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

Abstract

Background

There 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.

Methods

A 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.

Results

Forty-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).

Conclusions

The 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

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  Exposure to armed conflict poses substantial risk for somatic distress.

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  Very little evidence on somatic distress among conflict-affected civilians.

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  Nearly half of women and a third of men in our study were recorded as at risk of somatic distress.

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  Somatic distress was associated with trauma exposure, mental disorders, and disability.

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  Such high levels of somatic distress have implications for health services in Georgia.