The mental health sequelae and treatment of massive community violence in West Africa

Abstract

Sierra Leone is one of several countries in sub-Saharan Africa in which great deposits of diamonds have been exploited to fund regional wars. These wars have resulted in 3.7 million deaths (Amnesty International, 2007a), and massive and systematic human rights atrocities in Sierra Leone and Liberia. Although many international agencies overcame innumerable challenges during this period to provide in-camp relief services for refugees, conventional wisdom in this field suggested that ongoing data collection could not be done in the politically unstable, critically underfunded, and frequently unsafe conditions of a refugee camp. This paper explores the mental health sequelae of the massive violence perpetrated against the people of Sierra Leone and Liberia, and the relations between post-trauma symptomology, daily functioning, social support, and counseling while following survivors living in United Nations' refugee camps, internally-displaced-persons camps, and back to their home communities in West Africa. A secondary, cross-sectional analysis of data initially collected from 2001 to 2006 for program evaluation and the clinical assessment of 4010 adult clients attending a counseling program showed that reported exposure to violence was related to psychosocial symptomology and problematic functioning; worse symptoms were related to worse functioning; refugees who reported exposure to torture had worse symptoms, but no difference in functioning than refugees who reported no torture; females had worse symptoms and worse functioning than males; younger age was related to greater exposure to violence and worse symptoms; greater substance use was related to greater exposure to violence, worse symptoms, and male sex; and access to informal social support was related to better symptoms and better functioning. From the original dataset of 4010 completed intake assessments, a subset of data from 1186 clients who had been successfully tracked for two subsequent assessments was examined. Substantial improvement in symptoms, functioning, and social connectedness was found one month into an 8-to-10-week counseling program and at three-months. Also of significance, this study demonstrates that data can be effectively collected over an extended period under difficult and dangerous conditions, and that ongoing program evaluation and clinical assessment can be reasonably included as a regular component of refugee relief field-programs.