Mental disorders in postconflict communities

June 19, 2003

People who experience violence associated with armed conflict have a range of mental disorders, suggest researchers from the Netherlands in this week's issue of THE LANCET.

Postconflict psychiatric research in low-income countries has so far been focused on symptoms rather than on full psychiatric diagnostic assessment. Thus, few data are available for the prevalence of common mental disorders.

Dr Ivan Komproe and colleagues from Amsterdam, Netherlands, did population-based epidemiological surveys to examine the frequency of common mental disorders and analyse the effect of violence associated with armed conflict on prevalence and comorbidity rates. Using broad psychiatric diagnostic assessment, the researchers assessed more than 3000 people from postconflict communities in Algeria, Cambodia, Ethiopia, and Palestine.

Post-traumatic stress disorder and anxiety disorder were the two most frequently reported problems in all groups. In those exposed to violence, except for Cambodia, post-traumatic stress disorder was most common. However, in those not exposed to violence associated with armed conflict, apart from in Ethiopia, anxiety disorder was most frequently reported. Overall, Ethiopia had the lowest reported rates of mental disorders, and Algeria had the highest. Violent experience was associated with disorder in all groups. In comorbidity analyses (occurrence of more than one disorder less than a year apart), post-traumatic stress disorder with mood disorder and anxiety disorder was the combination seen most often.

Dr Komproe comments: "Our results show that common mental disorders are frequent in areas where most of the world's survivors of armed conflict live. Exposure to violence associated with armed conflict was a potent risk factor for various disorders and comorbidity in all groups. In postconflict settings, post-traumatic stress disorder is not only associated with experience of conflict violence, but also with a range of other stressors (eg, quality of camps, daily difficulties). Therefore, mental health programmes with a narrow focus on violence associated with armed conflict or post-traumatic stress disorder are probably not covering the full range of determinants and burden of common mental disorders in postconflict settings"
Contact: Dr Ivan H Komproe, Transcultural Psychosocial Organisation (TPO), WHO Collaborating Centre for Refugees and Ethnic Minorities, Keizersgracht 329, 1016 EE Amsterdam, Netherlands; T) 31-20-620-0005; F) 31-20-422-35-34; E)


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