Coping strategies and depression among survivors of torture in kurdistan, Iraq

High levels of mental distress have been documented in northern Iraq decades after the perpetration of torture, genocide, and chemical warfare against Kurdish populations. The nature of coping strategies used by survivors of torture living in Kurdistan and the relationship of these strategies to symptoms of distress has yet to be systematically explored. We assessed symptoms of depression and coping among 206 survivors or witnesses of torture who met symptom severity criteria as part of a randomized evaluation of a community mental health worker led counseling intervention in the Dohuk governate of Kurdistan. Depression was measured using a locally validated version of the Hopkins Symptom Checklist. A coping index was developed based on qualitative findings, with respondents indicating how frequently they used the following strategies: praying, sitting together with others to talk, going for walks, getting advice from others, and participating in recreation or sports activities. At baseline, the mean coping index score ranged from 0 to 14 with a mean 5.79. Praying and asking for advice were the most commonly employed strategies. On average, individuals used 1 to 2 coping strategies, although almost a quarter of respondents reported use of no strategy. Depression symptoms were significantly associated with coping index score at baseline and post-intervention (p value <0.001). Findings on the longitudinal association of depression and coping will also be presented, along with an exploration of the relationship between use of coping strategies and the impact of basic counseling.