According to an article published in the August 13 issue of JAMA, Liberian fighters who experienced sexual violence during civil wars were more likely to report higher rates of depression symptoms, post-traumatic stress disorder (PTSD), and suicidal thoughts compared with men and women non-combatants or former combatants who did not experience sexual violence.
Kirsten Johnson, M.D., M.P.H. (Harvard Humanitarian Initiative, Harvard University, Cambridge, Mass.) and colleagues write that, “Liberia’s wars since 1989 have cost tens of thousands of lives and left many people mentally and physically traumatized. This conflict has been characterized by ethnic killings and massive abuses against the civilian population between 1989 and 1997, and again in 2003 and 2004.”
To assess the magnitude and impact of war-related psychosocial trauma, the researchers studied participants in the Liberian civil wars. Johnson and colleagues used structured interviews and questionnaires to survey 1,666 adults (age 18 or older) on matters concerning exposure to sexual violence, social functioning, and mental health. Participants took the surveys in Liberia during a three-week period in May 2008.
Before looking specifically at those exposed to sexual violence, the researchers report some baseline statistics for Liberian adults gathered from their sample:
- 40% have major depressive disorder
- 44% have PTSD
- 8% met criteria for social dysfunction
- 33% served time with fighting forces
- 33.2% of former combatant respondents were women
“Both female and male former combatants who experienced sexual violence had worse mental health outcomes than non-combatants and other former combatants who did not experience exposure to sexual violence,” write the authors.
About 9.2% and 7.4% of non-combatant women and men, respectively, experienced exposure to sexual violence compared with 42.3% and 32.6% of former women and men combatants. Both former combatants and those who experienced sexual violence had higher rates of symptoms of depression, PTSD, and suicidal thoughts compared to non-combatants or those who had not experienced sexual violence.
Among females, 74% of former combatants who experienced sexual violence had PTSD symptoms compared to 44% of those who were not exposed to sexual violence. Among males, 81% of former combatants who experienced sexual violence had PTSD symptoms compared to 46% of those who did not experience sexual violence. In addition, male former combatants who were exposed to sexual violence reported higher rates of depression symptoms and thoughts of suicide.
“Like their female counterparts, male former combatants who experienced sexual violence have worse mental health outcomes than both the general population and also other former combatants,” write Johnson and colleagues. “Rehabilitation programs that do not address this specific population risk failing a critically vulnerable group.”
The researchers conclude: “This unexpected finding suggests that standard post-conflict rehabilitation programs and gender-based programs will need to adjust current programming to take into account males who have experienced sexual violence, especially former combatants.”
Association of Combatant Status and Sexual Violence With Health and Mental Health Outcomes in Postconflict Liberia
Kirsten Johnson, MD, MPH; Jana Asher, MSc; Stephanie Rosborough, MD, MPH; Amisha Raja, MA, PsyD; Rajesh Panjabi, MD, MPH; Charles Beadling, MD; Lynn Lawry, MD, MSPH, MSc
JAMA(2008). 300[6]: pp. 676-690.
Written by: Peter M Crosta