Cango Lyec (Healing the Elephant) : exploring impacts of the Lord’s Resistance Army insurgency on mental health of conflict-affected populations in Northern Uganda

Background: From 1986 to 2006, Northern Uganda experienced an atrocious civil war between the Lord’s Resistance Army and the Ugandan government which left in its wake mass casualties, child abductions, sexual violence, and socio-economic breakdown. The local Acholi people continue to be impacted by trauma sequelae of the war and a variety of daily stressors including poverty, hunger, and an ongoing HIV epidemic. To date, there is a dearth of gender-differentiated research in this post-conflict context examining mental health and associated vulnerability factors. Objectives: This thesis explores two mental health outcomes, PTSD and depression, among conflict-affected people in Northern Uganda five years after the cessation of hostilities. A socio-ecological framework is adopted to investigate risk factors at individual, relationship, and community levels. Special attention is paid to the plight of women and formerly abducted children. Methods: This research is embedded within a longitudinal cohort project, Cango Lyec (Healing the Elephant), which evaluates HIV and associated risks in post-conflict Northern Uganda. Baseline categorical variables were compared between males and females using Fisher’s exact test. Bivariate and multivariate logistic regression was used to model correlates of positive screening for PTSD and depression. All analyses were stratified by gender, and subgroup analyses for former abductees were conducted. Results: We found the overall prevalence of probable PTSD and depression was 11.7% and 15.2% respectively. Among former abductees, the prevalence was 23.2% for probable PTSD and 26.6% for probable depression. Females were significantly more likely to have poor mental health than their male counterparts. Factors found to be associated with poor mental health included environmental stressors, war-related trauma, abduction and experiences in the bush, sexual violence, intimate partner violence, sexually transmitted infections, and HIV. Conclusions: Cango Lyec participants displayed lower rates of PTSD and depressive symptoms compared to previous studies. Reviving the local agrarian economy, ensuring food and housing security, providing trauma-informed care, eliminating sexual violence and gender-biased social institutions, as well as increasing educational and employment opportunities for former abductees remain important tasks to facilitate post-conflict rehabilitation in Northern Uganda.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat