Conflict in the Indian Kashmir Valley II: Exposure to Violence

Background:India and Pakistan have disputed ownership of the Kashmir Valley region for manyyears, resulting in high levels of exposure to violence among the civilian population of Kashmir(India). A survey was done as part of routine programme evaluation to assess confrontation withviolence and its consequences on mental health, health service usage, and socio-economicfunctioning.Methods:We undertook a two-stage cluster household survey in two districts of Kashmir (India)using questionnaires adapted from other conflict areas. Analysis was stratified for gender.Results:Over one-third of respondents (n = 510) were found to have symptoms of psychologicaldistress (33.3%, CI: 28.3–38.4); women scoring significantly higher (OR 2.5; CI: 1.7–3.6). A third ofrespondents had contemplated suicide (33.3%, CI: 28.3–38.4). Feelings of insecurity wereassociated with higher levels of psychological distress for both genders (males: OR 2.4, CI: 1.3–4.4;females: OR 1.9, CI: 1.1–3.3). Among males, violation of modesty, (OR 3.3, CI: 1.6–6.8), forceddisplacement, (OR 3.5, CI: 1.7–7.1), and physical disability resulting from violence (OR 2.7, CI: 1.2–5.9) were associated with greater levels of psychological distress; for women, risk factors forpsychological distress included dependency on others for daily living (OR 2.4, CI: 1.3–4.8), thewitnessing of killing (OR 1.9, CI: 1.1–3.4), and torture (OR 2.1, CI: 1.2–3.7). Self-rated poor health(male: OR 4.4, CI: 2.4–8.1; female: OR 3.4, CI: 2.0–5.8) and being unable to work (male: OR 6.7,CI: 3.5–13.0; female: OR 2.6, CI: 1.5–4.4) were associated with mental distress.Conclusion:The ongoing conflict exacts a huge toll on the communities' mental well-being. Wefound high levels of psychological distress that impacts on daily life and places a burden on thehealth system. Ongoing feelings of personal vulnerability (not feeling safe) was associated with highlevels of psychological distress. Community mental health programmes should be considered as away reduce the pressure on the health system and improve socio-economic functioning of thosesuffering from mental health problems.