Current studies suggest relationships between sexual violence, stigma, and psychosocial functioning but cannot disentangle temporal relationships. We used longitudinal data from the Democratic Republic of Congo to fit models estimating whether stigma predicted the long-term psychosocial well-being of sexual-violence-exposed women who participated in a cognitive processing therapy trial. We found that felt stigma predicted depression and anxiety (β = 0.66, p = .005), traumatic stress (β = 0.54, p = .025), and sexual intimate partner violence (IPV; OR = 2.68, p = .044), but not other social (e.g., group membership) or violence-related (e.g., physical IPV) experiences. The results highlight the need for interventions that integrate stigma reduction alongside psychological care.
AlbuttK.KellyJ.KabangaJ.VanRooyenM. (2017). Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo. Disasters, 41(2), 211–227. https://doi.org/10.1111/disa.12202
2.
BaI.BhopalR. S. (2017). Physical, mental and social consequences in civilians who have experienced war-related sexual violence: A systematic review (1981–2014). Public Health, 142, 121–135. https://doi.org/10.1016/j.puhe.2016.07.019
3.
BartelsS.KellyJ.ScottJ.LeaningJ.MukwegeD.JoyceN.VanRooyenM. (2012). Militarized sexual violence in South Kivu, Democratic Republic of Congo. Journal of Interpersonal Violence, 28(2), 340–358. https://doi.org/10.1177/0886260512454742
4.
BartelsS. A.ScottJ. A.LeaningJ.KellyJ. T.JoyceN. R.MukwegeD.VanrooyenM. J. (2012). Demographics and care-seeking behaviors of sexual violence survivors in South Kivu province, Democratic Republic of Congo. Disaster Medicine and Public Health Preparedness, 6(4), 393–401. https://doi.org/10.1001/dmp.2012.66
5.
BassJ. K.AnnanJ.McIvor MurrayS.KaysenD.GriffithsS.CetinogluT.WachterK.MurrayL. K.BoltonP. A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine, 368(23), 2182–2191. https://doi.org/10.1056/NEJMoa1211853
6.
BassJ.MurrayS.ColeG.BoltonP.PoultonC.RobinetteK.SebanJ.FalbK.AnnanJ. (2016). Economic, social and mental health impacts of an economic intervention for female sexual violence survivors in eastern Democratic Republic of Congo. Global Mental Health, 3, Article e19. https://doi.org/10.1017/gmh.2016.13
7.
BassJ. K.RyderR. W.LammersM. C.MukabaT. N.BoltonP. A. (2008). Post-partum depression in Kinshasa, Democratic Republic of Congo: Validation of a concept using a mixed-methods cross-cultural approach. Tropical Medicine & International Health, 13(12), 1534–1542. https://doi.org/10.1111/j.1365-3156.2008.02160.x
8.
BenferN.HowellM. K.LuckstedA.RomeroE. G.DrapalskiA. L. (2023). Self-stigma and PTSD: Conceptualization and implications for research and treatment. Psychiatric Services, 74(10), 1081–1083. https://doi.org/10.1176/appi.ps.20220397
9.
BetancourtT. S.Agnew-BlaisJ.GilmanS. E.WilliamsD. R.EllisB. H. (2010). Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Social Science & Medicine, 70(1), 17–26. https://doi.org/10.1016/j.socscimed.2009.09.038
10.
BetancourtT. S.BrennanR. T.Rubin-SmithJ.FitzmauriceG. M.GilmanS. E. (2010). Sierra Leone's former child soldiers: A longitudinal study of risk, protective factors, and mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 49(6), 606–615. https://doi.org/10.1016/j.jaac.2010.03.008
11.
CascardiM. (2016). From violence in the home to physical dating violence victimization: The mediating role of psychological distress in a prospective study of female adolescents. Journal of Youth and Adolescence, 45(4), 777–792. https://doi.org/10.1007/s10964-016-0434-1
12.
ClayJ.EatonJ.GronholmP. C.SemrauM.VotrubaN. (2020). Core components of mental health stigma reduction interventions in low- and middle-income countries: A systematic review. Epidemiology and Psychiatric Sciences, 29, 1–16. https://doi.org/10.1017/S2045796020000797
13.
DeckerM. R.PeitzmeierS.OlumideA.AcharyaR.OjengbedeO.CovarrubiasL.GaoE.ChengY.Delany-MoretlweS.BrahmbhattH. (2014). Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15-19 years in vulnerable urban environments: A multi-country study. Journal of Adolescent Health, 55(6 Suppl), S58–S67. https://doi.org/10.1016/j.jadohealth.2014.08.022
14.
