Community perceptions of mental distress in a post-conflict setting: A qualitative study in Burundi

Abstract

There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.

Keywords:

• mental health
• distress
• qualitative
• developing country
• post-conflict

Acknowledgements

Itziar Familiar received the Global Heath Research Fund Award from the Johns Hopkins Center for Global Health to carry out this study. Special thanks to the people and institutions that made this assessment possible. Thanks to Yves Boyi and Menard Ntiyoberwa, who did a superb job as interviewers, translators and fieldwork assistants. Thanks to HNTPO Headquarters and the staff at HNTPO-Burundi for their interest and support in this project. Thanks to Wietse Tol for providing methodological guidance and agency. Finally, we are grateful to the communities in Burundi that participated in the interviews.