This paper evaluates rates of PTSD and depression symptoms among female refugees from Democratic Republic of Congo (DRC) living in Kampala, Uganda, and how mental health issues are associated with traumatic experiences, including rape. There were an estimated 48,000 Congolese living in Kampala when the research was undertaken in 2013.
Study participants were recruited using respondent-driven sampling (RDS), a peer-to-peer recruitment approach used to sample hard-to-reach populations where no sampling frame is available. 580 women were recruited who met the following eligibility criteria: Congolese nationals, 18 years or older; had been self-settled in Kampala for at least 6 months; and were documented asylum-seekers or refugees. Mental health outcomes were assessed using questionnaires previously administered in refugee settings.
Findings:
- Women were on average 33.7 years of age, 42 percent had completed between 8 and 12 years of schooling, and the majority (66 percent) were from the North Kivu province in DRC. 78 percent had been living in Uganda less than 6 years and 23 percent had been in a refugee camp before settling in Kampala. Most of the women reported being married (42 percent), unemployed (43 percent), and living with family (79 percent).
- Most of the women met symptom criteria for PTSD, depression and suicidal ideation. 73 percent met symptom criteria for PTSD, 57 percent for depression, and 65 percent reported thoughts of ending their life.
- A very high proportion of women had been raped, and more than half of the women had been raped on multiple occasions. 80 percent of women reported having been raped and over half (55 percent) reported more than one rape incident. Of those raped, most women reported being gang raped (82 percent), with 39 percent of gang-rape victims reporting more than four perpetrators. 50 percent identified the police or government soldiers as perpetrators. Although rape may have been a driver of displacement (60 percent reported being raped before displacement), more than one third (35 percent) of women reported being raped in transit, and 20 percent in the host country. Consequences of rape included genital injuries (87 percent), fistula (18 percent), and pregnancies (26 percent). 47 percent of women reported the rape incident to authorities, and 57 percent received some type of health care.
- The women frequently experienced additional traumatic experiences. Non-sexual traumatic incidents included experiencing a combat situation (93 percent), lack of food or water (88 percent), destruction of property (84 percent), physical abuse (84 percent), forced separation from family (84 percent), lack of shelter (83 percent), lack of access to health care (79 percent), extortion or robbery (78 percent), and witnessing beatings or torture (74 percent).
- Rates of PTSD were associated with experiences of rape and other traumatic events. PTSD was associated with being raped, being raped after displacement, lacking shelter, lacking food or water, lacking access to health care, forced labor, extortion and/or robbery, experiencing the disappearance/kidnapping of a family member or friend, and witnessing the killing or murder of other people. The number of traumatic experiences reported had a dose-response relationship with PTSD; women reporting at least 11 different incidents and above 15 had higher odds of PTSD than those reporting 10 or fewer.
- Rates of depression were associated with experiences of rape and other traumatic events. Depression was significantly associated with several traumatic experiences including rape and experiencing the disappearance/kidnapping of a child or spouse.
These findings highlight the high frequency of sexual and other forms of violence experienced by female refugees before, during and after flight, and the high rates of adverse mental health outcomes that are associated with these traumatic experiences. The fact that 20 percent of respondents reported being raped in the country of asylum and that higher rates of PTSD were associated with being raped post-displacements points to serious gaps in the protection afforded to self-settled refugees. The authors conclude that future programs addressing the needs of self-settled refugees should include services responding to high rates of rape and associated PTSD, as well as ongoing vulnerability to rape in the country of asylum.