Prevalence of Mental Health Conditions in Post-conflict Kasai Province, Democratic Republic of the Congo: A Repeated, Cross-sectional Study

Overview

Journal PLOS Glob Public Health

Date 2025 Jan 9

PMID 39787207

Authors

Maaike L Seekles

Jacob K Kadima

Pierre O L Omumbu

Junior K Kukola

Joy J Kim

Christian B Bulambo

Raphael M Mulamba

Motto Nganda

Laura Dean

Affiliations

Soon will be listed here.

Abstract

Globally, one in five people in post-conflict areas are estimated to be living with a mental health condition. As a key public health issue, these conditions negatively affect individuals, communities, and societies to function after a conflict. Documenting the prevalence of mental health conditions amongst these populations is crucial to prioritise and guide future mental health interventions. This study was the first to use a repeated cross-sectional design and sex-disaggregated analysis, with the aim of estimating the prevalence of depression (PHQ-9) and anxiety (GAD-7) in a post-conflict population of the Kasai Province, Democratic Republic of the Congo. Several domains of Quality of life (WHO-QoL-BREF) were also assessed to gain insight into the relationship between bio-psychosocial stressors and mental health status. Using random cluster sampling, data were collected in two waves from 385 participants, with a one-year interval. The pooled prevalence across both waves was 34.3% for major depression disorder and 26.5% for generalised anxiety disorder. Multivariable linear regression analysis showed that depression and anxiety were both predicted by being female, being of older age, and by experiencing lower physical quality of life, but not by the passing of time. For both mental health outcomes, environmental quality of life served as a significant predictor for women, but not for men. In conclusion, these results suggest that a lack of mental health services and continued exposure to daily stressors are linked to a sustained high prevalence of mental health conditions in our study population. There is a significant need for the development of mental health services in the region. These services should go beyond biomedical interventions and include multi-sectoral approaches that consider the social determinants of (mental) health.

References

Pham P, Weinstein H, Longman T . Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation. JAMA. 2004; 292(5):602-12. DOI: 10.1001/jama.292.5.602. View

Ngamaba K, Lombo L, Makopa I, Webber M, Liuta J, Madinga J . Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo. Npj Ment Health Res. 2024; 3(1):9. PMC: 10956021. DOI: 10.1038/s44184-023-00051-w. View

Johnson K, Scott J, Rughita B, Kisielewski M, Asher J, Ong R . Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. JAMA. 2010; 304(5):553-62. DOI: 10.1001/jama.2010.1086. View

. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022; 9(2):137-150. PMC: 8776563. DOI: 10.1016/S2215-0366(21)00395-3. View

Tol W, Patel V, Tomlinson M, Baingana F, Galappatti A, Silove D . Relevance or excellence? Setting research priorities for mental health and psychosocial support in humanitarian settings. Harv Rev Psychiatry. 2012; 20(1):25-36. PMC: 3335084. DOI: 10.3109/10673229.2012.649113. View

Kinyanda E, Weiss H, Mungherera M, Onyango-Mangen P, Ngabirano E, Kajungu R . Psychiatric disorders and psychosocial correlates of high HIV risk sexual behaviour in war-affected Eastern Uganda. AIDS Care. 2012; 24(11):1323-32. PMC: 4991752. DOI: 10.1080/09540121.2011.647676. View

Mugisha J, Muyinda H, Malamba S, Kinyanda E . Major depressive disorder seven years after the conflict in northern Uganda: burden, risk factors and impact on outcomes (The Wayo-Nero Study). BMC Psychiatry. 2015; 15:48. PMC: 4376071. DOI: 10.1186/s12888-015-0423-z. View

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

Schaal S, Weierstall R, Dusingizemungu J, Elbert T . Mental health 15 years after the killings in Rwanda: imprisoned perpetrators of the genocide against the Tutsi versus a community sample of survivors. J Trauma Stress. 2012; 25(4):446-53. DOI: 10.1002/jts.21728. View

10.

Marshall C . The inter-agency standing committee (IASC) guidelines on mental health and psychosocial support (MHPSS) in emergency settings: a critique. Int Rev Psychiatry. 2022; 34(6):604-612. DOI: 10.1080/09540261.2022.2147420. View

11.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

12.

Kinyanda E, Woodburn P, Tugumisirize J, Kagugube J, Ndyanabangi S, Patel V . Poverty, life events and the risk for depression in Uganda. Soc Psychiatry Psychiatr Epidemiol. 2009; 46(1):35-44. PMC: 3432478. DOI: 10.1007/s00127-009-0164-8. View

13.

Miller K, Rasmussen A . War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med. 2009; 70(1):7-16. DOI: 10.1016/j.socscimed.2009.09.029. View

14.

Ostergaard M, Aponte-Canencio D, Barajas Ortiz Y, Velez Botero H, Simon Modvig J, Brasholt M . Vulnerability factors in conflict-related mental health. Med Confl Surviv. 2023; 39(1):63-80. DOI: 10.1080/13623699.2022.2156232. View

15.

Roberts B, Damundu E, Lomoro O, Sondorp E . Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan. BMC Psychiatry. 2009; 9:7. PMC: 2656503. DOI: 10.1186/1471-244X-9-7. View

16.

Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S . New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019; 394(10194):240-248. PMC: 6657025. DOI: 10.1016/S0140-6736(19)30934-1. View