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Exposure to War Crimes and Implications for Peace Building in Northern Uganda
Patrick Vinck, PhD;
Phuong N. Pham, MPH, PhD;
Eric Stover, BA;
Harvey M. Weinstein, MD, MPH
JAMA. 2007;298:543-554.
Context Since the late 1980s, the Lord's Resistance Army has waged war against the Ugandan People's Democratic Army and the people of northern Uganda. Ending the conflict and achieving peace have proven to be challenges. In this context, it is important to examine population-based data on exposure to war crimes to understand how survivors perceive mechanisms aimed at achieving a lasting peace.
Objectives To assess the level of exposure to war-related violence and the prevalence of posttraumatic stress disorder (PTSD) and depression symptoms in northern Uganda and to determine how these variables are associated with respondents' views about peace.
Design, Setting, and Participants Multistage, stratified, random cluster survey of 2585 adults aged 18 years or older conducted in villages and camps for internally displaced persons in 4 districts of northern Uganda in April and May 2005.
Main Outcome Measures Rates and patterns of exposure to trauma; symptom criteria for PTSD, assessed via the PTSD Checklist–Civilian Version with a total severity score of 44; symptoms of depression, assessed via the Johns Hopkins Depression Symptom Checklist with a cutoff of 42; and opinions and attitudes about peace.
Results Among the respondents, 1774 of 2389 (74.3%) met PTSD symptom criteria and 1151 of 2585 (44.5%) met depression symptom criteria. Four patterns of exposure to trauma were distinguished: those with low exposure (group 1; 21.4%), witnesses to war-related violence (group 2; 17.8%), those threatened with death and/or physically injured (group 3; 16.4%), and those abducted (group 4; 44.3%). Respondents in groups 3 and 4, who experienced the most traumatic exposures, were more likely to have PTSD symptoms compared with group 1 (group 3 vs group 1: odds ratio [OR], 7.04 [95% confidence interval {CI}, 5.02-9.87]; group 4 vs group 1: OR, 6.07 [95% CI, 4.77-7.71]). Groups 3 and 4 were also more likely to meet depression symptom criteria (group 3 vs group 1: OR, 5.76 [95% CI, 4.34-7.65]; group 4 vs group 1: OR, 4.00 [95% CI, 3.16-5.06]). Respondents who met the PTSD symptom criteria were more likely to identify violence as a means to achieve peace (OR, 1.31; 95% CI, 1.05-1.65). Respondents who met the depression symptom criteria were less likely to identify nonviolence as a means to achieve peace (OR, 0.77; 95% CI, 0.65-0.93).
Conclusions Our study found high prevalence rates for symptoms of PTSD and depression in a conflict zone. Respondents reporting symptoms of PTSD and depression were more likely to favor violent over nonviolent means to end the conflict.
Author Affiliations: Payson Center for International Development, Tulane University, New Orleans, Louisiana (Drs Vinck and Pham); and Human Rights Center (Mr Stover and Dr Weinstein), School of Public Health (Mr Stover and Dr Weinstein), and Boalt Hall School of Law (Mr Stover), University of California, Berkeley. Dr Vinck is now with the Human Rights Center, University of California, Berkeley.
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