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Table 1 Description of included studies

From: A scoping review of the associations between mental health and factors related to HIV acquisition and disease progression in conflict-affected populations

Primary author and Year Country Study design Sampling strategy Sample size and participation rate Participant characteristics
Mental health and HIV serostatus/HIV-related outcomes
Adedimeji et al., 2015 Rwanda Cross-sectional
Baseline data from 2005 RWISA prospective cohort
Non random selection
HIV+ and HIV- women approximately 50% of whom experienced rape during the genocide
N = 928
99% of N = 936 included
Women over age 15 who experienced the 1994 genocide, 76% HIV+
20.5% < 30 years
48.4% 30–40 years
31.1% 40+ years
100% female
Adler et al., 2011 USA Time-series
Time 1: 4 months after return from deployment
Time 2: 4 months later
Non random selection
Part of a larger study on post deployment transition
N = 647
39% of N = 1651 included who completed both assessments
Active duty USA soldiers in a brigade combat team who had returned from a 15-month deployment in Iraq
Age not reported
96% male
4% female
Kinyanda et al., 2012 Uganda Cross-sectional
Nested in study on HIV-related psychiatric & psychosocial vulnerabilities in war-affected community
Random selection
Multistage sampling to include vulnerable and non-vulnerable individuals
N = 1560
98.5% of N = 1584 included who completed the interview
Vulnerable (widows, orphans, single mothers) and non-vulnerable individuals in a war-affected community
Aged 15 years and older
56% were aged between 18 and 44 years
43% male
57% female
Kinyanda et al., 2016 Uganda Cross-sectional
Nested in study addressing HIV-related psychiatric and psychosocial vulnerabilities in the war-affected community
Random sampling
Multistage sampling for representative sample of vulnerable and non-vulnerable individuals
N = 1110
71.2% with complete data included of N = 1560
Vulnerable (widowed, divorced, orphan, suffered torture, mental illness, etc.) and non-vulnerable individuals in a war-affected community
Aged 15 years and older
56% were aged between 18 and 44 years
43% male
57% female
Malamba et al., 2016 Uganda Cross-sectional
Baseline data from a longitudinal cohort study to determine HIV prevalence and risk factors to inform program development
Random selection
Two-stage stratified sampling for representative sample
N = 2388
97.5% who had HIV results included of N = 2449 consenting individuals
Conflict affected individuals aged 13–49
29.1% 13–19 years
20.2% 20–24 years
19.6% 25–29 years
12.4% 30–34 years
18.6% 35+ years
40% male
60% female
Svetlicky et al., 2010 Lebanon Cross-sectional
Collected 6 months post-conflict, collected for 4 months.
Non random selection
Combat reserve soldiers who sought treatment in the Combat Reaction Unit in the wake of the Second Lebanon War
N = 180
65.7% of N = 274 included who completed questionnaires
Mean age = 29.95 years (SD = 5.82; range = 20 to 54 years).
100% male
Most were Israeli-born (82.8%)
Talbot et al., 2013 Rwanda Time-series
Collected at baseline, 5, 9, and 12 months
Random selection
Orphans selected via random number generation from a list of all eligible orphans enrolled in program
N = 120
95% of N = 120 completed all 4 assessments; all participants were included in analysis
94% were orphaned from the genocide
Mean age = 18 years (range 15–25)
Male 47%
Female 53%
B.E. Cohen et al., 2012 USA Retrospective cohort
From a roster of all USA veterans from 2 operations
Non random selection
Separated USA veterans who were new users of Department of Veterans Affairs healthcare
N = 71,504 Veterans of Operations Enduring and Iraqi Freedom
Mean age = 28.5 to 29.5
100% female
Sexual violence and mental health outcomes
Amone P’Olak et al., 2013 Uganda Cross-sectional
Baseline data nested in a before and after study
Random selection
War-affected youth who had been abducted and lived in rebel captivity for at least 6 months
N = 539
83% of N = 650 who were invited to the study
Aged between 18 and 25 years
61% male
39% female
86% Acholi ethnic group
Roberts et al., 2008 Uganda Cross-sectional Random selection
Multi-stage cluster sampling of camps, administrative zones, and individuals
