedPubMedCentralCrossRef Carta MG, et al. Trauma- and stressor related disorders in the tuareg refugees of a cAMP in Burkina Faso. Clin Pract Epidemiol Ment Health. 2013;9:189–95.PubMedPubMedCentralCrossRef
7.
go back to reference Meger S. Rape of Congo: understanding sexual violence in the coflict in the Democtratic Republic of Congo. J Conteprary Afr Stud. 2010;28(2):119–29.CrossRef Meger S. Rape of Congo: understanding sexual violence in the coflict in the Democtratic Republic of Congo. J Conteprary Afr Stud. 2010;28(2):119–29.CrossRef
8.
go back to reference Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959–92.PubMedCrossRef Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959–92.PubMedCrossRef
9.
go back to reference Norris FH, Foster JD, Weisshaar DL. The epidemiology of gender differences in PTSD across developmental, societal, and research contexts, in Gender and PTSD. New York: Guilford press; 2002. p. 3–42. Norris FH, Foster JD, Weisshaar DL. The epidemiology of gender differences in PTSD across developmental, societal, and research contexts, in Gender and PTSD. New York: Guilford press; 2002. p. 3–42.
10.
go back to reference Kessler RC, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.PubMedPubMedCentralCrossRef Kessler RC, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.PubMedPubMedCentralCrossRef
11.
go back to reference O'Toole BI, Catts SV. Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res. 2008;64(1):33–40.PubMedCrossRef O'Toole BI, Catts SV. Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. J Psychosom Res. 2008;64(1):33–40.PubMedCrossRef
12.
go back to reference Carmassi C, et al. Gender differences in DSM-5 versus DSM-IV-TR PTSD prevalence and criteria comparison among 512 survivors to the L'Aquila earthquake. J Affect Disord. 2014;160:55–61.PubMedCrossRef Carmassi C, et al. Gender differences in DSM-5 versus DSM-IV-TR PTSD prevalence and criteria comparison among 512 survivors to the L'Aquila earthquake. J Affect Disord. 2014;160:55–61.PubMedCrossRef
13.
go back to reference Kessler RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60.PubMedCrossRef Kessler RC, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60.PubMedCrossRef
14.
go back to reference Irish LA, et al. Gender differences in PTSD symptoms: an exploration of peritraumatic mechanisms. J Anxiety Disord. 2011;25(2):209–16.PubMedCrossRef Irish LA, et al. Gender differences in PTSD symptoms: an exploration of peritraumatic mechanisms. J Anxiety Disord. 2011;25(2):209–16.PubMedCrossRef
15.
go back to reference Creamer M, Burgess P, McFarlane AC. Post-traumatic stress disorder: findings from the Australian National Survey of mental health and well-being. Psychol Med. 2001;31(7):1237–47.PubMedCrossRef Creamer M, Burgess P, McFarlane AC. Post-traumatic stress disorder: findings from the Australian National Survey of mental health and well-being. Psychol Med. 2001;31(7):1237–47.PubMedCrossRef
16.
go back to reference Stein MB, et al. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry. 1997;154(8):1114–9.PubMedCrossRef Stein MB, et al. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry. 1997;154(8):1114–9.PubMedCrossRef
17.
go back to reference Ditlevsen DN, Elklit A. Gender, trauma type, and PTSD prevalence: a re-analysis of 18 nordic convenience samples. Ann General Psychiatry. 2012;11(1):26.CrossRef Ditlevsen DN, Elklit A. Gender, trauma type, and PTSD prevalence: a re-analysis of 18 nordic convenience samples. Ann General Psychiatry. 2012;11(1):26.CrossRef
18.
go back to reference Christiansen DM, Hansen M. Accounting for sex differences in PTSD: a multi-variable mediation model. Eur J Psychotraumatol. 2015;6:26068.PubMedCrossRef Christiansen DM, Hansen M. Accounting for sex differences in PTSD: a multi-variable mediation model. Eur J Psychotraumatol. 2015;6:26068.PubMedCrossRef
19.
go back to reference Neuner F, et al. Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry. 2004;4:34.PubMedPubMedCentralCrossRef Neuner F, et al. Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry. 2004;4:34.PubMedPubMedCentralCrossRef
20.
go back to reference Kolassa I-T, et al. Spontaneous remission from PTSD depends on the number of traumatic event types experienced. Psychol Trauma Theory Res Pract Policy. 2010;2(3):169–74.CrossRef Kolassa I-T, et al. Spontaneous remission from PTSD depends on the number of traumatic event types experienced. Psychol Trauma Theory Res Pract Policy. 2010;2(3):169–74.CrossRef
21.
go back to reference Wilker S, et al. How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population. Eur J Psychotraumatol. 2015;6:28306.PubMedCrossRef Wilker S, et al. How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population. Eur J Psychotraumatol. 2015;6:28306.PubMedCrossRef
22.
go back to reference Schauer M, et al. PTSD and the “building block” effect of psychological trauma among West Nile Africans. Eur Soc Trauma Stress Stud Bull. 2003;10(2):5–6. Schauer M, et al. PTSD and the “building block” effect of psychological trauma among West Nile Africans. Eur Soc Trauma Stress Stud Bull. 2003;10(2):5–6.
