More than three-quarters of adults in the Central African Republic report witnessing or personally experiencing traumatic events during the most recent wave of violence, and more than half meet criteria for depression or anxiety, according to a report in the August 4 issue of JAMA, a theme issue on violence and human rights.
"For decades, the Central African Republic has experienced violence, economic stagnation and institutional failure," the authors write as background information in the article. "The latest wave of violence erupted in 2001 and continues to this day in some areas. Yet there has been little attention to the conflict and even less research to document and quantify the conflict's human cost."
To study levels of violence in the country, Patrick Vinck, Ph.D., and Phuong N. Pham, M.P.H., Ph.D., of the University of California, Berkeley, and Tulane University, New Orleans, conducted a survey of 1,879 adults (average age 36.4) from October to December 2009 in five administrative units of the Central African Republic. This included three units in the south, which has been free from recent violence, and two in the north, in which violence continues. Participants were asked about deaths in their households, exposure to traumatic events, sense of insecurity and physical and mental health status.
"High percentages of respondents reported witnessing or having personally experienced potential traumatic events over the course of the conflicts," the authors write. A total of 80.8 percent reported being displaced, 76.4 percent reported witnessing violence, 67.3 percent had been threatened with death, 60.7 percent had property stolen or destroyed, 10.8 percent reported abduction and 3.6 percent experienced sexual violence. In addition, more than one in four respondents reported a bad or very bad level of security walking in their village at night (29 percent), meeting strangers (27.4 percent) or traveling to the nearest town or village (25.7 percent).
The death rate was five per 1,000 individuals per month, with violence accounting for 0.8 deaths per 1,000 per month. A total of 35 percent of the participants reported their physical health as good or very good, whereas 29 percent described it as bad or very bad. Depression was identified among 55.3 percent of participants, and anxiety among 52.5 percent. Exposure to violence and self-reported physical health status was associated with these mental health conditions.
"Mortality rates, lower levels of physical health and access to health services and symptom scores for anxiety were higher among study respondents in the two northern prefectures experiencing ongoing violence compared with those in the south," the authors write. "Mortality rates in all the areas in the study were three to five times higher than that for sub-Saharan Africa and were higher than rates in some comparable conflict and post-conflict areas."
The findings could be used to advocate aid program and security sector reforms to protect civilians, the authors note. "The associations of violence with physical and mental health need to be further explored to develop a better framework in which to offer health care services in conflict and post-conflict situations," they write. "Unaddressed, these issues could further undermine Central African Republic's development and slow its progress toward social reconstruction."
(JAMA. 2010;304[5]:544-522. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: The work was supported by grants from the John D. and Catherine T. MacArthur Foundation, Chicago, and Humanity United, Redwood City, Calif. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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