Table 1 Description of included studies
Primary author and Year | Country | Study design | Sampling strategy | Sample size and participation rate | Participant characteristics |
|---|---|---|---|---|---|
Mental health and HIV serostatus/HIV-related outcomes | |||||
Adedimeji et al., 2015 | Rwanda | Cross-sectional Baseline data from 2005 RWISA prospective cohort | Non random selection HIV+ and HIV- women approximately 50% of whom experienced rape during the genocide | N = 928 99% of N = 936 included | Women over age 15 who experienced the 1994 genocide, 76% HIV+ 20.5% < 30 years 48.4% 30–40 years 31.1% 40+ years 100% female |
Adler et al., 2011 | USA | Time-series Time 1: 4 months after return from deployment Time 2: 4 months later | Non random selection Part of a larger study on post deployment transition | N = 647 39% of N = 1651 included who completed both assessments | Active duty USA soldiers in a brigade combat team who had returned from a 15-month deployment in Iraq Age not reported 96% male 4% female |
Kinyanda et al., 2012 | Uganda | Cross-sectional Nested in study on HIV-related psychiatric & psychosocial vulnerabilities in war-affected community | Random selection Multistage sampling to include vulnerable and non-vulnerable individuals | N = 1560 98.5% of N = 1584 included who completed the interview | Vulnerable (widows, orphans, single mothers) and non-vulnerable individuals in a war-affected community Aged 15 years and older 56% were aged between 18 and 44 years 43% male 57% female |
Kinyanda et al., 2016 | Uganda | Cross-sectional Nested in study addressing HIV-related psychiatric and psychosocial vulnerabilities in the war-affected community | Random sampling Multistage sampling for representative sample of vulnerable and non-vulnerable individuals | N = 1110 71.2% with complete data included of N = 1560 | Vulnerable (widowed, divorced, orphan, suffered torture, mental illness, etc.) and non-vulnerable individuals in a war-affected community Aged 15 years and older 56% were aged between 18 and 44 years 43% male 57% female |
Malamba et al., 2016 | Uganda | Cross-sectional Baseline data from a longitudinal cohort study to determine HIV prevalence and risk factors to inform program development | Random selection Two-stage stratified sampling for representative sample | N = 2388 97.5% who had HIV results included of N = 2449 consenting individuals | Conflict affected individuals aged 13–49 29.1% 13–19 years 20.2% 20–24 years 19.6% 25–29 years 12.4% 30–34 years 18.6% 35+ years 40% male 60% female |
Svetlicky et al., 2010 | Lebanon | Cross-sectional Collected 6 months post-conflict, collected for 4 months. | Non random selection Combat reserve soldiers who sought treatment in the Combat Reaction Unit in the wake of the Second Lebanon War | N = 180 65.7% of N = 274 included who completed questionnaires | Mean age = 29.95 years (SD = 5.82; range = 20 to 54 years). 100% male Most were Israeli-born (82.8%) |
Talbot et al., 2013 | Rwanda | Time-series Collected at baseline, 5, 9, and 12 months | Random selection Orphans selected via random number generation from a list of all eligible orphans enrolled in program | N = 120 95% of N = 120 completed all 4 assessments; all participants were included in analysis | 94% were orphaned from the genocide Mean age = 18 years (range 15–25) Male 47% Female 53% |
B.E. Cohen et al., 2012 | USA | Retrospective cohort From a roster of all USA veterans from 2 operations | Non random selection Separated USA veterans who were new users of Department of Veterans Affairs healthcare | N = 71,504 | Veterans of Operations Enduring and Iraqi Freedom Mean age = 28.5 to 29.5 100% female |
Sexual violence and mental health outcomes | |||||
Amone P’Olak et al., 2013 | Uganda | Cross-sectional Baseline data nested in a before and after study | Random selection War-affected youth who had been abducted and lived in rebel captivity for at least 6 months | N = 539 83% of N = 650 who were invited to the study | Aged between 18 and 25 years 61% male 39% female 86% Acholi ethnic group |
Roberts et al., 2008 | Uganda | Cross-sectional | Random selection Multi-stage cluster sampling of camps, administrative zones, and individuals | N = 1210 | Adults living in camps for internally displaced persons Mean age = 35.3 years 40% male 60% female 91% Acholi ethnic group |
