Skip to main content

Exploring Psychological Distress in Burundi During and After the Armed Conflict

Abstract

We assessed symptoms of psychological distress among a population-based sample of 9000-plus adults in Burundi during (1998) and after (2007) armed conflict. After exploratory and confirmatory factor analysis to an 8-item, self-report measure, we identified two domains of psychological distress “Depression/Anxiety” and “Functioning” with good fit to data. The questionnaire was invariant in males and females. Depression and Anxiety symptoms during conflict were more frequently reported than Functioning symptoms; all symptoms were more frequently reported by women. Psychological distress was found in 44 % of individuals during conflict and in 29 % 2 years after the conflict. Results call for further research in Burundi that can inform the development of mental health interventions.

This is a preview of subscription content, access via your institution.

References

  • Almedom, A. M., & Summerfield, D. (2004). Psychological well-being in settings of ‘complex emergency’: An overview. Journal of Biosocial Science, 36(4), 381–388.

    PubMed  Article  Google Scholar 

  • Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238.

    PubMed  Article  CAS  Google Scholar 

  • Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588.

    Article  Google Scholar 

  • Breslau, J. (2004). Introduction: Cultures of trauma: Anthropological views of posttraumatic stress disorder in international health. Culture, Medicine and Psychiatry, 28(2), 113–126.

    PubMed  Article  Google Scholar 

  • Bundervoet, T., Verwimp, P., & Akresh, R. (2008). Health and civil war in rural Burundi. Journal of Human Resources, 44(2), 536–563.

    Google Scholar 

  • Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.

    Article  Google Scholar 

  • Davis, J., Galyer, K., Halliday, T. J., Fitzgerald, J., & Ryan, J. M. (2008). Identifying psychological distress in New Zealand primary care: The General Health Questionnaire-12 (GHQ-12) as a screening instrument. Royal New Zealand College of General Practitioners, 35, 86–90.

    Google Scholar 

  • de Jong, J. T., Komproe, I. H., & Van Ommeren, M. (2003). Common psychological disorders in post-conflict settings. The Lancet, 361(9375), 2128–2130.

    Article  Google Scholar 

  • de Jong, J. T., Komproe, I. H., Van Ommeren, M., El Masri, M., Araya, M., Khaled, N., et al. (2001). Lifetime events and posttraumatic stress disorder in 4 post-conflict settings. The Journal of the American Medical Association, 286(5), 555–562.

    PubMed  Article  Google Scholar 

  • Dimitrov, D. M. (2010). Testing for factorial invariance in the context of construct validation. Measurement and Evaluation in Counseling and Development, 43(2), 121–149.

    Article  Google Scholar 

  • Eggerman, M., & Panter-Brick, C. (2010). Suffering, hope, and entrapment: Resilience and cultural values in Afghanistan. Social Science and Medicine, 71(1), 71–83.

    PubMed  PubMed Central  Article  Google Scholar 

  • Eytan, A., Gex-Fabry, M., Toscani, L., Deroo, L., Loutan, L., & Bovier, P. A. (2004). Determinants of post-conflict symptoms in Albanian Kosovars. Journal of Nervous and Mental Disorders, 192(10), 664–671.

    Article  Google Scholar 

  • Familiar, I., Sharma, S., Ndayisaba, H., Munyentwari, N., Sibomana, S., & Bass, J. (2013). Community perceptions of psychological distress in a post-conflict setting: A qualitative study in Burundi. Global Public Health, 8(8), 943–957.

    PubMed  Article  Google Scholar 

  • Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious psychological disorder in 7000 refugees resettled in Western countries: A systematic review. The Lancet, 365, 1309–1314.

    Article  Google Scholar 

  • Fernando, G. A., Miller, K. E., & Berger, D. E. (2010). Growing pains: The impact of disaster-related and daily stressors on the psychological and psychosocial functioning of youth in Sri Lanka. Child Development, 81(4), 1192–1210.

    PubMed  Article  Google Scholar 

  • Goldberg, D. P., Gater, R., Sartorius, N., Üstün, T. B., Piccinelli, M., Gureje, O., et al. (1997). The validity of two versions of the GHQ in the WHO study of psychological illness in general health care. Psychological Medicine, 27(01), 191–197.

