A study shown in the August 3 theme issue on violence and humanrights of JAMA reported that residents of Sri Lanka who were seeking refuge inneighboring countries or secure areas of their own country duringthe Sri Lankan civil war (1983 to 2009) have a higher occurrence ofwar-related mental health conditions including depression , anxiety and PTSD. Almost 2.7 million people worldwide live as refugees in foreigncountries or safe areas in their home country (internaldisplacement). The 26-year Sri Lankan war claimed 100,000 lives anddisplaced 800,000 people. The Jaffna District of Sri Lanka,situated in the far north of the country estimates that 23% of thepopulation had been internally displaced by July 2009. |
Even thoughoverall patterns of psychiatric morbidity among individualsaffected by conflict have been documented, the psychological effectof forced displacement of people remaining within their nationalborders is lesser-known. Farah Husain, D.M.D., M.P.H., of the Centers for Disease Controland Prevention, Atlanta, and team carried out a health survey amongresidents of Jaffna District to evaluate the connection betweendisplacement status and occurrence of common war-related mentalhealth conditions. The survey included 1,517 Jaffna households, including 2 internallydisplacement camps and was conducted between July and September2009, with a response rate of 92% (1,448 respondents of which 1,409were eligible). The time period of the individual displacements was broken downinto 2% of participants (n = 80) who were currently displaced,29.5% (n = 539) who were recently resettled, and 68.5% (n = 790)who were long-term residents.
31.8% of individuals (376)experienced no trauma events; 44% (578) reported experiencing 1 to4 events; 20.2% (336) experienced 5 to 9 events and 4% (72)experienced 10 or more events. The overall occurrence of PTSD was7.0%, with 32.6% suffering from anxiety and 22.2% experiencingdepression symptoms. Once the researchers adjusted for variables, they discovered thatthe likelihood for developing symptoms of depression, anxiety, andPTSD was substantially higher among displaced camp-basedindividuals compared with long-term residents and that chance ofdeveloping PTSD symptoms among recently resettled individuals washigher than that of long-term residents. Whilst female respondents were more likely to report symptoms ofanxiety and depression, those of older age were associated withPTSD, anxiety, and depression symptoms. In addition, the authorsdiscovered that displacement was no longer associated with mentalhealth symptoms after controlling for trauma exposure.
The investigators wrote: "Although the association between displacement status and symptomsof PTSD, depression, and anxiety was no longer significant afteradjusting for trauma exposure in this study, the act of beingdisplaced and the daily stressors associated with it may beconsidered traumatic in themselves and may be an indicator or proxyfor recent trauma as well. Therefore, the relationship betweendisplacement status and mental health symptoms may be driven by theunderlying trauma events displaced persons have experienced, eventsthat likely caused them to leave their homes." Research suggests that interventions in Sri Lanka should target themost vulnerable populations, mainly those living in displacementcamps. The authors wrote: "Internally displaced persons outnumber refugees globally andinitiatives addressing mental health needs, such as those developedby the Inter-Agency Standing Committee, should be considered. InJaffna District, interventions should include support from family,friends, religious leaders, and traditional counselors.
Finally, a longitudinal study of displaced populations would helpdetermine how the intensity of events, the time since events, andother factors, such as coping skills, affect mental healthsymptoms. In this way, stakeholders could begin to understand theshort- and long-term mental health implications of armed conflictand traumatic events associated with displacement." Written by Petra Rattue Copyright: Medical News Today Not to be reproduced without permission of Medical News Today Additional References Citations.
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