N = 1210 Adults living in camps for internally displaced persons
Mean age = 35.3 years
40% male
60% female
91% Acholi ethnic group
Nakimuli-Mpungu et al., 2013 Uganda Time series
Collected at baseline, 3, and 6 months
Non random selection
Analysis included only adults with a history of war-related traumatic experiences
N = 375
59% of N = 631 included who were present for at least 2 visits
Demographic data reported all patients N = 2868, many of whom were not included in the main analysis
Mean age adult men = 34.5
Mean age adult women = 37.3
47% male
53% female
Okello et al., 2007 Uganda Case control
Cross- sectional, unmatched
Cases were formerly abducted youth
Controls were non abducted youth
Random selection
Systematic recruitment, every 3rd name at 2 sites: a children’s support organization (case) and a mixed boarding school (control)
N = 153
Formerly abducted
N = 82
Non-abducted N = 71
War affected adolescents
Boys mean age = 15.5 years
Girls mean age = 15.2 years
Cases: 64% male; 36% female
Controls: 61% male; 39% female
100% of controls in secondary school, 12.2% of cases in secondary school
Betancourt, Agnew-Blais et al., 2010 Sierra Leone Prospective cohort
Collected at baseline and time 2
Non random selection
Two stage method: 1) master list of youth in care 2) Invited youth between ages 10–18 with contact information
N = 152
60% of N = 260 interviewed at both times
Former child soldiers
Mean age = 17.4 years
89% male
11% female
Betancourt et al., 2011 Sierra Leone Cross-sectional
Partially nested in a longitudinal study
Non random selection
Longitudinal participants from those who participated in one follow up visit, new participants recruited with NGO outreach lists
N = 273
N = 146 from longitudinal study and
N = 127 newly recruited for study (50% male, 50% female)
Former child soldiers
Mean age = 16.55 (SD 2.61)
71% male
29% female
Betancourt, Borisova et al., 2010 Sierra Leone Prospective cohort
Collected at baseline and time 2, approximately 2 years later
Non random selection
Two stage method: 1) master list of youth in care 2) Youth aged 10–18 who did not have a severe disability participated
N = 156
60% of N = 260 interviewed at both times
Former child soldiers
Mean age = 15.13 years
88% male
12% female
Betancourt, Brennan et al., 2010 Sierra Leone Prospective cohort
Collected at baseline (2002), time 2 (2004), and time 3 (2008)
Non random selection
Sample from a master list of youth assisted by program. Youth aged 10–17 with contact information invited to participate.
N = 260
56.5% (N = 147) assessed at time 2
68.8% (N = 179) assessed at time 3
Former child soldiers
Mean age at time 1 = 15.13 (SD = 2.22)
89% male
11% female
Johnson et al., 2008 Liberia Cross-sectional Random selection
Population based multi stage random cluster of households
N = 1666
98.2% of N = 1696 attempted interviews
Adults in Liberia; 1/3 were former combatants
Mean age = 41 years
47.2% male
52.8% female
Johnson et al., 2010 Democratic Republic of Congo Cross-sectional Non random selection
Accessible population based cluster (some originally selected villages were inaccessible due to weather and security concerns)
N = 998
98.9% of N = 1005 households surveyed
Adults in conflict-affected provinces and districts
Mean age = 40.1 years
40.6% male
59.4% female
Johnson et al., 2014 Kenya Cross-sectional Random sampling
Systematic sampling of 90 villages and 10 households to assess election-related violence
N = 916
95.8% of N = 956 households samples
Adults in Kenya
Mean age = 37.3 years
40% male
60% female
Cardozo et al., 2000 Kosovo Cross-sectional Random selection
Two-stage cluster sampling
N = 1358
Only women included in relevant analysis, N = 825
Kosovar ethnic Albanians aged 15+ years
45.3% 15–34
34.1% 35–54
10.9% 55–64
9.7% 65+
37.7% male
62.3% female
Sabin et al., 2003 Guatemalan refugees living in Mexico Cross-sectional Non random selection
Convenience sample of 5 camps; all households sampled in 4 camps, every 3rd house in 1 camp
N = 170
93% of N = 183 households
Adults and children in Mayan refugee camps
Mean age = 37.9 years
42% male
58% female
Wolfe et al., 1998 USA Retrospective cohort
Nested in longitudinal study. Baseline within 5 days of return from deployment, time 2 18–24 months later.
