title: Violence against Congolese refugee women in Rwanda and mental health: a cross-sectional study using latent class analysis.
abstract: OBJECTIVE
  To examine patterns of conflict-related violence and intimate partner violence (IPV) and their associations with emotional distress among Congolese refugee women living in Rwanda.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Two Congolese refugee camps in Rwanda.
  
  
  METHODS
  548 ever-married Congolese refugee women of reproductive age (15-49 years) residing in Rwanda.
  
  
  METHODS
  Our primary outcome was emotional distress as measured using the Self-Report Questionnaire-20 (SRQ-20). For analysis, we considered participants with scores greater than 10 to be experiencing emotional distress and participants with scores of 10 or less not to be experiencing emotional distress.
  
  
  RESULTS
  Almost half of women (49%) reported experiencing physical, emotional or sexual violence during the conflict, and less than 10% of women reported experiencing of any type of violence after fleeing the conflict. Lifetime IPV was reported by approximately 22% of women. Latent class analysis derived four distinct classes of violence experiences, including the Low All Violence class, the High Violence During Conflict class, the High IPV class and the High Violence During and After Conflict class. In multivariate regression models, latent class was strongly associated with emotional distress. Compared with women in the Low All Violence class, women in the High Violence During and After Conflict class and women in the High Violence During Conflict had 2.7 times (95% CI 1.11 to 6.74) and 2.3 times (95% CI 1.30 to 4.07) the odds of experiencing emotional distress in the past 4 weeks, respectively. Furthermore, women in the High IPV class had a 4.7 times (95% CI 2.53 to 8.59) greater odds of experiencing emotional distress compared with women in the Low All Violence class.
  
  
  CONCLUSIONS
  Experiences of IPV do not consistently correlate with experiences of conflict-related violence, and women who experience high levels of IPV may have the greatest likelihood for poor mental health in conflict-affected settings.
authors.affiliation: Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Sipsma
authors.affiliation: Department of Chronic Disease Epidemiology and Division of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Falb
authors.affiliation: Department of Chronic Disease Epidemiology and Division of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut, USA Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA.
authors.forename: Tiara
authors.initials: T
authors.lastname: Willie
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.affiliation: American Refugee Committee, Minneapolis, Minnesota, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bienkowski
authors.affiliation: American Refugee Committee, Minneapolis, Minnesota, USA.
authors.forename: Ned
authors.initials: N
authors.lastname: Meerdink
authors.affiliation: Department of Chronic Disease Epidemiology and Division of Social and Behavioural Sciences, Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Jhumka
authors.initials: J
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012036:Refugees; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology / Q000208:ethnology; D012742:Sex Offenses / Q000706:statistics & numerical data; D013179:Spouse Abuse / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: EPIDEMIOLOGY; MENTAL HEALTH; PUBLIC HEALTH; STATISTICS & RESEARCH METHODS