title: Respondent-driven sampling to assess mental health outcomes, stigma and acceptance among women raising children born from sexual violence-related pregnancies in eastern Democratic Republic of Congo.
abstract: OBJECTIVE
  Assess mental health outcomes among women raising children from sexual violence-related pregnancies (SVRPs) in eastern Democratic Republic of Congo and stigma toward and acceptance of women and their children.
  
  
  METHODS
  Participants were recruited using respondent-driven sampling.
  
  
  METHODS
  Bukavu, Democratic Republic of Congo in 2012.
  
  
  METHODS
  757 adult women raising children from SVRPs were interviewed. A woman aged 18 and older was eligible for the study if she self-identified as a sexual violence survivor since the start of the conflict (∼1996), conceived an SVRP, delivered a liveborn child and was currently raising the child. A woman was ineligible for the study if the SVRP ended with a spontaneous abortion or fetal demise or the child was not currently living or in the care of the biological mother.
  
  
  METHODS
  Trained female Congolese interviewers verbally administered a quantitative survey after obtaining verbal informed consent.
  
  
  METHODS
  Symptom criteria for major depressive disorder, post-traumatic stress disorder, anxiety and suicidality were assessed, as well as stigma toward the woman and her child. Acceptance of the woman and child from the spouse, family and community were analysed.
  
  
  RESULTS
  48.6% met symptom criteria for major depressive disorder, 57.9% for post-traumatic stress disorder, 43.3% for anxiety and 34.2% reported suicidality. Women who reported stigma from the community (38.4%) or who reported stigma toward the child from the spouse (42.9%), family (31.8%) or community (38.1%) were significantly more likely to meet symptom criteria for most mental health disorders. Although not statistically significant, participants who reported acceptance and acceptance of their children from the spouse, family and community were less likely to meet symptom criteria.
  
  
  CONCLUSIONS
  Women raising children from SVRPs experience symptoms of mental health disorders. Programming addressing stigma and acceptance following sexual violence may improve mental health outcomes in this population.
authors: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors: Jennifer
authors: J
authors: Scott
authors: Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Shada
authors: S
authors: Rouhani
authors: Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Ashley
authors: A
authors: Greiner
authors: Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Katherine
authors: K
authors: Albutt
authors: Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hansehospital Stralsund, Stralsund, Germany.
authors: Philipp
authors: P
authors: Kuwert
authors: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors: Michele R
authors: MR
authors: Hacker
authors: Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard School of Public Health, Boston, Massachusetts, USA.
authors: Michael
authors: M
authors: VanRooyen
authors: Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard School of Public Health, Boston, Massachusetts, USA.
authors: Susan
authors: S
authors: Bartels
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D016022:Case-Control Studies; D015023:Democratic Republic of the Congo; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D012929:Psychological Distance; D011902:Rape / Q000523:psychology*; D012742:Sex Offenses / Q000523:psychology; D057545:Social Stigma; D018454:Spouses; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D059020:Suicidal Ideation; D014857:Warfare; D055815:Young Adult
keywords: MENTAL HEALTH; OBSTETRICS; PUBLIC HEALTH