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Cited by 445Mental Health Treatment and AccessHealth and Conflict StudiesMigration, Health and Trauma

Mental Health, Social Functioning, and Disability in Postwar Afghanistan

Cardozo, Barbara Lopes·2004·JAMA
DOI 10.1001/jama.292.5.575
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Abstract

CONTEXT: More than 2 decades of conflict have led to widespread human suffering and population displacement in Afghanistan. In 2002, the Centers for Disease Control and Prevention and other collaborating partners performed a national population-based mental health survey in Afghanistan. OBJECTIVE: To provide national estimates of mental health status of the disabled (any restriction or lack of ability to perform an activity in the manner considered normal for a human being) and nondisabled Afghan population aged at least 15 years. DESIGN, SETTING, AND PARTICIPANTS: A national multistage, cluster, population-based mental health survey of 799 adult household members (699 nondisabled and 100 disabled respondents) aged 15 years or older conducted from July to September 2002. Fifty district-level clusters were selected based on probability proportional to size sampling. One village was randomly selected in each cluster and 15 households were randomly selected in each village, yielding 750 households. MAIN OUTCOME MEASURES: Demographics, social functioning as measured by selected questions from the Medical Outcomes Study 36-Item Short-Form Health Survey, depressive symptoms measured by the Hopkins Symptoms Checklist-25, trauma events and symptoms of posttraumatic stress disorder (PTSD) measured by the Harvard Trauma Questionnaire, and culture-specific symptoms of mental illness and coping mechanisms. RESULTS: A total of 407 respondents (62.0%) reported experiencing at least 4 trauma events during the previous 10 years. The most common trauma events experienced by the respondents were lack of food and water (56.1%) for nondisabled persons and lack of shelter (69.7%) for disabled persons. The prevalence of respondents with symptoms of depression was 67.7% (95% confidence interval [CI], 54.6%-80.7%) and 71.7% (95% CI, 65.0%-78.4%), and symptoms of anxiety 72.2% (95% CI, 63.8%-80.7%) and 84.6% (95% CI, 74.1%-95.0%) for nondisabled and disabled respondents, respectively. The prevalence of symptoms of PTSD was similar for both groups (nondisabled, 42.1%; 95% CI, 34.2%-50.1%; and disabled, 42.2%; 95% CI, 29.2%-55.2%). Women had significantly poorer mental health status than men did. Respondents who were disabled had significantly lower social functioning and poorer mental health status than those who were nondisabled. Feelings of hatred were high (84% of nondisabled and 81% of disabled respondents). Coping mechanisms included religious and spiritual practices; focusing on basic needs, such as higher income, better housing, and more food; and seeking medical assistance. CONCLUSIONS: In this nationally representative survey of Afghans, prevalence rates of symptoms of depression, anxiety, and PTSD were high. These data underscore the need for donors and health care planners to address the current lack of mental health care resources, facilities, and trained mental health care professionals in Afghanistan.

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  • Of the 67 studies with quality ratings of seven or higher on R/S and anxiety, 38 (55%) reported inverse relationships and seven (10%) found positive relationships.

    “Of the 67 studies with quality ratings of seven or higher, 38 (55%) reported inverse relationships [173–182] and seven (10%) found positive relationships (greater anxiety among the more R/S) [183–189].”

    From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [173]

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Authors
Cardozo, B. L.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Cardozo, Barbara Lopes
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2004-08-04
Volume
292
Issue
5
Pages
575
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.292.5.575
OpenAlex
W2082816136
Cited by
445
References
15
Citations by year
2026: 12 · 2025: 21 · 2024: 22 · 2023: 65 · 2022: 18 · 2021: 16 · 2020: 13 · 2019: 9 · 2018: 22 · 2017: 19 · 2016: 18 · 2015: 12 · 2014: 16 · 2013: 21 · 2012: 27
FWCI
19.47
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
mental health, disability, social functioning, post-traumatic stress disorder, depression, anxiety, trauma exposure, war trauma, population displacement, coping strategies, food and water insecurity, mental health service availability, mental health professionals, mental health policy
MeSH terms
Adolescent, Adult, Afghanistan, Anxiety Disorders, Depressive Disorder, Female, Persons with Disabilities, Disabled Persons, Health Resources, Health Services Research, Health Surveys, Humans, Male, Mental Health, Mental Health Services, Middle Aged, Sampling Studies, Social Adjustment, Stress Disorders, Post-Traumatic, Violence, Warfare, Cluster Analysis

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