Conflict in the Indian Kashmir Valley II: psychosocial impact

Conflict and Health 2008, 2:11 (14 October 2008)

Authors: Kaz de Jong1, Saskia van de Kam1, Nathan Ford1,2 email, Kamalini Lokuge1, Silke Fromm1, Renate van Galen1, Brigg Reilley1 and Rolf Kleber3

1 Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, the Netherlands

2 Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada

3 Department of Clinical Psychology, Utrecht University, the Netherlands

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.

Conflict in the Indian Kashmir Valley II: psychosocial impact

Conflict and Health 2008, 2:11