Nakimuli-Mpungu et al., 2013 | Uganda | Time series Collected at baseline, 3, and 6 months | Non random selection Analysis included only adults with a history of war-related traumatic experiences | N = 375 59% of N = 631 included who were present for at least 2 visits | Demographic data reported all patients N = 2868, many of whom were not included in the main analysis Mean age adult men = 34.5 Mean age adult women = 37.3 47% male 53% female |
Okello et al., 2007 | Uganda | Case control Cross- sectional, unmatched Cases were formerly abducted youth Controls were non abducted youth | Random selection Systematic recruitment, every 3rd name at 2 sites: a children’s support organization (case) and a mixed boarding school (control) | N = 153 Formerly abducted N = 82 Non-abducted N = 71 | War affected adolescents Boys mean age = 15.5 years Girls mean age = 15.2 years Cases: 64% male; 36% female Controls: 61% male; 39% female 100% of controls in secondary school, 12.2% of cases in secondary school |
Betancourt, Agnew-Blais et al., 2010 | Sierra Leone | Prospective cohort Collected at baseline and time 2 | Non random selection Two stage method: 1) master list of youth in care 2) Invited youth between ages 10–18 with contact information | N = 152 60% of N = 260 interviewed at both times | Former child soldiers Mean age = 17.4 years 89% male 11% female |
Betancourt et al., 2011 | Sierra Leone | Cross-sectional Partially nested in a longitudinal study | Non random selection Longitudinal participants from those who participated in one follow up visit, new participants recruited with NGO outreach lists | N = 273 N = 146 from longitudinal study and N = 127 newly recruited for study (50% male, 50% female) | Former child soldiers Mean age = 16.55 (SD 2.61) 71% male 29% female |
Betancourt, Borisova et al., 2010 | Sierra Leone | Prospective cohort Collected at baseline and time 2, approximately 2 years later | Non random selection Two stage method: 1) master list of youth in care 2) Youth aged 10–18 who did not have a severe disability participated | N = 156 60% of N = 260 interviewed at both times | Former child soldiers Mean age = 15.13 years 88% male 12% female |
Betancourt, Brennan et al., 2010 | Sierra Leone | Prospective cohort Collected at baseline (2002), time 2 (2004), and time 3 (2008) | Non random selection Sample from a master list of youth assisted by program. Youth aged 10–17 with contact information invited to participate. | N = 260 56.5% (N = 147) assessed at time 2 68.8% (N = 179) assessed at time 3 | Former child soldiers Mean age at time 1 = 15.13 (SD = 2.22) 89% male 11% female |
Johnson et al., 2008 | Liberia | Cross-sectional | Random selection Population based multi stage random cluster of households | N = 1666 98.2% of N = 1696 attempted interviews | Adults in Liberia; 1/3 were former combatants Mean age = 41 years 47.2% male 52.8% female |
Johnson et al., 2010 | Democratic Republic of Congo | Cross-sectional | Non random selection Accessible population based cluster (some originally selected villages were inaccessible due to weather and security concerns) | N = 998 98.9% of N = 1005 households surveyed | Adults in conflict-affected provinces and districts Mean age = 40.1 years 40.6% male 59.4% female |
Johnson et al., 2014 | Kenya | Cross-sectional | Random sampling Systematic sampling of 90 villages and 10 households to assess election-related violence | N = 916 95.8% of N = 956 households samples | Adults in Kenya Mean age = 37.3 years 40% male 60% female |
Cardozo et al., 2000 | Kosovo | Cross-sectional | Random selection Two-stage cluster sampling | N = 1358 Only women included in relevant analysis, N = 825 | Kosovar ethnic Albanians aged 15+ years 45.3% 15–34 34.1% 35–54 10.9% 55–64 9.7% 65+ 37.7% male 62.3% female |
Sabin et al., 2003 | Guatemalan refugees living in Mexico | Cross-sectional | Non random selection Convenience sample of 5 camps; all households sampled in 4 camps, every 3rd house in 1 camp | N = 170 93% of N = 183 households | Adults and children in Mayan refugee camps Mean age = 37.9 years 42% male 58% female |
Wolfe et al., 1998 | USA | Retrospective cohort Nested in longitudinal study. Baseline within 5 days of return from deployment, time 2 18–24 months later. | Non random selection Included women who completed the mailed sexual harassment questionnaire | N = 160 66.7% of N = 240 women assessed at baseline | Returned veterans of the Persian Gulf War Mean age = 28.2 years (SD = 6.8) 100% female |
