© © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.This longitudinal study indicates that exposure to the traumas of mass conflict and subsequent depressive symptoms play an important role in pathways leading to functional impairment in the postconflict period among women of child-rearing age. Our study, conducted in Timor-Leste, involved an analytic sample of 1292 women recruited at antenatal clinics in the capital and its surrounding districts. Women were re-interviewed at home 2 years later (77.3% retention). We applied the Edinburgh Postnatal Depression Scale, the Harvard Trauma Questionnaire for conflict-related traumatic events, the WHO Violence Against Women Instrument covering the past year for intimate partner violence and the WHO Disability Assessment Schedule (WHODAS V.2.0) to assess functional impairment. A longitudinal path analysis tested direct and indirect relationships involving past conflict-related trauma exposure, depressive symptoms measured over the two time points and functional impairment at follow-up. The prevalence of predefined clinically significant depressive symptoms diminished from 19.3% to 12.8%. Nevertheless, there was a tendency for depressive symptoms to persist over time (β=0.20; p<0.001). Follow-up depressive symptoms were associated with functional impairment (β=0.35; p<0.001). Reported conflict-related trauma occurring a minimum of 6 years earlier (β=0.23; p<0.001) and past-year physical intimate partner violence (β=0.26; p<0.001) were each associated with depressive symptoms at baseline and at follow-up. A measure of poverty specific to the context and reported health problems in the mother and infant also contributed to depressive symptoms. The findings highlight the association between ongoing trauma-related depressive symptoms and the capacity of women in the childbearing age to function in multiple areas of their lives in a postconflict country. Recognition of these relationships is important in the formulation and implementation of contemporary international recovery and development policies applied to postconflict countries.
| Original language | English |
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| Article number | e002039 |
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| Journal | BMJ global health |
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| Volume | 5 |
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| Issue number | 3 |
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| DOIs | |
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| Publication status | Published - 30 Mar 2020 |
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| Externally published | Yes |
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1Psychiatry, University of New South Wales, Sydney, New South Wales, Australia 2Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia 3Child and Maternal Health, Alola Foundation, Dili, Timor-Leste 4Psychology, The University of Sydney, Sydney, New South Wales, Australia 5Department of Mental Health, Johns Hopkins Sch Publ Hlth, Baltimore, Maryland, USA 6Richmond Hospital, St John of God Health Care, North Richmond, New South Wales, Australia Contributors DS and SJR designed the study, oversaw all aspects of its implementation including management, training and supervision, ensured the integrity of data collection and interactions with supportive agencies and took a lead in directing data management, analyses and writing of this manuscript; DS, SJR, WAT, ZS, MD and VE formulated the project, wrote the grant and received funding for this project; WAT, MD, VE, MM and ZS provided statistical guidance, feedback and advice; MM, DS and LK were responsible for the actual statistical analysis, design of figures and production of tables; SJR and LK conducted the literature review; NDJT provided cultural advice and oversight, oversaw field work and logistic support and provided on-the-ground supervision of the field team; DS, SJR, MM and LK prepared and revised the written manuscript; ZdC and ES were responsible for assisting with management, logistic and management support, attending to coordination of staff, overseeing and participating in data collection and checking and liaising with the hosting agency, the Alola Foundation and stakeholder groups. DS, SJR, WAT, ZS, MD and VE participated in regular planning meetings ensuring that all aspects of the project were monitored and, where necessary, adjusted to achieve the outcomes. WAT, ZS, MD and VE played an active role in assessing and advising on the methodological, analytical and theoretical interpretation of the data and in designing the structure of the paper. All authors reviewed and provided input into the final manuscript. Funding Funding for this research was provided by the National Health and Medical Research Council (NHMRC) of Australia. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not required. ethics approval This study was approved by the Human Research Ethics Committee of the University of New South Wales and the Ministry of Health of Timor-Leste.