Non random selection
Included women who completed the mailed sexual harassment questionnaire
N = 160
66.7% of N = 240 women assessed at baseline
Returned veterans of the Persian Gulf War
Mean age = 28.2 years (SD = 6.8)
100% female
Washington et al., 2013 USA Cross-sectional
Pertinent result presented as case (PTSD) control (no PTSD)
Random selection
Population-based stratified sample
Included those who completed the PTSD screener
N = 3598
99.6% of N = 3611
Veterans who had been called to duty
Mean age = 46.8 (SD = 17.3) for PTSD positive and 57.4 (SD = 17.0) for PTSD negative women
100% female
Kang et al., 2005 USA Case control
Nested data from a population based survey
Cases: PTSD
Controls: did not meet criteria for PTSD
Random selection
Stratified sample to include each subgroup of military personnel
N = 11,441
76.3% of N = 15,000 sampled
Gulf War veterans
Mean age:
Females: with PTSD = 39.1; without PTSD = 38.1
Males: with PTSD 40.4; without PTSD 39.6
81.4% male
18.6% female
HIV acquisition/disease progression and mental health outcomes
Epino et al., 2012 Rwanda Cross-sectional
From a prospective cohort
Non random selection
Patients from clinics
N = 610 HIV-positive adults who initiated lifelong ART
Mean age = 38 (SD = 10)
38% male
62% female
Mean CD4 count =214 (SD = 92)
Mugisha, Muyinda, Wandiembe et al., 2015 Uganda Cross-sectional
Baseline data from a project delivering a kinship intervention for post-conflict mental health
Random selection
Two-stage cluster sample stratified at the sub-county
N = 2361
98% with complete data of N = 2406
Adult residents of 3 of the most war affected districts
23.5% 18–24 years
27.3% 25–34 years
20.8% 35–44 years
28.5% 45–54 years
37.5% male
62.5% female
Mugisha, Muyinda, Malamba et al., 2015 Uganda Cross-sectional
Nested in project delivering a kinship intervention for post-conflict mental health
Random selection
Multistage sampling for a representative sample from 3 districts
N = 2361
98% who had complete data included of N = 2406
Adult residents of 3 of the most war affected districts
23.8% 18–24 years
27.1% 25–34 years
20.7% 35–44 years
28.4% 45+ years
37.5% male
62.5% female
Muldoon et al., 2014 Uganda Cross-sectional
From a larger community-based study of sex workers
Non random selection
Recruited through peer/sex worker led outreach in bars and hotels, and community-led outreach to former IDP camps
N = 129 Formerly abducted by the Lords Resistance Army
Median age = 22 years (IQR:20–26)
100% female
96.1% from Acholi tribe
M.H. Cohen et al., 2009 Rwanda Cross-sectional
Baseline data from a prospective cohort study
Non random selection
Mainly recruited by Rwandan women’s associations
N = 850
91% of N = 936 with available mental health data
HIV-positive and HIV-negative women
About half of each group experienced genocidal rape
Mean age = 36.4
100% female
M.H. Cohen et al., 2011 Rwanda Prospective cohort
Baseline, 6, 12, and 18 months later
Non random selection
Recruited from Rwandan women’s associations and HIV clinics in Kigali
N = 698
74.6% of N = 936 who completed baseline HTQ and at least 1 post-baseline HTQ
HIV-positive and HIV-negative women
50% of each group experienced genocidal rape
Mean age = 36.7 (SD = 8.3)
100% female
Other associations between mental health and HIV acquisition and disease progression
Gard et al., 2013 Rwanda Cross-sectional
Baseline data nested in a prospective cohort study
Non random selection
Recruited Rwandan women’s associations and clinical sites for HIV patients
N = 922
98.5% of N = 936 women who completed the Health-Related Quality of Life measure
HIV-positive and HIV-negative women
50% of each group experienced genocidal rape
20.8% under 30 years
48.4% aged 30–40 years
30.8% over 40 years
100% female
Kohli et al., 2014 Democratic Republic of Congo Cross-sectional
Baseline data from a randomized community trial
Non random selection
Included if provided family rejection information and had experienced at least 1 traumatic event in the past 10 years
N = 315 Conflict-affected adult women
1.9% 16–19 years
14.6% 20–24 years
28.25% 25–34 years
22.54% 35–44 years
29.52% 45–60 years
3.17% over 60 years
100% female
Sinayobye et al., 2015 Rwanda Cross-sectional
Baseline data from 2005 RWISA prospective cohort
Non random selection
HIV+ women, approximately 50% of whom experienced rape during the genocide
N = 710 HIV+ women over age 15, ART naïve
Mean age = 34.9 ± 7.0
100% female
  1. ART Antiretroviral therapy, HIV Human Immunodeficiency Virus, HTQ Harvard trauma questionnaire, IDP Internally displaced person, PTSD Post traumatic stress disorder, USA United States of America