Psychiatric morbidity among adult sexually abused females attending Nairobi Women's Hospital, Kenya

Abstract

A cross-sectional study of 116 sexually abused females aged 18 years and above attending Nairobi Women's Hospital (NWH) was carried out to determine Psychiatric Morbidity (PM). The following instruments were used: a socio-demographic data and sexual abuse situation variables questionnaire, the Self Rating Questionnaire, revised version of the Impact of Event Scale (IES-R) and the Standard Psychiatric Interview (SPI). Clinically those who were found to be psychologically impaired were introduced tot he hospital's psychiatric services. Data collected was analyzed using the SPSS version 10. The results were presented in tables and figures. The main findings were: • The psychiatric morbidity was found to be 74.1 %., which was higher than that noted in similar studies conducted in the developed world (43-61) %. • The following were significantly associated with PM: 1. Number of previous sexual partners, 2. Whether the survivor generally enjoyed sex or not 3. Psychological and medical interventions in last six months, 4. Type and number of abuser, 5. Place of sexual abuse 6. Whether the meeting was planned, 7. Possession of weapon by abuser 8. Survivors defense against the attack 9. The survivor's feeling like being killed, fear panic and completely helpless. 10. DSM IV Axis I Diagnosis was also statistically associated significantly with development of PM.

The other factors such as religion, marital status and highest level of education attained were found to be not statistically significant. • The two instruments used (SRQ and IES-R) were positively correlated and found to be measuring different pathology because they picked positivity differently. • Majority of those who scored positive with SRQ 74/86(85.8%) met criteria for an axis I Disorder according to DSM IV. • According to DSM IV diagnosis, most of the sexual abuse survivors suffered from Acute Stress Disorder (ASD) 29/74 (39.2%) and Post Traumatic Stress Disorder (PTSD) 25/74 (33.8%) more than the other PMs. In conclusion, from the research finding a person was most likely to be sexually assaulted if she was a female aged between 1 8 and 29 years, single with post primary education, while on the roadside, one who was not sexually active and had not been previously abused sexually. The survivor usually felt like she was going to be killed, mostly overwhelmed by the attack, was unlikely to resist the attack and could not believe t hat such a thing had happened to her. The abuser was most likely to be unknown to the sexual abuse survivor, was usually alone, without any weapon and not under the influence of alcohol or other substances of dependence. The risk factors for developing psychiatric morbidity after sexual abuse found in this study include; Being single When sexually abused by more than one person While on the roadside Having been previously sexually abused Being a Muslim Night sexual abuse Being sexually abused on Thursday and Friday.

The fact that the PM rates among the sexually abused females attending the NWH for counseling and medical attention was found to be higher than that found in the developed world warrants the need for specialized psychiatric services for this group. However, a similar study with control group is deemed to be necessary in order to compare and confirm t he findings in this study, as the present study is a primer not only in this country but the geographical region at large. The future research in this field should aim at identifying best approach in dealing with the PMs. This will assist in unraveling the long term course and hence recommend cost effective preventive and management methods for this condition in our locality and beyond.