Mental health and psychosocial support during physical rehabilitation in Eastern Democratic Republic of Congo: a retrospective cohort study

Abstract

Purpose

This study explores the relevance of integrating mental health and psychosocial support (MHPSS) into physical rehabilitation services in conflict settings.

Material and Methods

Symptoms of psychological distress and daily functioning of 132 physical rehabilitation service users in Eastern Democratic Republic of Congo were assessed before and after MHPSS. Logistical regression models were used to identify factors associated with these symptoms.

Results

Prior to receiving MHPSS, “extreme” symptoms of depression were reported by 64% of the service users. Amputation predicted high levels of depression (aOR 5.12, p = 0.021), anxiety (aOR 7.09, p = 0.004) and stress (aOR 3.37, p = 0.035), while having witnessed violence predicted high symptoms of stress (aOR 3.65, p = 0.014). Lack of social support was associated with high symptoms of stress prior to MHPSS (aOR 3.17, p = 0.046) as well as a large reduction in symptoms of depression following MHPSS (aOR 3.91, p = 0.019). Most physical rehabilitation service users reported a reduction in symptoms of depression (100.00%), anxiety (98.03%) and stress (100.00%) along with improved functioning (81.13%) after MHPSS.

Conclusion

MHPSS needs of physical rehabilitation service users in conflict settings stem from the combined impact of disability and exposure to violence. MHPSS care, particularly the mobilization of peer support, appears necessary and relevant.

Implications for rehabilitation

• In conflict settings, mental health and psychosocial support (MHPSS) needs of physical rehabilitation service users must address the combined impact of physical disability and exposure to violence.

• Physical rehabilitation service users who lacked social support prior to receiving MHPSS were more likely to report a large reduction in symptoms of depression following MHPSS.

• The study underlines the importance of social support, particularly peer support, in addressing MHPSS needs.

Keywords:

• International Committee of the Red Cross
• mental health and psychosocial support
• physical rehabilitation
• Democratic Republic of Congo
• conflict
• disability

Acknowledgements

The authors wish to thank the ICRC MHPSS and PRP teams in the DRC as well as their partners at Shirika la Umoja and Heri Kwetu.

This manuscript is the result of a study conducted in the framework of the International PhD in Global Health, Humanitarian Aid, and Disaster Medicine jointly organized by Università del Piemonte Orientale (UPO) and Vrije Universiteit Brussel (VUB).

Disclosure statement

No potential conflict of interest was reported by the author(s). The views expressed are those of the authors and do not necessarily represent the views, policies or decisions of their employers.