Associations of mental distress with residency in conflict zones, ethnic minority status, and potentially modifiable social factors following conflict in Sri Lanka: a nationwide cross-sectional study

Abstract

Background The subject of post-confl ict mental health lacks studies that are nationally representative or large enough to allow robust examination of levels of distress according to residency in geographical zones of confl ict and ethnic minority status. We undertook a nationwide study in Sri Lanka to address these issues. Methods We used tablet devices to survey 20 632 people across 18 of 25 districts in Sri Lanka, of which nine were purposefully selected and nine randomly selected districts. Based on their exposure to war and levels of population displacement, these districts were classifi ed as being in the severe, moderate, or minimal confl ict zones. Trained local fi eldworkers did private interviews with the participants in the local language; responses were entered directly into the tablet devices. The questions assessed exposure to a wide range of stresses, including ongoing adversities, threat or protection issues, and service access factors, and respondents provided categorical responses (yes/no) to a list of items. We used the 25-item Hopkins Symptom Checklist to measure depression and anxiety in participants. We used multivariate analysis and calculated population-attributable fractions to estimate potential improvement in mental distress if modifi able factors were addressed.