    PubMed  Article  CAS  Google Scholar 

  • Gureje, O. (1991). Reliability and the factor structure of the Yoruba version of the 12-item general health questionnaire. Acta Psychiatrica Scandinavica, 84(2), 125–129.

    PubMed  Article  CAS  Google Scholar 

  • Ip, W. Y., & Martin, C. (2006). Factor structure of the Chinese version of the 12-item General Health Questionnaire in pregnancy. Psychology Health and Medicine, 11(1), 60–69.

    Article  Google Scholar 

  • Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36–47.

    PubMed  Article  Google Scholar 

  • Jones, L., Asare, J., Elmasri, M., & Mohanraj, A. (2007). Psychological health in disaster settings. British Medical Journal, 335, 679.

    PubMed  PubMed Central  Article  Google Scholar 

  • Kalliath, T. J., O’Driscoll, M. P., & Brough, P. (2004). A confirmatory factor analysis of the general health Questionnaire-12. Stress and Health, 20(1), 11–20. doi:10.1002/smi.993.

    Article  Google Scholar 

  • Kidwai, R. (2014). Demographic factors, social problems and material amenities as predictors of psychological distress: A cross-sectional study in Karachi, Pakistan. Social Psychiatry and Psychiatric Epidemiology, 49(1), 27–39.

    PubMed  Article  Google Scholar 

  • Lindert, J., Brahler, E., Wittig, U., Mielck, A., & Priebe, S. (2008). Depression, anxiety and posttraumatic stress disorders in labor migrants, asylum seekers and refugees. A systematic overview. Psychotherapie, Psychosomatik, Medizinische Psychologie, 58(3–4), 109–122.

    PubMed  Article  Google Scholar 

  • Lopes Cardozo, B., Vergara, A., Agani, F., & Gotway, C. A. (2000). Psychological health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo. The Journal of the American Medical Association, 284(5), 569–577.

    PubMed  Article  CAS  Google Scholar 

  • Marshall, G. N., Schell, T. L., Elliot, M. N., Berthold, S. M., & Chun, C. A. (2005). Psychological health of refugees 2 decades after resettlement in the United States. Journal of the American Medical Association, 294(5), 571–579.

    PubMed  Article  CAS  Google Scholar 

  • Mba, N., Famuyiwa, O. O., & Aina, O. F. (2008). Psychiatric morbidity in two urban communities in Nigeria. East African Medical Journal, 85(8), 368–377.

    PubMed  Article  CAS  Google Scholar 

  • Miller, K. E., Kulkarni, M., & Kushner, H. (2006). Beyond trauma-focused psychiatric epidemiology: Bridging research and practice with war affected populations. American Journal of Orthopsychiatry, 76(4), 409–422.

    PubMed  Article  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998–2011). Mplus user's guide (6th ed.). Los Angeles, CA: Muthén & Muthén.

  • Onyut, L. P., Neuner, F., Ertl, V., Schauer, E., Odenwald, M., & Elbert, T. (2009). Trauma, poverty and psychological health among Somali and Rwandese refugees living in an African refugee settlement—An epidemiological study. Conflict and Health, 26, 3–6. doi:10.1186/1752-1505-3-6.

    Google Scholar 

  • Patel, V. (2007). Psychological health in low- and middle-income countries. British Medical Bulleting, 81(82), 81–96.

    Article  Google Scholar 

  • Perla, A. L., & German, C. (2012). The association between armed conflict, violence and psychological health: A cross sectional study comparing two populations in Cundinamarca department, Colombia. Conflict and Health, 6(1), 12.

    Article  Google Scholar 

  • Peterman, A., Palermo, T., & Bredenkamp, C. (2011). Estimates and determinants of sexual violence against women in the Democratic Republic of Congo. American Journal of Public Health, 101(6), 1060–1067.

    PubMed  PubMed Central  Article  Google Scholar 

  • Politi, P. L., Piccinelli, M., & Wilkinson, G. (1994). Reliability, validity and factor structure of the 12-item general health questionnaire among young males in Italy. Acta Psychiatrica Scandinavica, 90(6), 432–437.

    PubMed  Article  CAS  Google Scholar 

  • Priebe, S., Matanov, A., Jankovic Gavrilovic, J., McCrone, P., Ljubotina, D., Knezevic´, G., et al. (2009). Consequences of untreated posttraumatic stress disorder following war in former Yugoslavia: Morbidity, subjective quality of life, and care costs. Croatian Medical Journal, 50, 465–475.

