Stigma Modifies the Association between Social Support and Mental Health Among Sexual Violence Survivors in the Democratic Republic of Congo: Implications for Practice

Background and Purpose

While attention has been given to the magnitude of sexual violence in the Democratic Republic of Congo (DRC), researchers, practitioners and policy makers are less attuned to the interplay of psychological and social consequences of sexual violence. Survivors of sexual violence in DRC have described psychological symptoms consistent with depression, anxiety, and post-traumatic stress disorder (PTSD), impaired social functioning, abandonment and rejection by family and friends, concerns about providing for self and family. A nascent but growing body of empirical work related to sexual violence and stigma in eastern DRC can serve to inform efforts to improve women’s health and psychosocial outcomes in the DRC, throughout Africa, and globally across contexts.  Thus, this study examined how social support, stigma and mental health interrelate among women who have experienced sexual violence, employing data collected in eastern DRC to inform future directions for practice and research across contexts.

Methods

Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and post-traumatic stress disorder (PTSD).

Results

Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t = -2.49, p = .013), anxiety (t = -3.08, p = .002), and PTSD (t = -2.94, p = .003).  Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma. As women reported higher levels of stigma, the relationship between emotional support seeking and mental health symptoms weakened such that an increase in emotional support seeking was associated with a smaller increase in mental health symptoms.  Though the association was attenuated among women experiencing a higher level of stigma, positive conditional regression coefficients indicated that increased frequency of emotional support seeking was still associated with higher mental health symptoms among women experiencing across levels of stigma, with the exception of depression. 

Conclusions and Implications

The findings indicate that the relationship between emotional support seeking and mental health for women having experienced stigmatized violence is not intuitive and warrants further understanding. The findings point to the complexity and potential negative effects of discussing stigmatized problems among women’s interpersonal networks, as well as reinforce the importance of availing formal and culturally relevant support options to women.  How dynamics examined in this study carry over into women’s experiences in displacement and post-resettlement is of particular importance moving forward.  In addition, further understanding is needed regarding the interaction of a range of traumatic events women experience in war and displacement, and context-specific stigmas associated with the psychosocial consequences of those experiences.