Association of War-Related and Gender-Based Violence With Mental Health States of Yazidi Women

IMPORTANCE: Yazidi women in northern Iraq have experienced severe human rights violations through attacks by the so-called Islamic State group, with severe consequences for their health. However, no studies to date have investigated how war-related and gender-based violence, including partner violence, are associated with mental health disorders in this population. OBJECTIVE: To evaluate the associations between Yazidi women’s experiences of violence (ie, war violence, partner violence, enslavement) and their mental health. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of 326 women was conducted in camps for displaced persons in the Kurdistan region of Iraq between January and July 2017. Participants were married women from the Yazidi population in northern Iraq who were affected by Islamic State attacks. Participants were selected via household-randomized sampling. Data analysis was conducted from December 2018 to September 2019. EXPOSURES: Experiences of enslavement, war-related events, and intimate partner violence were measured with event checklists. MAIN OUTCOMES AND MEASURES: Posttraumatic stress disorder (PTSD) and depression levels were measured using culturally validated instruments. RESULTS: A total of 326 women (mean [SD] age, 34.3 [12.9] years) participated in the study. Almost all participants reported the experience of at least 1 war-related violent event (325 [99.7%]), 54 (16.6%) reported a history of abduction and sexual slavery, and 215 (66.0%) reported the experience of at least 1 type of intimate partner violence in the past year. There were no significant differences between women who did and did not experience abduction regarding exposure to intimate partner violence. Rates of PTSD and depression symptoms were high among the whole sample, and women who experienced abduction reported significantly higher levels of psychopathology than those who did not (mean [SD] PTSD score: 61.48 [12.38] vs 47.61 [14.42]; t(324) = −6.91; P < .001; mean [SD] depression score: 3.07 [0.68] vs 2.43 [0.68]; t(324) = −6.78; P < .001). Multivariate hierarchical regressions revealed that psychopathology was associated with exposure to war-related events (PTSD: β = 0.29; P < .001; depression: β = 0.27; P < .001) as well as with exposure to gender-based violence in Islamic State captivity (PTSD: β = 0.19; P = .001; depression: β = 0.28, P < .001) and in their marriage (PTSD: β = 0.13; P = .008; depression: β = 0.18; P < .001). CONCLUSIONS AND RELEVANCE: In this study, interviewed Yazidi women often experienced intimate partner violence as well as war-related and gender-based violence under Islamic State attacks and enslavement, experiences that were associated with mental health impairment. The findings underline the importance of also addressing gender-based violence within health care approaches for war-affected populations.