Cited by 137Gender, Security, and ConflictHealth and Conflict StudiesConflict, Peace, and Violence in Colombia

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Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions

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Tol, Wietse A, Stavrou, Vivi, Greene, M Claire, Mergenthaler, Christina, van Ommeren, Mark, García Moreno, Claudia·2013·Conflict and Health

DOI 10.1186/1752-1505-7-16PMC PMC3750365

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Abstract

BACKGROUND: Sexual and other forms of gender-based violence are common in conflict settings and are known risk factors for mental health and psychosocial wellbeing. We present findings from a systematic review of the academic and grey literature focused on the effectiveness of mental health and psychosocial support interventions for populations exposed to sexual and other forms of gender-based violence in the context of armed conflicts. METHODS: We searched the Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PubMed/ Medline, psycINFO, and PILOTS, as well as grey literature to search for evaluations of interventions, without date limitations. RESULTS: Out of 5,684 returned records 189 full text papers were assessed for eligibility. Seven studies met inclusion criteria: 1 non-randomized controlled study; 3 non-controlled pre- post-test designs; 1 retrospective cohort with a matched comparison group; and 2 case studies. Studies were conducted in West and Central Africa; Albania; UK and USA, included female participants, and focused on individual and group counseling; combined psychological, medical, social and economic interventions; and cognitive behavioral therapy (two single case studies). CONCLUSIONS: The seven studies, while very limited, tentatively suggest beneficial effects of mental health and psychosocial interventions for this population, and show feasibility of evaluation and implementation of such interventions in real-life settings through partnerships with humanitarian organizations. Robust conclusions on the effectiveness of particular approaches are not possible on the basis of current evidence. More rigorous research is urgently needed.

