title: Patterns of somatic distress among conflict-affected persons in the Republic of Georgia.
abstract: BACKGROUND
  There are substantial risk factors for somatic distress (SD) among civilian populations affected by armed conflict in low and middle income countries. However, the evidence is very limited. Our aim was to examine patterns of SD among conflict-affected persons in the Republic of Georgia, which has over 200,000 internally displaced persons (IDPs) from the wars over separatists regions in the 1990s and with Russia in 2008.
  
  
  METHODS
  A cross-sectional household survey was conducted with 3600 randomly selected IDPs and former IDPs (returnees). SD was measured using the Patient Health Questionnaire (PHQ-15). Post-traumatic stress disorder (PTSD), depression, anxiety, and disability were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and WHO Disability Assessment Schedule 2.0, respectively. Descriptive, tetrachoric and multivariate regression analyses were used.
  
  
  RESULTS
  Forty-two percent of respondents (29% men; 48% women) were recorded as at risk of SD (PHQ-15 score >5). In tetrachoric analysis, SD scores were highly correlated with depression (r = 0.60; p < 0.001), PTSD (r = 0.54; p < 0.001), and anxiety (r = 0.49; p < 0.001). Factors significantly associated with SD in the multivariate regression analysis were depression, PTSD, anxiety, individual trauma event exposure, cumulative trauma exposure, female gender, older age, bad household economic status, and being a returnee compared to an IDP. SD was also associated with increased levels of functional disability (b = 6.73; p < 0.001).
  
  
  CONCLUSIONS
  The high levels of SD among IDPs and returnees in Georgia indicate significant suffering. The findings have implications for both mental and physical health services in Georgia.
authors: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Ruben Moreno
authors: RM
authors: Comellas
authors: Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia; Ilia State University, Tbilisi, Georgia.
authors: Nino
authors: N
authors: Makhashvili
authors: Curatio International Foundations, Tbilisi, Georgia.
authors: Ivdity
authors: I
authors: Chikovani
authors: Cardiff University School of Medicine and Cardiff and Vale University Health Board, Cardiff, United Kingdom.
authors: Vikram
authors: V
authors: Patel
authors: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Martin
authors: M
authors: McKee
authors: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Jonathan
authors: J
authors: Bisson
authors: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: Bayard.roberts@lshtm.ac.uk.
authors: Bayard
authors: B
authors: Roberts
mesh_terms: D000367:Age Factors; D001007:Anxiety / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D007182:Income; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D013001:Somatoform Disorders / Q000453:epidemiology* / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014857:Warfare
keywords: Armed conflict; Forced displacement; Georgia; Internally displaced; Mental; Somatic distress; War