DossaN. I.ZunzuneguiM. V.HatemM.FraserW. D. (2014). Mental health disorders among women victims of conflict-related sexual violence in the Democratic Republic of Congo. Journal of Interpersonal Violence, 30(13), 2199–2220. https://doi.org/10.1177/0886260514552447
15.
DumkeL.van der HaerR.KoosC.HeckerT. (2021). Patterns of conflict-related trauma exposure and their relation to psychopathology: A person-centered analysis in a population-based sample from eastern DRC. SSM – Mental Health, 1, 1–8. https://doi.org/10.1016/j.ssmmh.2021.100005
EllsbergM.JansenH. A.HeiseL.WattsC. H.Garcia-MorenoC. (2008). Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: An observational study. The Lancet, 371(9619), 1165–1172. https://doi.org/10.1016/s0140-6736(08)60522-x
18.
García-MorenoC.PallittoC.DevriesK.StöcklH.WattsC.AbrahamsN. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization, London School of Hygiene and Tropical Medicine, and South African Medical Research Council. https://iris.who.int/bitstream/handle/10665/85239/9789241564625_eng.pdf?sequence=1
19.
HallB. J.BoltonP. A.AnnanJ.KaysenD.RobinetteK.CetinogluT.WachterK.BassJ. K. (2014). The effect of cognitive therapy on structural social capital: Results from a randomized controlled trial among sexual violence survivors in the Democratic Republic of the Congo. American Journal of Public Health, 104(9), 1680–1686. https://doi.org/10.2105/AJPH.2014.301981
20.
HartogK.PetersR. M. H.TukahiirwaR. K.JordansM. J. D. (2023). Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention. PLOS ONE, 18(10), 1–19. https://doi.org/10.1371/journal.pone.0292064
HatzenbuehlerM. L.PachankisJ. E. (2021). Does stigma moderate the efficacy of mental- and behavioral-health interventions? Examining individual and contextual sources of treatment-effect heterogeneity. Current Directions in Psychological Science, 30(6), 476–484. https://doi.org/10.1177/09637214211043884
23.
JaffeA. E.DiLilloD.GratzK. L.Messman-MooreT. L. (2019). Risk for revictimization following interpersonal and noninterpersonal trauma: Clarifying the role of posttraumatic stress symptoms and trauma-related cognitions. Journal of Traumatic Stress, 32(1), 42–55. https://doi.org/10.1002/jts.22372
24.
JohnsonK.ScottJ.RughitaB.KisielewskiM.AsherJ.OngR.LawryL. (2010). Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. JAMA, 304(5), 553–562. https://doi.org/10.1001/jama.2010.1086
25.
KellyJ.AlbuttK.KabangaJ.AndersonK.VanRooyenM. (2017). Rejection, acceptance and the spectrum between: Understanding male attitudes and experiences towards conflict-related sexual violence in eastern Democratic Republic of Congo. BMC Women's Health, 17(1), 1–11. https://doi.org/10.1186/s12905-017-0479-7
26.
KellyJ. T.BetancourtT. S.MukwegeD.LiptonR.VanRooyenM. J. (2011). Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: A mixed-methods study. Conflict and Health, 5(1), 1–8. https://doi.org/10.1186/1752-1505-5-25
27.
KellyJ.KabangaJ.CraginW.Alcayna-StevensL.HaiderS.VanrooyenM. J. (2012). ‘If your husband doesn't humiliate you, other people won't’: Gendered attitudes towards sexual violence in eastern Democratic Republic of Congo. Global Public Health, 7(3), 285–298. https://doi.org/10.1080/17441692.2011.585344
28.
KohliA.PerrinN. A.MpananoR. M.MullanyL. C.MurhulaC. M.BinkurhorhwaA. K.MirindiA. B.BanywesizeJ. H.BufoleN. M.NtwaliE. M.GlassN. (2014). Risk for family rejection and associated mental health outcomes among conflict-affected adult women living in rural eastern Democratic Republic of the Congo. Health Care Women International, 35(7-9), 789–807. https://doi.org/10.1080/07399332.2014.903953
29.
KohliA.ToshaM.RamazaniP.SafariO.BachunguyeR.ZahigaI.IragiA.GlassN. (2013). Family and community rejection and a Congolese led mediation intervention to reintegrate rejected survivors of sexual violence in eastern Democratic Republic of Congo. Health Care Women International, 34(9), 736–756. https://doi.org/10.1080/07399332.2012.721418
30.
KuijpersK. F.van der KnaapL. M.WinkelF. W. (2012). PTSD symptoms as risk factors for intimate partner violence revictimization and the mediating role of victims’ violent behavior. Journal of Traumatic Stress, 25(2), 179–186. https://doi.org/10.1002/jts.21676
31.
