Using mental health indicators to identify postdisaster gender-based violence among women displaced by Hurricane Katrina

Objective: Assessment of gender-based violence (GBV) among internally displaced persons (IDPs) is at best difficult. In complex humanitarian disasters, GBV inquiry can sometimes be dangerous and may lead to underestimation of the true prevalence. We developed a method of identifying women who have greater odds of having been exposed to postdisaster GBV (PDGBV) using mental health indicators. Methods: We systematically random sampled IDPs living in travel trailer parks in Louisiana and Mississippi and interviewed respondents using a health needs assessment survey during an 8-week period in April and May 2006. Women (n = 194) were screened for GBV and symptoms of depression. Results: Women were on average 43.3 years old (range 18-85). Of the nine symptoms assessed with the Patient Health Questionnaire-9 (PHQ-9), four were associated with PDGBV. Among women with sleep dysregulation, the odds of PDGBV were 2.5 times higher in comparison with women without sleep dysregulation (95% CI 1.2-5.1). Appetite dysregulation increased the odds by 3.8 (95% CI 1.4-10.3), low self-esteem increased the odds by 2.3 (95% CI 1.2-4.6), and suicidal ideation increased the odds by 2.7 (95% CI 1.1-6.7). The internal consistency reliability of this symptom cluster was higher among women with PDGBV. Women screening positive on all four symptoms were 2.7 times more likely to have experienced PDGBV (95% CI 1.03-7.1). Conclusions: Several but not all symptoms of depression indicated exposure to PDGBV. Sleeping dysregulation, appetite dysregulation, low self-esteem, and suicidal ideation should be considered secondary indicators useful for identifying the prevalence of PDGBV exposure among female IDPs. This model may be useful for identifying women with exposure to PDGBV in settings where direct questioning may not be safe and reliable.