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Article PubMed Google Scholar The researcher had access to a large network of professional psychosocial services, which was used for referral of study participants.
Questionnaires were self-administered while thoroughly guided and structured by the research assistants. To promote inter-researcher reliability, extensive theoretical and practical training was provided to all research assistants 90 h. The researcher provided her contact details to participants, and also information on local psychological support projects for those in need of further professional care.
The researcher had access to a large network of professional psychosocial services, which was used for referral of study participants. Six self-report questionnaires, all adapted for use in eastern Sex dating Bunia [ 60 Sex dating Bunia were administered.
Specific questions regarding experiences of sexual violence were added to the questionnaire. They comprised 14 daily stressors e.
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These stigmatization items were initially derived from the Everyday Discrimination Scale [ 62 ] and then adapted Sex dating Bunia the particular cultural context following the procedure of Mels and colleagues [ 60 ].
Fourth, symptoms of posttraumatic stress were measured with the culturally adapted Congolese French version [ 60 ] of the Impact of Event Scale-Revised [ 63 ], a diagnostic self-administered questionnaire comprising 22 questions to be answered on a 5-point Likert scale from 0 never to 5 extremelyaccompanied by a visual probe.
Items were Sex dating Bunia into three subscales symptoms of intrusion, avoidance, and hyper-arousal.
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Finally, the culturally adapted Congolese French version [ 60 ] of the Hopkins Symptom Checklist for Adolescents [ 64 ] measured symptoms of anxiety 12 itemsdepression 13 itemsand externalising problems 12 items. The externalizing scale that had a Chronbach alpha Sex dating Bunia. To avoid multicollinearity, factors were effect-coded and the covariates were centered. Five separate models were fitted for the different mental health Sex dating Bunia.
Considering the large sample and the range of variables included in the analysis, the level of significance was put more conservatively at. Sex dating Bunia were performed using R Potentially traumatic war-related events were frequently reported Table 2.
Overall, victims of sexual violence both rape and non-consensual sexual violence were at higher risk of having experienced war-related traumatic events than girls who did not report sexual violence. Further the risk for victims of rape Sex dating Bunia have also experienced other traumatic events was higher than for participants who reported experiences of non-consensual sexual violence.
Being enlisted as a child soldier and imprisonment were, in particular, frequently reported by rape victims. Material daily stressors were equally frequently reported, with significant differences between the three groups Table 3. Compared to participants who did not report sexual violence, victims of rape reported over eight times more risk of being accused of witchcraft and over four times more risk of insufficient medical care or lack of schooling.
But girl victims of non-consensual sexual violence Sex dating Bunia showed a higher risk of experiencing daily stressors compared to girls who Sex dating Bunia not experience sexual violence. In addition, the results showed that girls who labeled their experiences as rape had a considerably higher risk of reporting daily stressors compared Sex dating Bunia adolescent victims of non-consensual sexual violence.
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Similarly, victims of sexual violence both rape and non-consensual sexual violence had a much higher risk of experiencing stigmatization compared to participants who did not report sexual violence Table 4. Girls who Sex dating Bunia rape experienced more stigmatization than girls who reported non-consensual sexual violence. Mental health outcomes for the three groups are reported in Table 5. Daily stressors were associated with an increase of posttraumatic Sex dating Bunia symptoms avoidance, intrusion, and hyper-arousal.
Hereby, higher scores in war-related trauma, stigmatization, and daily stressors always led to more psychological problems. The type of sexual violence that participants reported impacted hyper-arousal symptoms see also additional variance explained by type of sexual violence, as mentioned in Table 6. The highest level was for girls who reported experiences of non-consensual sexual violence, although we need to take into account the high variance of hyper-arousal symptoms reported by girls who labeled their sexual violence experiences as rape Figure 1.
For symptoms of intrusion IES-Ran interaction effect between type of sexual violence and the covariate stigmatization was found Figure 2. All types of sexual violence showed positive relations between stigmatization and intrusion symptoms, but compared to girls with rape experiences, the estimated regression lines showed stronger effects for participants who experienced non-consensual sexual violence or who did not report sexual violence, Sex dating Bunia higher mean scores for victims of non-consensual sexual violence.
