Patterns of somatic distress among conflict-affected persons in the Republic of Georgia

Ruben Moreno Comellas,Nino Makhashvili,Ivdity Chikovani,Vikram Patel,Martin Mckee,Jonathan Bisson,Bayard Roberts

doi:10.1016/j.jpsychores.2015.01.015

Abstract

BackgroundThere are substantial risk factors for somatic distress (SD) among civilian populations affected by armed conflict in low and middle income countries. However, the evidence is very limited. Our aim was to examine patterns of SD among conflict-affected persons in the Republic of Georgia, which has over 200,000 internally displaced persons (IDPs) from the wars over separatists regions in the 1990s and with Russia in 2008. MethodsA cross-sectional household survey was conducted with 3600 randomly selected IDPs and former IDPs (returnees). SD was measured using the Patient Health Questionnaire (PHQ-15). Post-traumatic stress disorder (PTSD), depression, anxiety, and disability were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and WHO Disability Assessment Schedule 2.0, respectively. Descriptive, tetrachoric and multivariate regression analyses were used. ResultsForty-two percent of respondents (29% men; 48% women) were recorded as at risk of SD (PHQ-15 score >5). In tetrachoric analysis, SD scores were highly correlated with depression (r=0.60; p<0.001), PTSD (r=0.54; p<0.001), and anxiety (r=0.49; p<0.001). Factors significantly associated with SD in the multivariate regression analysis were depression, PTSD, anxiety, individual trauma event exposure, cumulative trauma exposure, female gender, older age, bad household economic status, and being a returnee compared to an IDP. SD was also associated with increased levels of functional disability (b=6.73; p<0.001). ConclusionsThe high levels of SD among IDPs and returnees in Georgia indicate significant suffering. The findings have implications for both mental and physical health services in Georgia.

Highlights

There are substantial risk factors for somatic distress (SD) among civilian populations affected by armed conflict in low and middle income countries
A total sample size of 3,600 was determined to provide adequate statistical power for the overall study and consisted of 1,200 respondents from each of the three main conflict-affected populations groups in Georgia: those displaced from the conflicts in the 1990s (“1990s internally displaced persons (IDPs)”), those displaced from the 2008 conflict (“2008 IDPs”), and former IDPs from the 2008 conflict who have returned to their home areas (“returnees”)
Three hundred and sixty primary sampling units (PSUs) (120 PSUs for each of the three study population groups of 1990 IDPs, 2008 IDPs, and returnees) were selected based on probability proportion to size, using a sampling frame from data provided by the Ministry of Internally Displaced Persons and the Governor's office of the Shida Kartli region

Summary

Introduction

There are substantial risk factors for somatic distress (SD) among civilian populations affected by armed conflict in low and middle income countries. Factors significantly associated with SD in the multivariate regression analysis were depression, PTSD, anxiety, individual trauma event exposure, cumulative trauma exposure, female gender, older age, bad household economic status, and being a returnee compared to an IDP. Almost 50 million people have been forcibly displaced from their home areas by armed conflict globally, the vast majority of whom live in low- and middle-income countries. These comprise over 33 million internally displaced persons (IDPs) who remain within the borders of their countries and over 16 million refugees and stateless persons who are living in other countries [26,47]. Less attention appears to have been paid to somatic distress (SD)

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