Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions

Conflict and Health

Claudia García Moreno²  Mark van Ommeren⁵  Christina Mergenthaler¹  M Claire Greene¹  Vivi Stavrou³  Wietse A Tol⁴ 

[1] Global Health Initiative, Yale University, New Haven, CT, USA;Department of Reproductive Health & Research, World Health Organization, Geneva, Switzerland;Columbia Group for Children in Adversity, Columbia University, New York, NY, USA;Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House Room 863, Baltimore, MD 21205-1996, USA;Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

关键词: Efficacy;    Effectiveness;    Treatment evaluation;    Prevention;    Psychosocial interventions;    Mental health;    Gender-based violence;    Sexual violence;    Armed conflict;   

Others  :  804545
DOI  :  10.1186/1752-1505-7-16

 received in 2013-02-08, accepted in 2013-07-24,  发布年份 2013

【 摘 要 】

Background

Sexual and other forms of gender-based violence are common in conflict settings and are known risk factors for mental health and psychosocial wellbeing. We present findings from a systematic review of the academic and grey literature focused on the effectiveness of mental health and psychosocial support interventions for populations exposed to sexual and other forms of gender-based violence in the context of armed conflicts.

Methods

We searched the Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PubMed/ Medline, psycINFO, and PILOTS, as well as grey literature to search for evaluations of interventions, without date limitations.

Results

Out of 5,684 returned records 189 full text papers were assessed for eligibility. Seven studies met inclusion criteria: 1 non-randomized controlled study; 3 non-controlled pre- post-test designs; 1 retrospective cohort with a matched comparison group; and 2 case studies. Studies were conducted in West and Central Africa; Albania; UK and USA, included female participants, and focused on individual and group counseling; combined psychological, medical, social and economic interventions; and cognitive behavioral therapy (two single case studies).

Conclusions

The seven studies, while very limited, tentatively suggest beneficial effects of mental health and psychosocial interventions for this population, and show feasibility of evaluation and implementation of such interventions in real-life settings through partnerships with humanitarian organizations. Robust conclusions on the effectiveness of particular approaches are not possible on the basis of current evidence. More rigorous research is urgently needed.