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Impact of setting insecurity on Cognitive Processing Therapy implementation and outcomes in eastern Democratic Republic of the Congo
Kaysen, D. L., Stappenbeck, C. A., Carroll, H. A., Fukunaga, R., Robinette, K., Dworkin, E. R., Murray, S. M., Tol, W. A., Annan, J. R., Bolton, P. A., et al. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1735162 · Cited by 18
“…occur when treating trauma in the context of ongoing conflict (Bass et al., 2013; Gillespie et al., 2002; Murray et al., 2013; Robjant, Roberts, & Katona, 2017; Tol et al., 2013), but expands this work to suggest that the degree of safety risk posed by a setting does not appear to affect outcomes.”
BackgroundResult
The Impact of a Community Based Rehabilitation Program in Afghanistan: A Longitudinal Analysis Using Propensity Score Matching and Difference in Difference Analysis
Trani, J., Escallon, J. V., & Bakhshi, P. (2020) · Conflict and Health · doi:10.1186/s13031-021-00397-y · Cited by 13
In between the lines of the narrative map: Phenomenological analysis of war rape victims in Amhara Regional State, Ethiopia
Wondie, Y., Zeleke, W. A., & Melesse, M. (2023) · PLoS ONE · doi:10.1371/journal.pone.0289106 · Cited by 15
“This includes 39% of women during the Rwandan genocide, 25% of women in Azerbaijan, 19% of women in Burundi, and 11% displaced women in Cambodia [2, 3].”
Background
The impact of support programmes for survivors of sexual violence: micro-level evidence from eastern Democratic Republic of the Congo
Amisi, C., Biaba, R., Cikara, A., Østby, G., Nordås, R., Rustad, S. A., & Quattrochi, J. P. (2018) · Medicine Conflict & Survival · doi:10.1080/13623699.2018.1541625 · Cited by 13
“One broader systematic review of the academic and grey literature by Tol et al. (2013) focusing on ‘the effectiveness of mental health and psychosocial support interventions for populations exposed to sexual and other forms of gender-based violence in the context of armed conflicts’ found that…”
Background
High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study
Nemat, A., Yaftali, S., Danishmand, T. J., Nemat, H., Raufi, N. K., & Asady, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-18497-x · Cited by 10
The mental health and well-being of internally displaced female Yazidis in the Kurdistan Region of Iraq: a realist review of psychosocial interventions and the impact of COVID-19
Lobanov‐Rostovsky, S., & Kiss, L. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.55 · Cited by 12
“The most recent systematic review of psychosocial interventions for survivors of sexual violence included data ranging from over a decade ago (Tol et al., 2013).”
Background
Exploring the Impact of a Family-Focused, Gender-Transformative Intervention on Adolescent Girls’ Well-Being in a Humanitarian Context
Seff, I., Koris, A., Giuffrida, M., Ibala, R., Anderson, K., Shalouf, H., Deitch, J., & Stark, L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192215357 · Cited by 10
“Adolescents in Gaza expressed reduced anti-social behavior, depressive sequelae, and aggression in households characterized by increased parental support and warm parenting practices [27,28].”
Background
Breaking the silence through MANTRA: Empowering Tamil MAN survivors of torture and rape
Fernandes, P., & Aiello, Y. (2018) · Torture Journal · doi:10.7146/torture.v28i3.111181 · Cited by 10
Centering Subjectivities
Wachter, K., & Snyder, S. (2018) · Affilia · doi:10.1177/0886109918766620 · Cited by 12
“…consequences of violence against women in armed conflict and forced displacement (Abrahams et al., 2014; Stark & Ager, 2011; Stark & Wessells, 2012; Tol et al., 2013; Vu et al., 2013), practitioners in the United States and other resettlement sexual violence that may carry into resettlement…”
Background
Improving and sustaining livelihoods through group-based interventions: mapping the evidence
(3ie), I. I. F. I. E., Barooah, B., Chinoy, S. L., 3ie, Dubey, P., 3ie, Sarkar, R., 3ie, Bagai, A., 3ie, et al. (2019) · doi:10.23846/egm013 · Cited by 15
Sexual Violence Against Men in Conflict and Post-Conflict Settings: A Qualitative Research Methodology
Olaluwoye, T., Hoban, E., Connors, P., & Williams, J. W. (2022) · American Journal of Men s Health · doi:10.1177/15579883221084496 · Cited by 9
“Recruiting participants through NGOs may not always be possible considering that there are not many such organizations that support male refugees specifically, and that the male sexual violence survivors themselves may be reluctant to approach the existing organizations (Chynoweth et al., 2017; Spangaro et al., 2013;…”
BackgroundInfluential
A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape
Abrahams, N., & Gevers, A. (2017) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v23i0.959 · Cited by 9
A comprehensive approach to providing services to survivors of sexual and gender-based violence in Democratic Republic of Congo: addressing more than physical trauma
Bennett, C., Banda, M., Miller, L., Ciza, J., Clemmer, W., Linehan, M., & Sthreshley, L. (2017) · Development in Practice · doi:10.1080/09614524.2017.1329400 · Cited by 9
“There is a growing evidence base for the efficacy of trauma-focused cognitive behavioural therapy (O’Callaghan et al. 2013), cognitive processing therapy (Bass et al. 2013), and other forms of mental health and psychosocial support interventions in improving mental health outcomes (Tol et al. 2013).”
Background
Prevalence and Risk Factors Associated With Physical and/or Sexual Abuse Among Female Middle School Students: A Cross- Sectional Study in Kinshasa, DRC
Jonas, K. A. W. M., Tang, H., Deng, L.-C., Yu, Y., Baptiste, K. N. J., KISUNGU, B. K., Opoku, S., & Meng, H. (2020) · Journal of Interpersonal Violence · doi:10.1177/0886260520976221 · Cited by 8
“…prevalence rates of the current study were higher even when compared to the levels of sexual and gender-based violence recorded by prior studies conducted in other African countries affected by armed conflict: 11% in Colombia, 19% in Burundi, 39% in Rwanda (Tol et al., 2013; Ward & Marsh, 2006).”
BackgroundResultInfluential
Multilevel Determinants of Integrated Service Delivery for Intimate Partner Violence and Mental Health in Humanitarian Settings
Greene, M. C., Bencomo, C., Rees, S. J., Ventevogel, P., Likindikoki, S. L., Nemiro, A., Bonz, A. G., Mbwambo, J. K. K., Tol, W. A., & McGovern, T. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312484 · Cited by 15
“Psychological interventions for survivors of IPV have shown promising impacts on reducing the symptoms of common mental health problems [21].”
Background
Rehabilitation services must include support for sexual and gender-based violence survivors in Ukraine and other war- and conflict-affected countries
Morgan, R., Asiimwe, L., Ager, A. L., Haq, Z., Thumba, L., & Shcherbinina, D. (2023) · Health Policy and Planning · doi:10.1093/heapol/czad005 · Cited by 8
Risk and protective factors for GBV among women and girls living in humanitarian setting: systematic review protocol
Murphy, M., Ellsberg, M. C., Balogun, A., & García‐Moreno, C. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01795-2 · Cited by 10
The ligaments of counter-terrorism regime: sexual violence and the vicarious traumatisation of female non-governmental organisation workers: evidence from Nigeria
Njoku, E. T. (2019) · Small Wars and Insurgencies · doi:10.1080/09592318.2019.1649830 · Cited by 8
Recent research involving consent, alcohol intoxication, and memory: Implications for expert testimony in sexual assault cases
Cornelius, T. L., Jozkowski, K. N., Ross, J. M., Reidy, D. E., Wehle, S. M. J., Temple, J. R., & Drouin, M. A. (2024) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2024.102034 · Cited by 7
‘A woman’s place…’: community-based approaches to gender-based violence in Malawi
Gaynor, N., & Cronin, M. (2017) · Community Development Journal · doi:10.1093/cdj/bsx034 · Cited by 7