The estimated regression line for victims of rape thus indicated that the expected level of intrusion symptoms depended less on the level of stigmatization than for the other groups. A similar interaction Sex dating Bunia was also found for daily stressors and type of sexual violence on symptoms of depression and anxiety: expected levels of anxiety and depression were less dependent on daily stressors for rape victims, while a strong positive relation was found for girls report NCSE or no Sex dating Bunia violence.
Interaction effect type of sexual violence and stigmatization on IES-R Sex dating Bunia symptoms. More than one third of the eastern Congolese girls in this study reported experiences of sexual violence, which is congruent with the high prevalence of sexual violence in eastern Congo that has been reported for many years [ 11 ].
Self-report measures of mental health symptoms, war-related traumatic events, experiences of sexual violence, daily stressors, and stigmatization were administered.
Girls who lived in poorer socioeconomic situations, as well as girls who have lower parental availability one or two parents deceasedreported more sexual violence experiences than their peers. While little research has been undertaken in this context, other studies alluded to the risk that both a poorer socioeconomic status and parental separation could lead to a higher prevalence of Sex dating Bunia violence [ 2 ].
On the other hand, sexual violence could Sex dating Bunia its turn also lead to more difficult economic situations or to separation from parents exclusion from family.
Particular sociocultural gender norms about rape may Sex dating Bunia have restrained victims from labeling their sexual violence experiences as rape because of either uncertainty as to whether or not an experience was rape [ 67 ] or fear of stigmatization [ 39 ].
This latter element shows up as highly relevant in our study, since girls who label their experiences as rape are clearly confronted with more negative Sex dating Bunia responses, as shown in the high levels of reported stigmatization experiences. We hereby need to acknowledge that these experiences of stigmatization referred to perceived stigmatization, which might be higher in particular conceptualizations of sexual violence i.
Next to these higher levels of stigmatization, for both war-related traumatic experiences and material daily stressors we found similar patterns as for stigmatization: rape victims clearly reported more of these compared to victims who reported non-consensual sexual violations, although the latter group also experienced more of all investigated stressors war-related trauma, daily stressors, and stigmatization compared to girls who did not report any sexual violence experience. This clearly shows that sexual violence is mostly not Sex dating Bunia single trauma event, but goes Sex dating Bunia in hand with exposure to other impacting events, whether concurrently with, preceding, or in the aftermath of the sexual violence, the latter being particularly the case with stigmatization of the victim by the wider community [ 528 โ 30 ].
This accumulation of stressors and traumatic events is one of the greatest explanatory factors in the mental health impact of sexual violence on adolescent victims, as shown in the high prevalence of mental health problems in this study, both in participants who labeled the sexual violence as rape as those who did not [ 52 Sex dating Bunia, 5768 ].
However, contrary to the expectation that โ given the lower exposure to all investigated stressors in victims of non-consensual sexual violence compared to rape victims and the high explanatory role of these factors in mental health outcomes โ the latter group would report significantly higher levels of mental health symptoms, we did not find significant differences between the two groups in symptoms of posttraumatic stress avoidancedepression and anxiety. And Sex dating Bunia hyperarousal and intrusion symptoms PTSDwe even found higher levels in girls who did not label their sexual violence experience as rape, in this Sex dating Bunia also differing from other studies that reported higher levels of PTSD symptoms in acknowledged compared to unacknowledged rape victims [ 52 ].
The evidence suggests, although not consistently, that victims of sexual violence who do not label their sexual violence experience as rape report more impaired coping [ 52 ], which is in its turn associated with negative mental health outcomes after a traumatic experience [ 4169 ]. This study has important Sex dating Bunia implications.
While the need for psychosocial support to acknowledged rape victims has been recognized although often it is not readily availablethis study clearly describes the need for mental health support to victims of sexual violence who do not label their experience as rape.
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Sensitization campaigns Sex dating Bunia raise awareness of a broadened definition of sexual violence, including other forms Sex dating Bunia non-consensual sexual experience, and the large negative impact of these experiences, could be a first step towards also reaching out to these adolescents and offering them โ where needed and wished โ appropriate support services.
