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. 2008 Oct 14:2:11.
doi: 10.1186/1752-1505-2-11.

Conflict in the Indian Kashmir Valley II: psychosocial impact

Kaz de Jong  1 , Saskia van de Kam, Nathan Ford, Kamalini Lokuge, Silke Fromm, Renate van Galen, Brigg Reilley, Rolf Kleber
Affiliations

Conflict in the Indian Kashmir Valley II: psychosocial impact

Kaz de Jong et al. Confl Health. .

Abstract

Background: India and Pakistan have disputed ownership of the Kashmir Valley region for many years, resulting in high levels of exposure to violence among the civilian population of Kashmir (India). A survey was done as part of routine programme evaluation to assess confrontation with violence and its consequences on mental health, health service usage, and socio-economic functioning.

Methods: We undertook a two-stage cluster household survey in two districts of Kashmir (India) using questionnaires adapted from other conflict areas. Analysis was stratified for gender.

Results: Over one-third of respondents (n = 510) were found to have symptoms of psychological distress (33.3%, CI: 28.3-38.4); women scoring significantly higher (OR 2.5; CI: 1.7-3.6). A third of respondents had contemplated suicide (33.3%, CI: 28.3-38.4). Feelings of insecurity were associated with higher levels of psychological distress for both genders (males: OR 2.4, CI: 1.3-4.4; females: OR 1.9, CI: 1.1-3.3). Among males, violation of modesty, (OR 3.3, CI: 1.6-6.8), forced displacement, (OR 3.5, CI: 1.7-7.1), and physical disability resulting from violence (OR 2.7, CI: 1.2-5.9) were associated with greater levels of psychological distress; for women, risk factors for psychological distress included dependency on others for daily living (OR 2.4, CI: 1.3-4.8), the witnessing of killing (OR 1.9, CI: 1.1-3.4), and torture (OR 2.1, CI: 1.2-3.7). Self-rated poor health (male: OR 4.4, CI: 2.4-8.1; female: OR 3.4, CI: 2.0-5.8) and being unable to work (male: OR 6.7, CI: 3.5-13.0; female: OR 2.6, CI: 1.5-4.4) were associated with mental distress.

Conclusion: The ongoing conflict exacts a huge toll on the communities' mental well-being. We found high levels of psychological distress that impacts on daily life and places a burden on the health system. Ongoing feelings of personal vulnerability (not feeling safe) was associated with high levels of psychological distress. Community mental health programmes should be considered as a way reduce the pressure on the health system and improve socio-economic functioning of those suffering from mental health problems.

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References

    1. The Official Site of the Government of Jammu & Kashmir http://jammukashmir.nic.in
    1. de Jong K, Ford N, van de Kam S, Lokuge K, Fromm S, van Galen R, Reilley B, Kleber R. Conflict in the Indian Kashmir Valley I: Exposure to Violence. Confl Health. 2008;2:10. - PMC - PubMed
    1. de Jong J, Komproe IH, van Ommeren M, El Masri M, Araya M, Khaled N, Put W van der, Somasundram D. Lifetime events and posttraumatic stress disorder in 4 post conflicts settings. JAMA. 2001;86:555–562. doi: 10.1001/jama.286.5.555. - DOI - PubMed
    1. Kleber RJ, Brom D. Theory, prevention and treatment. Lisse: Swets & Zeitlinger; 1992. Coping with trauma.
    1. World Health Organization . World Health Organization, Division of Mental Health. Geneva: WHO/MNH/PSF/94.8, Division of Mental Health; 1994. User's Guide to the Self Reporting Questionnaire.

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