Association between Human Rights Violations, Hunger, and Depression in Chin State, Burma

Objectives: Physicians for Human Rights conducted an evaluation of depression, household hunger, and human rights violations in a representative population of Chin State, Burma in 2009. Methods: A three-staged systematic household sampling strategy reached 621 households and recorded cumulative exposure to forced displacement, forced labor, destruction/theft of food supplies and other human rights violations (HRVs) during the preceding 12 months. Crude and adjusted prevalence rate ratios for the co-primary outcomes of depression (Patient Health Questionnaire 2) household hunger (FANTA-2 questionnaire) were estimated using generalized linear models. Results: Cumulative exposure to HRVs demonstrated strong, dose-response relationships with both depression and household hunger. Compared to households that did not report exposure to any HRVs, households experiencing 2, 4 and 6 HRVs were 2.7 (95%CI 1.1-6.3), 4.2 (95% CI 1.7-10.2) and 5.8 (95% CI 2.4-13.8) times more likely to suffer from household hunger, respectively. Households reporting exposure to 4 and 6 HRVs were 2.1 (95% CI 1.1-4.1) and 3.3 (95%CI 1.7-6.4) times more likely to report moderate to severe depression. Associations with HRVs persisted for both outcomes after adjusting for potential confounders including rural residence, destruction of crops by pests, and hunger/depression. Conclusion: Exposure to HRVs is common despite longstanding ceasefire agreements and is positively and cumulatively associated with household hunger and depression. Our findings contribute to a growing body of evidence linking HRVs to food insecurity and mental health outcomes. Organizations providing food aid in populations affected by HRVs may consider screening aid recipients for depression and partnering with mental health professionals.