LilisL.Nina PamelaS. (2019). Relationship between sexual violence with self efficacy among female adolescent at junior high school in Tasikmalaya City. KnE Life Sciences, 4(13), 233–238. https://doi.org/10.18502/kls.v4i13.5245
MessingJ. T.La FlairL.CavanaughC. E.KangaM. R.CampbellJ. C. (2012). Testing posttraumatic stress as a mediator of childhood trauma and adult intimate partner violence victimization. Journal of Aggression, Maltreatment & Trauma, 21(7), 792–811. https://doi.org/10.1080/10926771.2012.686963
34.
MurrayS. M.AugustinaviciusJ.KaysenD.RaoD.MurrayL. K.WachterK.AnnanJ.FalbK.BoltonP.BassJ. K. (2018). The impact of cognitive processing therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: Results from a cluster randomized controlled trial. Conflict and Health, 12, 1–9. https://doi.org/10.1186/s13031-018-0142-4
35.
MurrayS. M.RobinetteK. L.BoltonP.CetinogluT.MurrayL. K.AnnanJ.BassJ. K. (2018). Stigma among survivors of sexual violence in Congo: Scale development and psychometrics. Journal of Interpersonal Violence, 33(3), 491–514. https://doi.org/10.1177/0886260515608805
36.
PetermanA.PalermoT.BredenkampC. (2011). Estimates and determinants of sexual violence against women in the Democratic Republic of Congo. American Journal of Public Health, 101(6), 1060–1067. https://doi.org/10.2105/AJPH.2010.300070
37.
ResickP. A.MonsonC. M.ChardK. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.
38.
ResickP. A.SchnickeM. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756. https://doi.org/10.1037//0022-006x.60.5.748
39.
RockA.McNaughton ReyesH. L.GoV.MamanS.PerezM.DonastorgY.KerriganD.BarringtonC. (2022). Relationships between stigma and intimate partner violence among female sex workers living with HIV: Social and economic exclusion. Violence Against Women, 29(11), 1971–1997. https://doi.org/10.1177/10778012221127722
40.
Réseau des Femmes pour un Développement Associatif, Réseau des Femmes pour la Défense des Droits et la Paix (RFDP) and International Alert. (2004). Women's bodies as a battleground: Sexual violence against women and girls during the war in the Democratic Republic of Congo, South Kivu. International Alert. https://www.international-alert.org/app/uploads/2021/09/DRC-Sexual-Violence-Against-Women-EN-2005.pdf.
41.
ScottJ.RouhaniS.GreinerA.AlbuttK.KuwertP.HackerM. R.VanRooyenM.BartelsS. (2015). Respondent-driven sampling to assess mental health outcomes, stigma and acceptance among women raising children born from sexual violence-related pregnancies in eastern Democratic Republic of Congo. BMJ Open, 5(4), 1–11. https://doi.org/10.1136/bmjopen-2014-007057
42.
StanglA. L.EarnshawV. A.LogieC. H.van BrakelW.SimbayiL. C.BarréI.DovidioJ. F. (2019). The health stigma and discrimination framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), 1–13. https://doi.org/10.1186/s12916-019-1271-3
43.
StataCorp. (2017). Stata statistical software: Release 15. In StataCorp LLC.
44.
SteinerB.BennerM. T.SondorpE.SchmitzK. P.MesmerU.RosenbergerS. (2009). Sexual violence in the protracted conflict of DRC programming for rape survivors in South Kivu. Conflict and Health, 3(1), 1–9. https://doi.org/10.1186/1752-1505-3-3
45.
StrausM. A.HambyS. L.Boney-McCoyS. U. E.SugarmanD. B. (1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17(3), 283–316. https://doi.org/10.1177/019251396017003001
46.
VerelstA.De SchryverM.BroekaertE.DerluynI. (2014). Mental health of victims of sexual violence in eastern Congo: Associations with daily stressors, stigma, and labeling. BMC Women's Health, 14(1), 1–12. https://doi.org/10.1186/1472-6874-14-106
47.
VerelstA.De SchryverM.De HaeneL.BroekaertE.DerluynI. (2014). The mediating role of stigmatization in the mental health of adolescent victims of sexual violence in Eastern Congo. Child Abuse & Neglect, 38(7), 1139–1146. https://doi.org/10.1016/j.chiabu.2014.04.003
48.
WachterK.MurrayS. M.HallB. J.AnnanJ.BoltonP.BassJ. (2018). Stigma modifies the association between social support and mental health among sexual violence survivors in the Democratic Republic of Congo: Implications for practice. Anxiety, Stress, & Coping, 31(4), 459–474. https://doi.org/10.1080/10615806.2018.1460662
