Dinesh Bhugra, Maria Francesca Moro, Fadimata Wallet Oumar, Elisa Pintus, Federica Sancassiani, Mirra Pintus, Daniela Moro, Luigi Minerba, Antonio Preti, Mauro Giovanni Carta, Elisabetta Pascolo-Fabrici, Giovanni Carta, Mauro, Moro, Daniela, Wallet Oumar, Fadimata, Francesca Moro, Maria, Pintus, Mirra, Pintus, Elisa, Minerba, Luigi, Sancassiani, Federica, PASCOLO-FABRICI, Elisabetta, Preti, Antonio, Kumar Bhugra, Dinesh, Carta, M. G., Moro, D., Oumar, F. W., Moro, M. F., Pintus, M., Pintus, E., Minerba, L., Sancassiani, F., Pascolo-Fabrici, E., Preti, A., and Bhugra, D. K.
Populations fleeing war have often suffered or have witnessed violence, persecution, and imprisonment; they are at high risk of exposure to traumas and consequently to manifesting psychopathologies, stress-related disorders, and post-traumatic stress disorder (PTSD). Regarding the condition of refugees, factors inherent in the conditions of escaping, traveling, and reception in the host country can also aggravate the psychopathology linked to previous traumas, or even add new ones. The prevalence of PTSD in refugee camps in Africa varies from 15.8% in Ethiopia to 37.4% in Algeria. The presence of any severe mental disorder ranged from 17.5% in Ethiopian to 60.5% in Algerian refugees. In people of three Sub-Saharan refugee camps in postwar scenarios in Darfur Hamid and Musa, 54% of people were found positive at a screening test for PTSD and 70% positive in a screening test for general distress. The literature contains several studies on small cohorts in refugee camps suffering from disorders who had been subjected to specific treatments. However, studies on population samples or entire refugee populations repeated over time are infrequent. One of the studies, considered as a milestone in this field, shows in Bosnian refugees in Croatia that 45% of those who met the DSM-IV criteria for depression or PTSD presented these disorders 3 years later, and 16% of asymptomatic persons developed the disorders. A decrease in psychiatric symptoms at follow-up was shown 10 years later, but people suffering from PTSD showed an upward trend and the presence of PTSD was found associated with the unsuccessful extinction of traumatic memories. The few studies found in the literature do not clarify what social mechanisms may occur in the processes of recovery of hope, also because the different circumstances studied probably present specific variables that characterize each situation. However, the results of some studies, even on minors, appear to suggest that restoring a condition of safety and responding to primary needs is not always associated with an improvement in general and stress-related psychopathology. We had previously evaluated a sample of refugees of Tuareg ethnicity who were living in the Subgandé refugee camp in Burkina Faso. At that time (immediately after the crisis in Mali), refugees in the camp were faced with strong tensions and fear. There were no international organizations guaranteeing security and survival. These refugees had fled from Mali with very little information on those who had remained behind. Meanwhile, interventions by Islamic extremists meant that the political and military situation was not going well for the Tuaregs, who were fighting for independence. The majority of the Tuareg rebels were in fact engaged in the MLNA (Mouvement de Liberation de l’Azawar), the lay and losing party of the Malian rebels (1). At that time, around 60% of our sample had screened positive for the contemporary presence of both psychopathological stress-related symptoms (as positivity to Short Screening Scale for PTSD) and for the presence of general psychopathological symptoms and impairment linked to psychopathology [as positivity to the K6 screening scale], thus indicating severe mental distress and probable PTSD. Women aged 40 and older were found to be at higher risk of PTSD symptoms. Younger women (39 or younger) had higher frequencies of K6 positivity, but the distribution of people with both PTSD and K6 scales positivity was homogeneous by gender and age. During the 2-year period, many people had left the Subgandé camp and had been relocated to other camps where they appeared to be better supported. In this follow-up study 2 years later, we retraced a substantial portion of the first sample, but many were about to return to Mali. The aim of the follow-up is to ascertain the health status of those previously interviewed and those we were able to trace. We wanted to see whether the amended general conditions (e.g., protection provided by international organizations and the conclusion of negotiations) had contributed to changes in the levels of mental distress.