title: Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania.
abstract: BACKGROUND
  Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation.
  
  
  OBJECTIVE
  This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula.
  
  
  METHODS
  Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons.
  
  
  RESULTS
  Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, post-traumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support.
  
  
  CONCLUSIONS
  Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions.
authors: Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC, 27708, USA. sarah.wilson@duke.edu.|Duke Global Health Institute, Durham, NC, USA. sarah.wilson@duke.edu.
authors: Sarah M
authors: SM
authors: Wilson
authors: Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC, 27708, USA.|Duke Global Health Institute, Durham, NC, USA.
authors: Kathleen J
authors: KJ
authors: Sikkema
authors: Duke Global Health Institute, Durham, NC, USA.
authors: Melissa H
authors: MH
authors: Watt
authors: Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors: Gileard G
authors: GG
authors: Masenga
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005402:Fistula / Q000523:psychology*; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D010045:Outpatients; D011247:Pregnancy; D011594:Psychometrics; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013636:Tanzania; D055815:Young Adult
keywords: Depression; Global mental health; Obstetric fistula; PTSD; Vesicovaginal fistula (VVF); Women’s health