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Liberian fighters exposed to sexual violence have more mental health disorders after war

August 13, 2008

Men and women who experienced sexual violence while fighting in Liberian civil wars report higher rates of symptoms of depression, post-traumatic stress disorder (PTSD), and thoughts of suicide than non-combatants or other former combatants who were not exposed to sexual violence, according to a study in the August 13 issue of JAMA, a theme issue on violence and human rights.

"Liberia's wars since 1989 have cost tens of thousands of lives and left many people mentally and physically traumatized," the authors write. "This conflict has been characterized by ethnic killings and massive abuses against the civilian population between 1989 and 1997, and again in 2003 and 2004."

Kirsten Johnson, M.D., M.P.H., of the Harvard Humanitarian Initiative, Harvard University, Cambridge, Mass., and colleagues conducted a study to assess the prevalence and impact of war-related psychosocial trauma, including information on participation in the Liberian civil wars, exposure to sexual violence, social functioning, and mental health. The researchers surveyed 1,666 adults aged 18 or older using structured interviews and questionnaires. The survey was conducted in Liberia during a three-week period in May 2008.

In the Liberian adult household-based population, 40 percent met symptom criteria for major depressive disorder, 44 percent met symptom criteria for PTSD and 8 percent met criteria for social dysfunction. Thirty-three percent of the respondents reported serving time with fighting forces, and 33.2 percent of the former combatant respondents were women.

"Both female and male former combatants who experienced sexual violence had worse mental health outcomes than non-combatants and other former combatants who did not experience exposure to sexual violence," the authors report.

Among women, 42.3 percent of former combatants experienced exposure to sexual violence, compared with 9.2 percent of non-combatants. Among men, 32.6 percent of former combatants experienced exposure to sexual violence, compared with 7.4 percent of non-combatants. Symptoms of depression, PTSD and thoughts of suicide were higher among former combatants than non-combatants, and higher among those who experienced sexual violence than those who did not.

Seventy-four percent of female former combatants who experienced sexual violence had symptoms of PTSD, compared with 44 percent who did not experience sexual violence. Among male former combatants, 81 percent who experienced sexual violence had symptoms of PTSD, compared with 46 percent who did not experience sexual violence. Male former combatants who experienced sexual violence also reported higher rates of depression symptoms and thoughts of suicide.

"Like their female counterparts, male former combatants who experienced sexual violence have worse mental health outcomes than both the general population and also other former combatants," the authors write. "Rehabilitation programs that do not address this specific population risk failing a critically vulnerable group."

"This unexpected finding suggests that standard post-conflict rehabilitation programs and gender-based programs will need to adjust current programming to take into account males who have experienced sexual violence, especially former combatants," they conclude.

JAMA and Archives Journals