Washington et al., 2013 | USA | Cross-sectional Pertinent result presented as case (PTSD) control (no PTSD) | Random selection Population-based stratified sample Included those who completed the PTSD screener | N = 3598 99.6% of N = 3611 | Veterans who had been called to duty Mean age = 46.8 (SD = 17.3) for PTSD positive and 57.4 (SD = 17.0) for PTSD negative women 100% female |
Kang et al., 2005 | USA | Case control Nested data from a population based survey Cases: PTSD Controls: did not meet criteria for PTSD | Random selection Stratified sample to include each subgroup of military personnel | N = 11,441 76.3% of N = 15,000 sampled | Gulf War veterans Mean age: Females: with PTSD = 39.1; without PTSD = 38.1 Males: with PTSD 40.4; without PTSD 39.6 81.4% male 18.6% female |
HIV acquisition/disease progression and mental health outcomes | |||||
Epino et al., 2012 | Rwanda | Cross-sectional From a prospective cohort | Non random selection Patients from clinics | N = 610 | HIV-positive adults who initiated lifelong ART Mean age = 38 (SD = 10) 38% male 62% female Mean CD4 count =214 (SD = 92) |
Mugisha, Muyinda, Wandiembe et al., 2015 | Uganda | Cross-sectional Baseline data from a project delivering a kinship intervention for post-conflict mental health | Random selection Two-stage cluster sample stratified at the sub-county | N = 2361 98% with complete data of N = 2406 | Adult residents of 3 of the most war affected districts 23.5% 18–24 years 27.3% 25–34 years 20.8% 35–44 years 28.5% 45–54 years 37.5% male 62.5% female |
Mugisha, Muyinda, Malamba et al., 2015 | Uganda | Cross-sectional Nested in project delivering a kinship intervention for post-conflict mental health | Random selection Multistage sampling for a representative sample from 3 districts | N = 2361 98% who had complete data included of N = 2406 | Adult residents of 3 of the most war affected districts 23.8% 18–24 years 27.1% 25–34 years 20.7% 35–44 years 28.4% 45+ years 37.5% male 62.5% female |
Muldoon et al., 2014 | Uganda | Cross-sectional From a larger community-based study of sex workers | Non random selection Recruited through peer/sex worker led outreach in bars and hotels, and community-led outreach to former IDP camps | N = 129 | Formerly abducted by the Lords Resistance Army Median age = 22 years (IQR:20–26) 100% female 96.1% from Acholi tribe |
M.H. Cohen et al., 2009 | Rwanda | Cross-sectional Baseline data from a prospective cohort study | Non random selection Mainly recruited by Rwandan women’s associations | N = 850 91% of N = 936 with available mental health data | HIV-positive and HIV-negative women About half of each group experienced genocidal rape Mean age = 36.4 100% female |
M.H. Cohen et al., 2011 | Rwanda | Prospective cohort Baseline, 6, 12, and 18 months later | Non random selection Recruited from Rwandan women’s associations and HIV clinics in Kigali | N = 698 74.6% of N = 936 who completed baseline HTQ and at least 1 post-baseline HTQ | HIV-positive and HIV-negative women 50% of each group experienced genocidal rape Mean age = 36.7 (SD = 8.3) 100% female |
Other associations between mental health and HIV acquisition and disease progression | |||||
Gard et al., 2013 | Rwanda | Cross-sectional Baseline data nested in a prospective cohort study | Non random selection Recruited Rwandan women’s associations and clinical sites for HIV patients | N = 922 98.5% of N = 936 women who completed the Health-Related Quality of Life measure | HIV-positive and HIV-negative women 50% of each group experienced genocidal rape 20.8% under 30 years 48.4% aged 30–40 years 30.8% over 40 years 100% female |
Kohli et al., 2014 | Democratic Republic of Congo | Cross-sectional Baseline data from a randomized community trial | Non random selection Included if provided family rejection information and had experienced at least 1 traumatic event in the past 10 years | N = 315 | Conflict-affected adult women 1.9% 16–19 years 14.6% 20–24 years 28.25% 25–34 years 22.54% 35–44 years 29.52% 45–60 years 3.17% over 60 years 100% female |
Sinayobye et al., 2015 | Rwanda | Cross-sectional Baseline data from 2005 RWISA prospective cohort | Non random selection HIV+ women, approximately 50% of whom experienced rape during the genocide | N = 710 | HIV+ women over age 15, ART naïve Mean age = 34.9 ± 7.0 100% female |