These need to be threefold. Hereby, attention should be paid towards possible differences between perceived and actual or intended experiences of stigmatization. Second, on a community and society level awareness and sensitization campaigns are needed to address the problem of sexual violence and its consequences. Community perceptions and attitudes towards rape, including stigmatization and blaming attitudes, Sex dating Bunia how victims of sexual violence label their experiences, impact their mental health [ 32 โ 34 ], and restrain adolescents, in particular those who label their experiences as non-consensual sexual experiences, from disclosing them and seeking help [ 3971 ].
Hereby, it could be helpful to supersede particular narrow definitions of sexual violence e. Lastly, these sensitization and awareness campaigns also hopefully help to reduce the Sex dating Bunia of sexual violence, since its prevalence Sex dating Bunia particular post-conflict contexts is still astonishing.
These sensitization activities could address stereotypes of sexual violence and its consequences with the aim of promoting acknowledgment of rape by individuals and of fostering positive social reactions in order to create a supportive social environment [ 247172 ]. While often interventions on sexual violence and non-consensual sexual experiences target girls in particular, public health programming seems to be needed for both men and women, on traditional gender roles and norms, and on perceptions of non-consensual Sex dating Bunia experiences [ 38 ].
Overall, an integrative and ecological approach towards psychosocial support for adolescent victims of sexual violence is needed, including not only interventions with the individual Sex dating Bunia, but also interventions directed towards the wider social ecology of the adolescents. Second, this study also focuses solely on girls, while also considerable levels of sexual violence towards men and boys in the region have been reported [ 28 ]. Also, for logistical reasons only girls who were in schools were included in the study, reducing its generalizability to out-of-school adolescents.
Third, while the psychological impact of acknowledgement of rape has been studied, there was no previous knowledge of the psychological well-being of the participants.
These longitudinal findings could have added to an understanding of whether already existing psychological Sex dating Bunia influenced the labeling of the sexual violence experiences as non-consensual sexual experience or as rape.
Girls who did not label their sexual violence experience as rape reported more posttraumatic intrusion and hyper-arousal symptoms compared to those labeling the sexual violence as Sex dating Bunia. These findings point to the important association between labeling a sexual violence experience and mental health, in relation to other stressors, in particular daily stressors, war-related trauma, and stigmatization.
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Important implications of these findings are the need to implement an integrative and context-oriented approach towards psychosocial support for adolescent victims of sexual violence, thereby hopefully fostering Sex dating Bunia enhanced supportive social environment. Furthermore, culturally appropriate sensitization activities need to be developed for communities and other stakeholders in order to address stereotypes of sexual violence and its consequences and in an effort to reduce the prevalence of sexual violence and adverse social reactions to it.
Article PubMed Google Scholar. Int Alert. Google Scholar. J Mod Afr Stud. Article Google Scholar. Vlassenroot K, Raeymaekers T: The politics of rebellion and intervention Sex dating Bunia Ituri: the emergence of a new political complex?.
Afr Aff. Harv Humanitarian Initiat Oxfam Int. Wood EJ: Variation in sexual violence during war. Polit Soc. Am J Public Health. Gender Politics in the Sex dating Bunia Balkans.
Edited by: Ramet SP. PLoS Med. Human Rights Q. PLoS One. Med Confl Surviv. Occasional Paper no. Resick PA: The psychological impact of rape. J Interpers Violence. Child Abuse Negl.
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Trauma Violence Abuse. J Consult Clin Psychol. Transcult Psychiatry. Miller KE, Rasmussen A: War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks.
Soc Sci Med. Glob Public Health. Confl Heal. Psychol Crime Law. Violence Vict. Gendered War Sex dating Bunia Peace. Edited by: Pankhurst D. Signs J Women Cult Soc. Popul Rep. Arata CM: Sex dating Bunia with rape: the roles of prior sexual abuse and attributions of blame.
J Adolesc. Psychol Women Q. Violence Against Women. Sex Roles.
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Background
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Democratic Republic of the Congo, Eastern Province, Bunia
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