【 授权许可】

   
2013 Tol et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Themner L, Wallensteen P: Armed conflicts, 1946–2010. J Peace Res 2011, 48(4):525-536.
• [2]Wood EJ: Sexual violence during war: explaining variation. In Order, Conflict and Violence Conference. New Haven, CT: Yale University; 2004.
• [3]Jewkes R, Sen P, Garcia-Moreno C: Chapter 6. Sexual Violence. In World Report on Violence and Health. Edited by Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Geneva, Switzerland: WHO; 2002.
• [4]Marsh M, Purdin S, Navani S: Addressing sexual violence in humanitarian emergencies. Glob Public Health 2006, 1(2):133-146.
• [5]Palermo T, Peterman A: Undercounting, overcounting and the longevity of flawed estimates: statistics on sexual violence in conflict. Bull World Health Organ 2011, 89:924-925.
• [6]Ward J, Marsh M: Sexual Violence Against Women and Girls in War and Its Aftermath: Realities, Responses, and Required Resources. Belgium: United Nations Population Fund (UNFPA); 2006.
• [7]Inter-Agency Standing Committee [IASC]: Guidelines for Gender-Based Violence Interventions in Humanitarian Settings: Focusing on Prevention of and Response to Sexual Violence in Emergencies (Field Test Version). Geneva: Inter-Agency Standing Committee; 2005.
• [8]Stark L, Ager A: A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma Violence Abuse 2011, 12(3):127-134.
• [9]Josse E: ‘They came with two guns’: the consequences of sexual violence for the mental health of women in armed conflicts. International Review of the Red Cross 2010, 92(877):177-195.
• [10]Kelly JT, Betancourt TS, Mukwege D, Lipton R, VanRooyen MJ: Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study. Confl Heal 2011, 5:25. BioMed Central Full Text
• [11]Kinyanda E, Musisi S, Biryabarema C, Ezati I, Oboke H, Ojiambo-Ochieng R, Were-Oguttu J, Levin J, Grosskurth H, Walugembe J: War related sexual violence and it’s medical and psychological consequences as seen in Kitgum, Northern Uganda: a cross-sectional study. BMC International Health and Human Rights 2010, 10:28. BioMed Central Full Text
• [12]Johnson K, Asher J, Rosborough S, Raja A, Panjabi R, Beadling C, Lawry L: Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. JAMA 2008, 300(6):676-690.
• [13]Inter-Agency Standing Committee [IASC]: IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: IASC; 2007.
• [14]Tol WA, Barbui C, Galappatti A, Silove D, Betancourt TS, Souza R, Golaz A, van Ommeren M: Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet 2011, 378(9802):1581-1591.
• [15]Gleditsch NP, Wallensteen P, Eriksson M, Sollenberg M, Strand H: Armed conflict 1946–2001: a new dataset. J Peace Res 2002, 39(5):615-637.
• [16]Eriksson M, Wallensteen P, Sollenberg M: Armed conflict, 1989–2002. J Peace Res 2003, 40(5):593-607.
• [17]Eriksson M, Wallensteen P: Armed conflict, 1989–2003. J Peace Res 2004, 41(5):625-636.
• [18]Harbom L, Wallensteen P: Armed conflict and its international dimensions, 1946–2004. J Peace Res 2005, 42(5):625-635.
• [19]Harbom L, Högbladh S, Wallensteen P: Armed conflicts and peace agreement. J Peace Res 2006, 43(5):617-631.
• [20]Harbom L, Wallensteen P: Armed conflict, 1989–2006. J Peace Res 2007, 44:623-634.
• [21]Harbom L, Melander E, Wallensteen P: Dyadic dimensions of armed conflict, 1946 2007. J Peace Res 2008, 45:697-710.
• [22]Harbom L, Wallensteen P: Armed conflicts, 1946 2008. J Peace Res 2009, 46:577-586.
• [23]Harbom L, Wallensteen P: Armed conflicts, 1946–2009. J Peace Res 2010, 47(4):501-509.
• [24]Heidelberg Institute for International Conflict Research: Conflict Barometer 2006. Heidelberg, Germany: HIIK; 2006.
• [25]Heidelberg Institute for International Conflict Research: Conflict Barometer 2007. Heidelberg, Germany: HIIK; 2007.
• [26]Heidelberg Institute for International Conflict Research: Conflict Barometer 2008. Heidelberg, Germany: HIIK; 2008.
• [27]Heidelberg Institute for International Conflict Research: Conflict Barometer 2009. Heidelberg, Germany: HIIK; 2009.
• [28]Ramsay J, Carter Y, Davidson L, Dunne D, Eldridge S, Hegarty K, Rivas C, Taft A, Warburton A, Feder G: Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse. Cochrane Datanase of Systematic Reviews 2009., 8(3) CD005043
• [29]McDevitt-Murphy ME, Casey LB, Cogdal P: Helping individuals health from rape connected to conflict and/or war. In Trauma Rehabilitation After War and Conflict: Community and Individual Perspectives. Edited by Martz E. New York: Springer; 2010.
• [30]Jina R, Jewkes R, Munjana SP, Mariscal JD, Dartnall D, Gebrehiwot Y, FIGO Working Group: Report of the FIGO Working Group on Sexual Violence/HIV: guidelines for the management of female survivors of sexual assault. Int J Gynaecol Obstet 2010, 109(2):85-92.
• [31]Dehaybi S: Brief Systematic Review on the Prevalence, Factors, and Psychosocial Therapies Surrounding Global Sexual Violence. Geneva: World Health Organization; 2011.
• [32]Yohani S, Hagen KT: Refugee women survivors of war related sexualised violence: a multicultural framework for service provision in resettlement countries. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict 2010, 8(3):207-222.
• [33]Howard LM, Trevillion K, Khalifeh H, Woodall A, Agnew-Davies R, Feder G: Domestic violence and severe psychiatric disorders: prevalence and interventions. Psychol Med 2010, 40:881-893.
• [34]Ager A, Ager W, Stavrou V, Boothby N: Inter-Agency Guide to the Evaluation of Psychosocial Programming in Emergencies. New York: UNICEF; 2011.
• [35]Downs SH, Black N: The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998, 52:377-384.
• [36]Lekskes J, van Hooren S, de Beus J: Appraisal of psychosocial interventions in Liberia. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict 2007, 5(1):18-26.
• [37]Bolton P: Assessing the Impact of the IRC Program for Survivors of Gender Based Violence in Eastern Democratic Republic of Congo - Final Report. Washington, DC: USAID; International Rescue Committee; Johns Hopkins Bloomberg School of Public Health; 2009.
• [38]Hustache S, Moro MR, Roptin J, Souza R, Gansou GM, Mbemba A, Roederer T, Grais RF, Gaboulaud V, Baubet T: Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo. Int J Ment Heal Syst 2009, 3(1):7. BioMed Central Full Text
• [39]Plester G: Evaluation of a group counselling for traumatised women in Albani. Medica Mondiale; 2007. http://www.medicamondiale.org/fileadmin/content/07_Infothek/Trauma/Evaluation_group_counselling_Albania_english_summary.pdf webcite
• [40]Ager A, Stark L, Olsen J, Wessells M, Boothby N: Sealing the past, facing the future: an evaluation of a program to support the reintegration of girls and young women formerly associated with armed groups and forces in Sierra Leone. Girlhood Studies 2010, 3(1):70-93.
• [41]Vickers B: Cognitive model of the maintenance of and treatment of post-traumatic stress disorder applied to children and adolescents. Clin Child Psychol Psychiatry 2005, 10(2):217-234.
• [42]Schulz PM, Marovic-Johnson D, Huber CL: Cognitive-behavioral treatment of rape- and war-related posttraumatic stress disorder with a female, Bosnian refugee. Clinical Case Studies 2006, 5:191-208.
• [43]Bland JM, Altman DG: Some examples of regression towards the mean. Br Med J 1994, 309(6957):780-780.
• [44]Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, Wachter K, Murray LK, Bolton PA: Controlled trial of psychotherapy for Congolese survivors of sexual violence. New Engl J Med 2013, 368(23):2182-2191.