“A number of quantitative studies (Abramsky and Devries, 2012, Kohli, 2012, Tol 2013) find CBAs effective in both GBV prevention and in service take-up.”
Background
Multiyear, Multisectoral Training Program in Kenya to Enhance Medical–Legal Processes in Response to Sexual and Gender-Based Violence
Albezreh, S., Anastario, M. P., Ulibarrí, B. J., Naimer, K., Johnson, K., McHale, T., Mishori, R., Macias‐Konstantopoulos, W., Olson, R. M., & Nelson, B. D. (2022) · Violence Against Women · doi:10.1177/10778012221099984 · Cited by 7
“Sexual and other forms of gender-based violence increase in prevalence in times of conflict and are known risk factors for mental health conditions and reduced psychosocial well-being (Tol et al., 2013).”
Background
A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape
Abrahams, N., & Gevers, A. (2017) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v23i1.959 · Cited by 7
A scoping review of nursing interventions to reduce PTSD in adolescents who have been sexually abused
Yosep, I., Suryani, S., Mediani, ‎. S., Mardhiyah, A., & Hernawaty, T. (2024) · BMC Nursing · doi:10.1186/s12912-024-02130-5 · Cited by 8
“Another study showed that nursing interventions can effectively reduce symptoms of low self-esteem in victims of sexual violence [14, 15].”
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What works to prevent violence against women and girls? Evidence review of the effectiveness of response mechanisms in preventing violence against women and girls
Jewkes, R. K. (2014) · Cited by 6
Sexual and Gender-Based Violence as Warfare
Cherepanov, E. (2021) · Springer eBooks · doi:10.1007/978-3-319-89999-2_106 · Cited by 6
Withstanding psychological distress among internally displaced Yazidis in Iraq: 6 years after attack by the Islamic State of Iraq and the Levant
Rasheed, O. S., López‐Rodríguez, L., & Navas, M. (2022) · BMC Psychology · doi:10.1186/s40359-022-00973-8 · Cited by 8
Interventions to promote social cohesion in Sub-Saharan Africa
King, E., & Samii, C. (2012) · doi:10.23846/sr1012 · Cited by 7
A qualitative exploration of the impact of the COVID-19 pandemic on gender-based violence against women living with HIV or tuberculosis in Timor Leste
Martins, N., Soares, D., Gusmão, C., Nunes, M., Abrantes, L., Valadares, D., Marcal, S., Mali, M. A., Alves, L., Martins, J., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306106 · Cited by 5
Systematic Review of Gender and Humanitarian Situations Across Africa
Nwoke, C., & Cochrane, L. (2022) · Africa Spectrum · doi:10.1177/00020397221128322 · Cited by 8
“However, it has proved difficult to measure the effectiveness of mental health and psychosocial support interventions in such complex contexts (Tol et al., 2013).”
Background
Resilience and Ethics in Post-conflict Settings: Kwihangana, Living After Genocide Rape, and Intergenerational Resilience in Post-genocide Rwanda
Zraly, M., & Kagoyire, M. G. (2021) · Springer eBooks · doi:10.1007/978-3-030-66296-7_13 · Cited by 5
Disability in Humanitarian and Conflict Settings
Shah, M. H., Wayn, D. K., & Ali, N. (2025) · Springer eBooks · doi:10.1007/978-3-031-40858-8_460-1 · Cited by 5
Mental health and psychosocial support interventions for populations affected by ongoing armed conflict: a scoping review
Fréel, S., Punski‐Hoogervorst, J. L., Hoeboer, C. M., Ruzek, J. I., Beardmore, L., Olff, M., & Javakhishvili, J. D. (2026) · BMJ Global Health · doi:10.1136/bmjgh-2025-022708 · Cited by 6
“…effective-ness—rather than scope, among either highly specific populations such as women and children, 41 42 refugees and asylum seekers, 43 or following exposure to distinct types of traumatic events including natural disasters or sexual and gender-based violence 44 within armed conflict settings.”
Examining the effectiveness of psychological interventions for marginalised and disadvantaged women and individuals who have experienced gender-based violence: protocol for a scoping review
Yalcinoz-Ucan, B., Zilney, L. J., Zientarska-Kayko, A., Ireland, T., & Browne, D. T. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060479 · Cited by 6
Cameroonian Political Conflict, Displacement, and Refugee Women’s Struggle in the Informal Economy in Nigeria
Lenshie, N. E., Miapyen, B. S., Idris, A., & Obi, K. C. (2025) · Society · doi:10.1007/s12115-025-01094-9 · Cited by 4
Sexual and Gender-Based Violence as Warfare
Cherepanov, E. (2019) · Springer eBooks · doi:10.1007/978-3-319-62122-7_106-1 · Cited by 4
Palestinian and Norwegian Kindergarten Teachers' Perspectives on Psychosocial Support: A Qualitative Study
El-Khodary, B., Christensen, I. R., Abou-Dagga, S. I., Raji, S., & Lyden, S. C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.761303 · Cited by 6
“The teachers all describe how they see psychosocial support as measures for the child’s emotional, physical, and cognitive development, highlighting a resilience perspective, seeing good mental health and developmental outcomes, despite exposure to significant adversity (Tol et al., 2013).”
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Activity Of Charity and Civil Society Organizations in Gaza
Hamarsha, M. M. (2025) · Civil Szemle · doi:10.62560/csz.2025.02.3 · Cited by 3
Support interventions to promote health and wellbeing among women with health-related consequences following traumatic experiences linked to armed conflicts and forced migration: a scoping review
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“…a limited number of studies investigating mental health and psychosocial support interventions for populations exposed to sexual abuse and other forms of gender-based violence in the context of armed conflicts, hindering the possibility of drawing any firm conclusions about effectiveness [28].”
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Support for children born of rape in the Democratic Republic of the Congo: mother’s experiences and challenges
Kaningini, E. W., & Vandeninden, F. (2025) · Conflict and Health · doi:10.1186/s13031-025-00674-0 · Cited by 3
Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala
Kansiime, P., van der Westhuizen, C., & Kagee, A. (2018) · Social Work and Social Sciences Review · doi:10.1921/swssr.v19i3.1196 · Cited by 2
“…that sexual violence has always been part of many armed conflicts worldwide, but it differs in the scale, type, target group and tactics (Jewkes, Sen, & Garcia-Moreno, 2012; Tol et al., 2013), and it 2 is globally recognised as a human rights violation and security issue (Cohen & Nordas, 2014).”
BackgroundResult
Concerning ‘Neglect’: Perspectives on the Prioritisation of Mental Health Conditions in Protracted Displacement Contexts
Ghafoerkhan, R. S., Lowe, L., Weme, D. N., Griede, E., & Jeffery, L. R. (2024) · Medicine Anthropology Theory · doi:10.17157/mat.11.2.7725 · Cited by 2
Sibling-Support for Adolescent Girls (SSAGE): A study protocol for a pilot randomized-controlled trial of a whole-family, gender transformative approach to preventing mental illness among forcibly displaced adolescent girls
Seff, I., Deitch, J., Harker, A., Rodríguez, C., Andia, T. S., Pena, T. A., & Stark, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303588 · Cited by 3
Community-based intervention packages for reducing maternal morbidity and mortality and improving neonatal outcomes
", Lassi, Z. S., & Haider, B. A. (2012) · doi:10.23846/sr1014 · Cited by 3
Expanding the evidence on integration of cash assistance in gender-based violence case management in humanitarian settings: lessons learned from multi-country evaluations
Lyles, E., Glass, N. E., Sidabutar, E., Roa, E. G., Hoyos, C., Pacheco, A., Sarria, D., Golay, A., Friedman, J., Argenti, E., et al. (2025) · Conflict and Health · doi:10.1186/s13031-025-00691-z · Cited by 2
“Consistent with global findings on mental health in global and humanitarian settings [38, 39], women in all three countries reported symptoms of poor mental health.”

