Intermittent explosive disorder amongst women in conflict affected Timor-Leste: associations with human rights trauma, ongoing violence, poverty, and injustice.
BACKGROUND
Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development.


METHODS
A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice.


RESULTS
Women with Intermittent Explosive Disorder (n = 184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X(2) (2) = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08-2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48-3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09-3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27-2.77); extreme poverty (OR 1.23, 95%, CI 1.08-1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35-3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger.


CONCLUSIONS
Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development.
Psychiatry Research and Teaching Unit, University of New South Wales, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia. s.j.rees@unsw.edu.au
Susan
S
Rees
Derrick
D
Silove
Teresa
T
Verdial
Natalino
N
Tam
Elisa
E
Savio
Zulmira
Z
Fonseca
Rosamund
R
Thorpe
Belinda
B
Liddell
Anthony
A
Zwi
Kuowei
K
Tay
Robert
R
Brooks
Zachary
Z
Steel
D000328:Adult; D003220:Conflict, Psychological; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data*; D045809:Human Rights Abuses / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D012935:Social Justice / Q000523:psychology / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D049648:Timor-Leste / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data; D016387:Women's Health / Q000706:statistics & numerical data*; D055815:Young Adult