    PubMed  PubMed Central  Article  Google Scholar 

  • Rasmussen, A., Nguyen, L., Wilkinson, J., Vundla, S., Raghavan, S., Miller, K. E., et al. (2010). Rates and impact of trauma and current stressors among Darfuri refugees in eastern Chad. American Journal of Orthopsychiatry, 80(2), 227–236.

    PubMed  PubMed Central  Article  Google Scholar 

  • Roberts, B., & Browne, J. (2011). A systematic review of factors influencing the psychological health of conflict-affected populations in low- and middle-income countries. Global Public Health, 6(8), 814–829.

    PubMed  Article  Google Scholar 

  • Roberts, B., Ocaka, K. F., Browne, J., Oyok, T., & Sondorp, E. (2008). Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC Psychiatry, 8, 38.

    PubMed  PubMed Central  Article  Google Scholar 

  • Saab, B. R., Chaaya, M., Doumit, M., & Farhood, L. (2003). Predictors of psychological distress in Lebanese hostages of war. Social Science and Medicine, 57(7), 1249–1257.

    PubMed  Article  Google Scholar 

  • Satorra, A., & Bentler, P. M. (2001). A scaled difference Chi square test statistic for moment structure analysis. Psychometrika, 66(4), 507–514.

    Article  Google Scholar 

  • StataCorp. (2009). Stata statistical software: Release 11. College Station, TX: StataCorp LP.

    Google Scholar 

  • Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with psychological health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302(5), 537–549.

    PubMed  Article  CAS  Google Scholar 

  • Steiger, J. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25(2), 173–180.

    Article  Google Scholar 

  • Toyabe, S., Shioiri, T., Kobayashi, K., Kuwabara, H., Koizumi, M., Endo, T., et al. (2007). Factor structure of the general health questionnaire (GHQ-12) in subjects who had suffered from the 2004 Niigata–Chuetsu earthquake in Japan: A community-based study. BMC Public Health, 7(1), 175.

    PubMed  PubMed Central  Article  Google Scholar 

  • Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1–10.

    Article  Google Scholar 

  • Umubyeyi, A., Mogren, I., Ntanganira, J., & Krantz, G. (2014). Women are considerably more exposed to intimate partner violence than men in Rwanda: Results from a population-based, cross sectional study. BMC Women’s Health, 14, 99.

    PubMed  PubMed Central  Article  Google Scholar 

  • Uvin, P. (2009). Life after violence: A people’s story of Burundi. London: Zed Books.

    Google Scholar 

  • Ventevogel, P., Jordans, M., Reis, R., & de Jong, J. (2013). Madness or sadness? Local concepts of psychological illness in four conflict-affected African communities. Conflict and Health, 7, 3.

    PubMed  PubMed Central  Article  Google Scholar 

  • Werneke, U., Goldberg, D. P., Yalcin, I., & Ustun, B. (2000). The stability of the factor structure of the general health questionnaire. Psychological Medicine, 30(04), 823–829.

    PubMed  Article  CAS  Google Scholar 

  • Yeomans, P. D., Forman, E. M., Herbert, J. D., & Yuen, E. (2010). A randomized trial of a reconciliation workshop with and without PTSD psycho-education in Burundian sample. Journal of Traumatic Stress, 23(3), 305–312.

    PubMed  Google Scholar 

  • Yeomans, P. D., Herbert, J. D., & Forman, E. M. (2008). Symptom comparison across multiple solicitation methods among Burundians with traumatic event histories. Journal of Traumatic Stress, 21(2), 231–234.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

Data collection was financed by the MICROCON project under the European Union 6th Framework and was implemented in cooperation with the National Institute of Statistics and Economics in Burundi (ISTEEBU).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Itziar Familiar.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights statement

This article does not contain any studies with animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Familiar, I., Hall, B., Bundervoet, T. et al. Exploring Psychological Distress in Burundi During and After the Armed Conflict. Community Ment Health J 52, 32–38 (2016). https://doi.org/10.1007/s10597-015-9902-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-015-9902-4

Keywords

  • Depression
  • Anxiety
  • Functioning
  • Factor analysis
  • Armed conflict
  • Burundi