23.
go back to reference Fullerton CS, et al. Gender differences in posttraumatic stress disorder after motor vehicle accidents. Am J Psychiatry. 2001;158(9):1486–91.PubMedCrossRef Fullerton CS, et al. Gender differences in posttraumatic stress disorder after motor vehicle accidents. Am J Psychiatry. 2001;158(9):1486–91.PubMedCrossRef
24.
go back to reference Ertl V, et al. Validation of a mental health assessment in an African conflict population. Psychol Assessement. 2010;22(2):318–24.CrossRef Ertl V, et al. Validation of a mental health assessment in an African conflict population. Psychol Assessement. 2010;22(2):318–24.CrossRef
25.
go back to reference Catani C, et al. Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-East Sri Lanka. BMC Psychiatry. 2009;9:22. Catani C, et al. Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-East Sri Lanka. BMC Psychiatry. 2009;9:22.
26.
go back to reference Hermenau K, et al. Addressing post-traumatic stress and aggression by means of narrative exposure: a randomized controlled trial with ex-combatants in the eastern DRC. J Aggress Maltreat Trauma. 2013;22(8):916–34.CrossRef Hermenau K, et al. Addressing post-traumatic stress and aggression by means of narrative exposure: a randomized controlled trial with ex-combatants in the eastern DRC. J Aggress Maltreat Trauma. 2013;22(8):916–34.CrossRef
27.
go back to reference Ainamani HE, et al. PTSD symptom severity relates to cognitive and psycho-social dysfunctioning - a study with Congolese refugees in Uganda. Eur J Psychotraumatol. 2017;8(1):1283086.PubMedPubMedCentralCrossRef Ainamani HE, et al. PTSD symptom severity relates to cognitive and psycho-social dysfunctioning - a study with Congolese refugees in Uganda. Eur J Psychotraumatol. 2017;8(1):1283086.PubMedPubMedCentralCrossRef
28.
go back to reference Hecker T, et al. The cycle of violence: associations between exposure to violence, trauma-related symptoms and aggression--findings from Congolese refugees in Uganda. J Trauma Stress. 2015;28(5):448–55.PubMedCrossRef Hecker T, et al. The cycle of violence: associations between exposure to violence, trauma-related symptoms and aggression--findings from Congolese refugees in Uganda. J Trauma Stress. 2015;28(5):448–55.PubMedCrossRef
29.
go back to reference Foa EB, et al. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6(4):459–73.CrossRef Foa EB, et al. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6(4):459–73.CrossRef
30.
go back to reference Foa EB, Tolin DF. Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. J Trauma Stress. 2000;13(2):181–91.PubMedCrossRef Foa EB, Tolin DF. Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. J Trauma Stress. 2000;13(2):181–91.PubMedCrossRef
31.
go back to reference Hecker T, et al. Aggression inoculates against PTSD symptom severity-insights from armed groups in the eastern DR Congo. Eur J Psychotraumatol. 2013;4:10.3402.CrossRef Hecker T, et al. Aggression inoculates against PTSD symptom severity-insights from armed groups in the eastern DR Congo. Eur J Psychotraumatol. 2013;4:10.3402.CrossRef
32.
go back to reference Hollifield M, et al. Measuring trauma and health status in refugees: a critical review. JAMA. 2002;288(5):611–21.PubMedCrossRef Hollifield M, et al. Measuring trauma and health status in refugees: a critical review. JAMA. 2002;288(5):611–21.PubMedCrossRef
33.
go back to reference Alpak G, et al. Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. Int J Psychiatry Clin Pract. 2015;19(1):45–50.PubMedCrossRef Alpak G, et al. Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. Int J Psychiatry Clin Pract. 2015;19(1):45–50.PubMedCrossRef
34.
go back to reference Saile R, et al. Children of the postwar years: A two-generational multilevel risk assessment of child psychopathology in northern Uganda. Dev Psychopathol. 2015;1:1–14. Saile R, et al. Children of the postwar years: A two-generational multilevel risk assessment of child psychopathology in northern Uganda. Dev Psychopathol. 2015;1:1–14.
35.
go back to reference Neuner F, et al. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. J Consult Clin Psychol. 2004;72(4):579–87.PubMedCrossRef Neuner F, et al. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. J Consult Clin Psychol. 2004;72(4):579–87.PubMedCrossRef
36.
go back to reference Tekin A, 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.PubMedCrossRef Tekin A, 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.PubMedCrossRef
37.
38.
go back to reference Hall BJ, et al. The importance of establishing reliability and validity of assessment instruments for mental health problems: an example from Somali children and adolescents living in three refugee camps in Ethiopia. Psychol Injury Law. 2014;7(2):153–64.CrossRef Hall BJ, et al. The importance of establishing reliability and validity of assessment instruments for mental health problems: an example from Somali children and adolescents living in three refugee camps in Ethiopia. Psychol Injury Law. 2014;7(2):153–64.CrossRef
Metadata
Title
Gender differences in response to war-related trauma and posttraumatic stress disorder – a study among the Congolese refugees in Uganda
Authors
Herbert E. Ainamani
Thomas Elbert
David Kani Olema
Tobias Hecker
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Rape
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-019-2420-0

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