Perpetual Persecution: A Systematic Literature Review on Mental and Physical Health Effects of Non-Partner Violence Among Displaced Women of Burmese Descent Residing Within and Outside of Myanmar Open Access

Abstract

Background: Experience of violence has long been associated with negative physical, mental

and social health outcomes. In Myanmar, a country plagued by historic political unrest,

persecuted ethnic minority groups have long been subject to various forms of violence. The

extent to which the effect of non-partner violence on the overall health and well-being of

Burmese people has been examined remains unknown.

Methods: A systematic literature review was carried out to investigate mental and physical

health outcomes associated with non-partner physical, sexual, and/or psychological violence

among women of Burmese descent residing within and outside of Myanmar who have been

displaced due to armed conflict. Three electronic databases were searched for original peer-

reviewed studies: PSYCInfo, Embase, and PubMed.

Results: Six studies were analyzed in the final review, five of which examined health effects

among the Karen and other ethnic minorities in eastern Myanmar. One study focused on health

outcomes of the Rohingya people in western Myanmar. Symptoms of depression, anxiety, post-

traumatic stress disorder and somatization, and suicide ideation were significantly associated

with reported non-partner violence, as well as anemia and symptoms of pregnancy

complications. Significant gaps in outcomes under study were lack of prospective and

longitudinal studies, lack of studies on internally displaced persons who lack security and health

services, and missing studies on physical outcomes (i.e., non-communicable diseases,

HIV/STIs).

Discussion: This review highlights the need for investment in longitudinal studies on the

association between non-partner violence and health outcomes among persons of Burmese

descent. The drivers of suicide ideation among conflict-affected of Burmese require further

investigaton, paired with increased focus on the Rohingya and other ethnic minorities, as well as

extra attention to physical health outcomes.

Table of Contents

1. Chapter 1……………………………………………………………………………….….1 a. Introduction ……………………………………………………………………….1 2. Chapter 2 ………………………………………………………………………………….1 a. Myanmar historical and political context, and ethnic demographics……………..1 i. Figure 1: Geographical context and states of Myanmar…………………..2 b. Violence…………………………………………………………………………...7 i. Standardized definitions …………………………………………………………………………….7 ii. Studies on non-partner violence …………………………………………………………………………….8 iii. Mental and physical health impacts of violence ……………………...…10 c. Forced migration/ displacement ………………………………………………....11 i. Standardized definitions ……………………………………………..…..11 d. Mental and physical health………………………………………………............12 i. Standardized definitions ……………………………………………..…..12 e. The present study…………………………………………………..................….13 3. Chapter 3………………………………………………..………………………………..14 a. Methods…………………………………….…………………….…………..…..14 i. Literature search………………………………………………….…..…..14 ii. Conduct of search………………………………………………………..16 iii. Title and abstract relevance……………………..…………………….....16 iv. Full text review…………………………………………………………..17 v. Data extraction………………………………………………………………...1 vi. Data analysis…………………………………………………………………..18 b. Results……………………………………………………………………………1 c. Article yield……………………………………………………………………...19 i. Figure 2: PRISMA 2009 Flow Chart……………………………….……20 d. Study properties……………………………………………………………...…..20 e. Characteristics of non-partner violence victimization………………………...…22 f. Physical and mental health outcomes assessed…………………………..……....28 g. Quality assessment of studies ………………………………..…….................…34 4. Chapter 4 ………………………………………………………………………………...35 a. Discussion………………………………………………………………………..35 b. Limitations ………………………………………………………………………39 c. Conclusions………………………………………………………………………40 d. Recommendations …………………………………………………………...…..40 References……………………………………………………………………………….42 Appendix…………………………………………………………………………….…..46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health Health Sciences, Epidemiology
Keyword	physical health conflict-affected public health Bangladesh reproductive health Karen Rohingya mental health internally displaced persons Burma Rakhine health outcomes asylum seekers armed conflict migrants Myanmar civil war complex humanitarian emergency refugees
Committee Chair / Thesis Advisor	Ameeta Kalokhe, MD, MS, Emory University

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