Psychopathological sequelae of female genital mutilation and their neuroendocrinological associations

Abstract

BackgroundAnecdotal evidence suggests the frequently traumatic nature of female genital mutilation (FGM). At present, systematic research on the psychological sequelae of this tradition has remained limited. The study provides preliminary, high-quality psychodiagnostic data on potential psychopathological consequences of FGM, with a focus on posttraumatic stress disorder (PTSD), shutdown dissociation and other stress-related variables.MethodsWe investigated a convenience sample of N = 167 women, supported by the women’s affairs headquarters in Jijiga (capital of the Ethiopian Somali Region) and a local Ethiopian non-governmental organization. Our main outcome measures were PTSD (PSS-I) and shutdown dissociation (ShuD). We also assessed depression and anxiety (HSCL-25), major depression, substance abuse and dependence, suicidality and psychotic disorders (M.I.N.I.; sub-scales A., B., K., and L.). In addition, we collected hair samples to assess hair cortisol concentrations (HCC) as a neuroendocrinological measure.ResultsThe majority of women endured FGM (FGM I: 36%, FGM II/III: 52%) and, regardless of the level of the physical invasiveness, almost all women reported having felt intense fear and/or helplessness. FGM II/III, the more invasive form, was associated with a greater vulnerability to PTSD symptoms (p < .001) and shutdown dissociation (p < .001). Symptoms of depression (p < .05) and anxiety (p < .01) were also elevated. Random forest regression with conditional inference trees revealed evidence of an alteration of the cortisol levels in relation to the age when FGM was experienced (< 1 year) and the invasiveness of the procedure.ConclusionMore extensive forms of FGM are associated with more severe psychopathological symptoms – particularly with an increased vulnerability to PTSD. Higher hair cortisol levels in women who experienced FGM before their first year of age or had more severe forms of FGM indicate long-term neuroendocrinological consequences of FGM and trauma in general on the stress system.

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.…”

“…Studies varied in quality but the majority received a rating of ‘fair’ quality. Only one study received a rating of ‘good’ quality,27 nine studies received a rating of ‘fair’ quality24–26 28 30 31 33 35 37 and six studies received a rating of ‘poor’ quality 7 29 32 34 36 38. Lack of sample size justification, limited assessment of confounding factors (lifetime traumatic events in particular) and lack of outcome stratification based on FGM/C type were the most common limitations.…”