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Mental Health, Social Functioning, and Disability in Postwar Afghanistan
Barbara Lopes Cardozo, MD, MPH;
Oleg O. Bilukha, MD, PhD;
Carol A. Gotway Crawford, PhD;
Irshad Shaikh, MD, PhD;
Mitchell I. Wolfe, MD, MPH;
Michael L. Gerber, MPH;
Mark Anderson, MD, MPH
JAMA. 2004;292:575-584.
Context More than 2 decades of conflict have led to widespread human suffering and population displacement in Afghanistan. In 2002, the Centers for Disease Control and Prevention and other collaborating partners performed a national population-based mental health survey in Afghanistan.
Objective To provide national estimates of mental health status of the disabled (any restriction or lack of ability to perform an activity in the manner considered normal for a human being) and nondisabled Afghan population aged at least 15 years.
Design, Setting, and Participants A national multistage, cluster, population-based mental health survey of 799 adult household members (699 nondisabled and 100 disabled respondents) aged 15 years or older conducted from July to September 2002. Fifty district-level clusters were selected based on probability proportional to size sampling. One village was randomly selected in each cluster and 15 households were randomly selected in each village, yielding 750 households.
Main Outcome Measures Demographics, social functioning as measured by selected questions from the Medical Outcomes Study 36-Item Short-Form Health Survey, depressive symptoms measured by the Hopkins Symptoms Checklist-25, trauma events and symptoms of posttraumatic stress disorder (PTSD) measured by the Harvard Trauma Questionnaire, and culture-specific symptoms of mental illness and coping mechanisms.
Results A total of 407 respondents (62.0%) reported experiencing at least 4 trauma events during the previous 10 years. The most common trauma events experienced by the respondents were lack of food and water (56.1%) for nondisabled persons and lack of shelter (69.7%) for disabled persons. The prevalence of respondents with symptoms of depression was 67.7% (95% confidence interval [CI], 54.6%-80.7%) and 71.7% (95% CI, 65.0%-78.4%), and symptoms of anxiety 72.2% (95% CI, 63.8%-80.7%) and 84.6% (95% CI, 74.1%-95.0%) for nondisabled and disabled respondents, respectively. The prevalence of symptoms of PTSD was similar for both groups (nondisabled, 42.1%; 95% CI, 34.2%-50.1%; and disabled, 42.2%; 95% CI, 29.2%-55.2%). Women had significantly poorer mental health status than men did. Respondents who were disabled had significantly lower social functioning and poorer mental health status than those who were nondisabled. Feelings of hatred were high (84% of nondisabled and 81% of disabled respondents). Coping mechanisms included religious and spiritual practices; focusing on basic needs, such as higher income, better housing, and more food; and seeking medical assistance.
Conclusions In this nationally representative survey of Afghans, prevalence rates of symptoms of depression, anxiety, and PTSD were high. These data underscore the need for donors and health care planners to address the current lack of mental health care resources, facilities, and trained mental health care professionals in Afghanistan.
Author Affiliations: International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health (Drs Lopes Cardozo, Bilukha, and Anderson, and Mr Gerber), Epidemic Intelligence Service, Epidemiology Program Office (Dr Bilukha), Division of Environmental Hazards and Health Effects, National Center for Environmental Health (Dr Gotway Crawford), Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention (Dr Wolfe), Centers for Disease Control and Prevention, Atlanta, Ga; Vietnam Veterans of America Foundation, Washington, DC (Dr Shaikh).
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