Mental health and psychosocial support for the war-wounded: A retrospective cohort study from the Democratic Republic of Congo, Mali and Nigeria

Abstract

Background For more than 150 years, war surgery has been at the heart of the humanitarian assistance offered by the International Committee of the Red Cross (ICRC) in conflict zones around the world. Mental health and psychosocial support (MHPSS) is increasingly recognized as an integral part of the medical care offered to this highly vulnerable group of patients. This study seeks to identify patient characteristics associated with high distress prior to MHPSS and predictors of improvement following it. Methods Between October 2018 and April 2020, 2,008 weapon-wounded patients received MHPSS in ICRC-supported hospitals in the Democratic Republic of Congo (DRC), Mali and Nigeria. The 21-item Depression and Anxiety Scale (DASS21), the Impact of Events Scale Revised (IES-R) and the ICRC functionality scale for Africa were administered before and after the MHPSS response. Logistic regression models were used to measure associations between outcome and exposure variables. Data was initially collected for monitoring purposes and analyzed retrospectively for the sake of this study. Results The main reasons for surgery were firearms (65%), other weapons (13%) and mines (5%). Linear trends were found between increasing number of days between violence and first consultation and decreased likelihood of presenting high levels of anxiety (aOR 0.75, p = 0.014), and stress (aOR 0.78, p = 0.032). Violence committed by military/armed group was associated with increased likelihood of reporting high levels of anxiety (aOR 2.47, p = 0.047). On the IES-R, high scores at baseline were more likely to be found among illiterate patients (aOR 0.08, p = 0.042) and having been wounded by firearms considerably increased the likelihood of reporting high levels of PTSD (aOR 21.34, p = 0.035). Following MHPSS, 92.28% of the patients showed a reduction in symptoms on the DASS21, 93.00% showed a reduction in symptoms on the IES-R and 83.04% showed an improvement on the ICRC Africa functioning scale. On the DASS21, factors negatively associated with improved anxiety included lack of social support (aOR 0.17, p = 0.047) and suffering from a chronic medical/physical condition (aOR 0.40, p = 0.013). Patients with reduced IES-R scores were more likely to have a high level of education (aOR 8.95, p = 0.029) and to have received MHPSS that lasted between 22 and 30 days (aOR 8.73, p = 0.008). Predictors of improved functioning included being 35–44 years of age (aOR 3.74, p = 0.004) and suffering from a severe or chronic medical condition (aOR 1.66, p = 0.044). Conclusions Clinical implications of this study include the increased involvement of family and other caregivers in the MHPSS and longer-term follow-up of patients with severe and/or chronic medical conditions. Further research is needed with regard to joint psychological and physical outcomes, the role of the patient’s education level and the personal styles and techniques used by the counsellors.

Psychometric Validation of the Domestic Violence Questionnaire in Swahili Among Congolese Female Survivors of Domestic Violence

“…Regarding concurrent validity, this study presents new results about the relationship between domestic violence as assessed by DVQ and different variables of interest. A direct positive relationship was validated between depression symptoms and DVQ scores, congruent with prior findings, thus providing support for the internal validity of the DVQ (Andersen et al, 2022;Calvete et al, 2007;Sharma et al, 2021). Second, mental wellbeing presented significant negative correlations with DVQ scores (Mootz et al, 2020).…”

Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo

“…To address the mental health treatment gap in LMICs, then, there is a need to develop psychosocial interventions that are culturally appropriate and embedded in local knowledge, values and practices 56 . Although most medical and psychological interventions have been developed and evaluated in high-income countries, this review found positive effects for psycho-social interventions such as group therapy, music therapy, family support, and socio-economic projects 18 , 36 , 37 . This matches previous research in humanitarian settings, which supports the efficacy of psychosocial interventions for adults with common mental disorders 57 , and therapy for reducing suicidal ideation 58 .…”

“…Thirty-one studies (64%) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence 6 . Among the remaining 19 studies, two were cross-national looking at the association between key factors 18 , 19 , four looked at the service provision at the national level 20 – 22 , eleven were conducted in the capital city Kinshasa, one was conducted in Vanga health zone in Central-West region, and one study was conducted in Equateur in the North-West region, and one study conducted in the southeast. All studies were published between 2005 and 2022.…”

“… Andersen, I. 2022 18 DRC, Mali, Nigeria 2008 war-wounded DRC: 791 Mali: 538 Nigeria: 679 To identify patient characteristics associated with high distress prior to & after pre- and post-intervention. Mental health and psychosocial support (MHPSS) Logistic regression model, Cross-sectional The 21-item Depression and Anxiety Scale (DASS21), the Impact of Events Scale Revised (IES-R) and the ICRC functionality scale before and after MHPSS intervention.…”

“…For example, after 6-month follow-ups, group psychotherapy reduced PTSD symptoms and combined depression and anxiety symptoms among Congolese women survivors of sexual violence 36 . A cross-national study conducted in DRC, Mali and Nigeria found that the involvement of family and other caregivers in psychosocial support reduced the symptoms of depression and anxiety among war-wounded men 18 . Similar positive findings were found in another cross-national study, where brief trauma-focused therapy and Medicine Sans Frontier (MSF) mental health therapeutic intervention were used among young people.…”