Authors: Tol, W. A., Stavrou, V., Greene, M. C., Mergenthaler, C., van Ommeren, M., & García Moreno, C.
Affiliations: Johns Hopkins University (US)
Columbia University (US)
Yale University (US)
Corresponding author: Tol, Wietse A
ORCID: Tol, Wietse A
Greene, M Claire
Mergenthaler, Christina
Venue: Conflict and Health
Publisher: Springer Science and Business Media LLC
Published: 2013-08-05
Volume: 7
Issue: 1
Pages: 16-16
ISSN: 1752-1505 (ISSN-L)
DOI: 10.1186/1752-1505-7-16
PMC: PMC3750365
OpenAlex: W2158842686
Cited by: 137
References: 38
Citations by year: 2026: 9 · 2025: 11 · 2024: 15 · 2023: 5 · 2022: 15 · 2021: 23 · 2020: 13 · 2019: 6 · 2018: 10 · 2017: 12 · 2016: 5 · 2015: 2 · 2014: 7 · 2013: 1
FWCI: 2.55
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: Conflict and Health (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Funders: World Health Organization
Topics: Social Sciences › Gender Studies › Gender, Security, and Conflict
Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
Social Sciences › Sociology and Political Science › Conflict, Peace, and Violence in Colombia
Keywords: sexual violence, gender-based violence, armed conflict, mental health interventions, psychosocial support, post-traumatic stress, cognitive behavioral therapy, group counseling, humanitarian organizations, conflict-affected populations

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Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions

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