Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.
Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq.
JAMA Netw Open. 2020 Sep 1;3(9):e2013418. doi: 10.1001/jamanetworkopen.2020.13418.
Yazidi women in northern Iraq have experienced severe human rights violations through attacks by the so-called Islamic State group, with severe consequences for their health. However, no studies to date have investigated how war-related and gender-based violence, including partner violence, are associated with mental health disorders in this population.
To evaluate the associations between Yazidi women's experiences of violence (ie, war violence, partner violence, enslavement) and their mental health.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of 326 women was conducted in camps for displaced persons in the Kurdistan region of Iraq between January and July 2017. Participants were married women from the Yazidi population in northern Iraq who were affected by Islamic State attacks. Participants were selected via household-randomized sampling. Data analysis was conducted from December 2018 to September 2019.
Experiences of enslavement, war-related events, and intimate partner violence were measured with event checklists.
Posttraumatic stress disorder (PTSD) and depression levels were measured using culturally validated instruments.
A total of 326 women (mean [SD] age, 34.3 [12.9] years) participated in the study. Almost all participants reported the experience of at least 1 war-related violent event (325 [99.7%]), 54 (16.6%) reported a history of abduction and sexual slavery, and 215 (66.0%) reported the experience of at least 1 type of intimate partner violence in the past year. There were no significant differences between women who did and did not experience abduction regarding exposure to intimate partner violence. Rates of PTSD and depression symptoms were high among the whole sample, and women who experienced abduction reported significantly higher levels of psychopathology than those who did not (mean [SD] PTSD score: 61.48 [12.38] vs 47.61 [14.42]; t324 = -6.91; P < .001; mean [SD] depression score: 3.07 [0.68] vs 2.43 [0.68]; t324 = -6.78; P < .001). Multivariate hierarchical regressions revealed that psychopathology was associated with exposure to war-related events (PTSD: β = 0.29; P < .001; depression: β = 0.27; P < .001) as well as with exposure to gender-based violence in Islamic State captivity (PTSD: β = 0.19; P = .001; depression: β = 0.28, P < .001) and in their marriage (PTSD: β = 0.13; P = .008; depression: β = 0.18; P < .001).
In this study, interviewed Yazidi women often experienced intimate partner violence as well as war-related and gender-based violence under Islamic State attacks and enslavement, experiences that were associated with mental health impairment. The findings underline the importance of also addressing gender-based violence within health care approaches for war-affected populations.
在伊拉克北部，雅兹迪妇女遭受了所谓的伊斯兰国组织的袭击，经历了严重的人权侵犯，这对她们的健康造成了严重后果。然而，迄今为止，尚无研究调查战争相关和基于性别的暴力（包括伴侣暴力）与该人群的心理健康障碍之间的关系。
评估雅兹迪妇女的暴力经历（即战争暴力、伴侣暴力、奴役）与她们的心理健康之间的关系。
设计、地点和参与者：这是一项在 2017 年 1 月至 7 月期间在伊拉克库尔德地区的流离失所者营地中对 326 名妇女进行的横断面研究。参与者是来自伊拉克北部雅兹迪人口中受伊斯兰国袭击影响的已婚妇女。参与者是通过家庭随机抽样选择的。数据分析于 2018 年 12 月至 2019 年 9 月进行。
通过事件清单测量奴役、与战争有关的事件和亲密伴侣暴力的经历。
使用文化验证工具测量创伤后应激障碍（PTSD）和抑郁水平。
共有 326 名女性（平均[标准差]年龄，34.3[12.9]岁）参加了这项研究。几乎所有参与者都报告了至少 1 次与战争有关的暴力事件（325[99.7%]），54 名（16.6%）报告了绑架和性奴役的历史，215 名（66.0%）报告了过去 1 年内至少 1 种亲密伴侣暴力的经历。在经历亲密伴侣暴力方面，有过或没有被绑架经历的女性之间没有显著差异。整个样本的 PTSD 和抑郁症状发生率较高，经历过绑架的女性报告的精神病理学水平明显高于未经历过绑架的女性（平均[标准差]PTSD 得分：61.48[12.38]与 47.61[14.42]；t324=−6.91；P<0.001；平均[标准差]抑郁得分：3.07[0.68]与 2.43[0.68]；t324=−6.78；P<0.001）。多变量层次回归显示，精神病理学与暴露于与战争有关的事件有关（PTSD：β=0.29；P<0.001；抑郁：β=0.27；P<0.001），以及与伊斯兰国囚禁期间的性别暴力（PTSD：β=0.19；P=0.001；抑郁：β=0.28，P<0.001）和婚姻中的性别暴力（PTSD：β=0.13；P=0.008；抑郁：β=0.18；P<0.001）有关。
在这项研究中，接受采访的雅兹迪妇女经常经历亲密伴侣暴力以及伊斯兰国袭击和奴役下的战争相关和基于性别的暴力，这些经历与心理健康受损有关。研究结果强调了在为受战争影响的人群提供医疗保健方法时，还必须解决性别暴力问题。
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