title: The mediating role of stigmatization in the mental health of adolescent victims of sexual violence in Eastern Congo.
abstract: This study aims to explore the factors that explain the mental sequelae of war-related sexual violence and focuses in particular on the role of stigmatization. Drawing on a large-scale quantitative survey undertaken in the war-affected region of eastern Democratic Republic of the Congo, we analyze how stigmatization mediates the mental health impact of sexual violence on adolescent girls who were victims of rape. Twenty-two secondary schools were randomly selected out of a stratified sample in Bunia, Eastern Congo. In a cross-sectional, population-based survey, 1,305 school-going adolescent girls aged 11-23 completed self-report measures assessing war-related traumatic events, experiences of sexual violence, stigmatization, and mental health symptoms. Of the 1,305 participants, 38.2% (n=499) reported experiences of sexual violence. Victims of sexual violence reported more war-related traumatic events and more stigmatization experiences. Several hierarchical regression analyses examined the mediating impact of stigmatization on the relationship between sexual violence and mental health outcomes, thereby controlling for sociodemographics (age, parental availability, and socioeconomic status) and war-related traumatic exposure. Our findings show that this stigmatization largely explains the mental health impact of sexual violence, in particular, on adolescent girls' reported symptoms of depression (full mediation) and posttraumatic stress (avoidance and total PTSD: full mediation; hyperarousal: partial (40%) mediation). No evidence of mediation by stigmatization was found for symptoms of anxiety and intrusion. Stigmatization plays thus an important role in shaping the mental sequelae of sexual violence, a finding with major consequences for clinical practice.
authors.affiliation: Department of Social Welfare Studies, Centre for Children in Vulnerable Situations, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Verelst
authors.affiliation: Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: De Schryver
authors.affiliation: Department of Education, Culture and Society, Centre for Children in Vulnerable Situations, KU Leuven, Andreas Vesaliusstraat 2 - Box 3761, 3000 Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: De Haene
authors.affiliation: Department of Orthopedagogics, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Broekaert
authors.affiliation: Department of Social Welfare Studies, Centre for Children in Vulnerable Situations, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Derluyn
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D011902:Rape / Q000523:psychology* / Q000706:statistics & numerical data; D057566:Self Report; D013240:Stereotyping; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D014857:Warfare; D055815:Young Adult
keywords: Eastern Democratic Republic of the Congo; Post-conflict; Sexual violence; Stigma