Researchers Examine PTSD and Depression in African Refugees

Epidemiological studies have shown a higher than normal prevalence of depression and post traumatic stress disorder (PTSD) in refugee populations. In Africa, where about 20 percent of the world's displaced people have found refuge in neighboring nations, the pressing need for mental health outreach has become apparent. A team of researchers publishing in the journal Conflict and Health studied rates of trauma exposure and prevalence of PTSD and depression in a population of Rwandan and Somali refugees.

The study took place in 2003 at the Nakivale Refugee Settlement, in southwestern Uganda, one of Uganda's eight "official" refugee camps. At that time 14,400 refugees were living at Nakivale, 12,000 who had fled the Rwandan massacres of the early nineties and over 500 refugees from Somalia's 1991-1992 civil war. Safety is never a certainty inside the camps. In general, residents of the camps are impoverished, undernourished, and in poor health. Camps do provide educational opportunities for school-aged children, along with opportunities to supplement income through farming on government lands. Basic health care is also available; however, refugees have little or no access to mental health services.

All Somalis over the age of 12 agreed to be interviewed, while a sample number of Rwandese households, proportionate to the total, were chosen at random. The authors questioned respondents on their displacement history, educational and socio-economic background, nutritional intake, and health status. They were also asked about exposure to traumatic events, and mental disorders that correlate with such exposures, with a particular focus on PTSD and depression.

The final analysis included data from 1422 interviews. Typically, Somali refugees had spent more time in the camp. They were also younger and had larger households than the Rwandese. Somalis reported more traumatic events in their lives than the Rwandese, and PTSD prevalence was more prominent in Somali men and women than in Rwandese men and women. Rwandese women reported the lowest number of lifetime traumatic events, and the lowest incidence of PTSD, but Somali women reported as many traumatic events as Somali men. Rwandese men reported more traumatic events, and demonstrated a higher prevalence of PTSD than Rwandese women, while PTSD prevalence was equal in Somali men and women.

Overall, women demonstrated more symptoms of anxiety than men. Rwandese men and women were more likely to be drinkers of the local crude alcoholic brew than Somali men and women. Somali men and women scored higher than Rwandese men and women on all indicators of poor mental health.

The majority of respondents had experienced multiple traumatic events, with a mean number of 9.98, and a mean of 0.29 for the year prior to the interview. Many had witnessed mutilated or dead bodies, bombings, sniper attacks or crossfire, burning homes, beatings or torture, combat, murder, and harassment. A small number of respondents had been victims of sex crimes, but a larger number had witnessed a sex crime against someone else. Somali women reported the most sexual violence.

In their efforts to address the problem of PTSD and depression in the refugee population, the research group developed a mental health intervention program for the purpose of training local interviewers and therapists. Findings from this study are consistent with studies of other refugee populations, and demonstrate the prevalence and persistence of PTSD and depression in the refugee populations of poor African countries. Mental illness can affect a person's ability to recover from trauma and return to some type of normalcy in life. Therefore, the authors of the study argue that access to mental health services be added to the list of urgent priorities when considering the needs of refugee populations.

Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study