Depression, Anxiety, Post-traumatic Stress Disorder and a History of Pervasive Gender-Based Violence Among Women Asylum Seekers Who Have Undergone Female Genital Mutilation/Cutting: A Retrospective Case Review

Abstract

We sought to evaluate the frequency of anxiety, depression, PTSD, and any experiences of violence in women who had undergone Female Genital Mutilation/Cutting (FGM/C) and were seeking asylum in the United States. We undertook a retrospective qualitative descriptive study of FGM/C cases seen in an asylum clinic over a 2-year period. Standardized questionnaires provided quantitative scores for anxiety, depression and PTSD. Clients' personal and physician medical affidavits were analyzed for experiences of violence. Of the 13 cases, anxiety and depression were exhibited by 92 and 100% of women, while all seven women screened for PTSD had symptoms. Qualitative analysis revealed extensive violence perpetrated against these women, demonstrating that FGM/C is only part of the trauma experienced. The high level of mental health disorders and endured violence has implications for providers working with FGM/C survivors and indicates the need for accessible mental health services and trauma-informed care.

Is female genital mutilation/cutting associated with adverse mental health consequences? A systematic review of the evidence

“…Of the 16 studies we included, six focused solely on the adverse mental outcomes of FGM/C 7 24–28. The other 10 studies examined a variety of FGM/C-related health measures, including adverse mental health outcomes 29–38…”

“…While a number of studies restricted their populations to a specific ethnic group or age category, others included a wide range of demographic characteristics. Ten studies were conducted at the participants’ country of origin: Egypt, Ethiopia, Iran, Iraq, Israel, Kuwait and Senegal7 24–27 30–32 34 35 and six studies targeted migrant women in Greece, the Netherlands, Spain and the USA 28 29 33 36–38. Seven studies examined potential adverse mental health outcomes spanning adolescence and adulthood,7 27 30–32 34 38 six studies restricted their populations to adults,25 28 29 33 36 37 two studies to adolescents24 26 and one study35 did not list participants’ age range.…”

“…All studies were cross-sectional in nature and did not follow participants over time. Eleven studies used comparison groups of women who did not undergo FGM/C7 24–27 29–32 34 35 while five studies reported results only from women who underwent FGM/C 28 33 36–38…”

“…Studies used a variety of instruments for psychological assessment. Four studies used the Hopkins symptoms check list 25 (SCL 25) to assess the burden of depression and anxiety 27 28 33 37. Three studies used the SCL 90 to assess the burden of somatisation, depression, anxiety, hostility and phobia 24 25 32.…”

Asylum Seekers: Our Patients at the Border

“…3 Our gynecologists have dedicated countless hours to women, especially from West Africa, who have survived female genital mutilation/cutting and who hope to protect their daughters from the same permanent trauma. 4 These are the individuals the US government cannot find the moral authority to welcome. While the courts will not ultimately deem every asylum claim legitimate, our program's experience in documenting physical and psychological evidence of human rights abuses suggests that far too many are grounded in horrific truth.…”