Associations of Conflict-Related Trauma and Ongoing Stressors with the Mental Health and Functioning of West Papuan Refugees in Port Moresby, Papua New Guinea (PNG).
Documentation is limited in relation to the mental health of the people of West Papua, a territory that has been exposed to decades-long political persecution. We examined associations of traumatic events (TEs) and current stressors with mental disorder and functioning, amongst 230 West Papuan refugees residing in six settlements in Port Morseby, Papua New Guinea (PNG). We used culturally adapted modules to assess exposure to TEs and mental disorders. Current stressors and functioning were assessed using modifications of measures developed by the World Health Organization (WHO). 129 of 230 respondents (56%) reported exposure to at least one traumatic event (TE), including: political upheaval (36.5%), witnessing or hearing about family members tortured and murdered (33.9%), and not being able to access medical care for family members (33%). One fifth of respondents (47, 20.4%) experienced exposure to high levels of TEs (16 to 23). 211 (91.7%) endorsed at least one or more ongoing stressors, including: exposure to illicit substance use in the community (91.7%), problems with safety and the protection of women (89.6%), no access to legal rights and citizenship (88.3%), and lack of adequate shelter and facilities (85.2%). A quarter (26.9%) met criteria for one or more current mental disorder, and 69.1% reported functional impairment ranging from mild to extreme. Mental disorder was associated with being male (adjusted odds ratio=2.00; 95% CI=1.01-3.97), and exposure to the highest category of ongoing stressors (AOR=2.89; 95% CI=1.08-7.72). The TE count showed a dose-response pattern in its relationship with functional impairment, the greatest risk (AOR=11.47; 95% CI=2.11-62.37) being for those experiencing the highest level of TE exposure (16-23 events). West Papuans living in settlements in Port Moresby reported a range of TEs, ongoing stressors and associated mental disorders characteristic of populations exposed to mass conflict and persecution, prolonged displacement, and ongoing conditions of extreme hardship.
Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia; South Western Sydney Clinical School, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Alvin Kuowei
AK
Tay
Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia.
Susan
S
Rees
South Western Sydney Clinical School, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia; Simpson Centre for Health Services Research, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Jack
J
Chen
Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia.
Moses
M
Kareth
Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea.
Sylvester
S
Lahe
Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea.
Russell
R
Kitau
Port Moresby General Hospital and School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea.
Kura
K
David
Port Moresby General Hospital and School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea.
Joyce
J
Sonoling
Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia.
Derrick
D
Silove
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D001315:Australia; D003220:Conflict, Psychological; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010219:Papua New Guinea; D012036:Refugees; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013315:Stress, Psychological / Q000453:epidemiology