Systematic human rights violations scale. A 23-item scale measuring systematic human rights violations against Rohingya communities in Rakhine State was developed by researchers.a This measure was based on information from focus groups and key informants, including Rohingya community leaders, and was cross-referenced with existing reports regarding human rights violations occurring in Rakhine State [13]. Respondents were instructed to answer questions based on the experience of Rohingya people in Rakhine State in the last six years. The scale is intended to measure individual perceptions of the experiences of Rohingya communities in Rakhine State as a whole. Although Rohingya have experienced persecution in Myanmar for generations, the timeframe of six years was selected to capture increasingly rigid restrictions beginning in 2012. This was also based on an assumption that memories for relatively recent events would be more accurate than reports of restrictions occurring many years earlier. Individual items referred to specific restrictions in Rakhine, yoked to examples (e.g., “were Rohingya people in Rakhine State blocked from travelling freely, for example, not being able to travel from one township to another without authorization or permission?”). Response options ranged from 1 (not at all) to 4 (extremely). Individual items included restrictions on: citizenship, documentation, voting, using the name ‘Rohingya’, religious practices, travel, education, working, holding government positions, accessing medical services, accessing legal services, meeting in groups, marriage, childbirth, building/repairing homes, expressing feelings/thoughts, pressure to accept unwanted documentation, and ‘not receiving the same protection and rights as others’. Cronbach’s ⍺ indicated acceptable internal consistency (.74). As a result, human rights violations, with the exception of “receiving the same rights as others” and “protected by security forces” were combined to create a sum score of systematic human rights violations.b
Trauma events inventory. A 38-item Trauma Events Inventory, previously used with Rohingya refugees and based on the Harvard Trauma Questionnaire (HTQ) was adapted for use in this study [9, 14]. The adaptation process included the addition of a few items based on literature review and focus group discussions. The new items reflected specific events that some Rohingya experienced during the most recent wave of violence, for example witnessing the destruction/burning of villages. Respondents were asked to indicate if they had “experienced any of the following events” during their lifetime. They were asked to indicate ‘‘yes’’ or ‘‘no’’ for each item, and to share whether the event took place in Myanmar, Bangladesh, or both. In contrast to the human rights violations scale, participants were asked to endorse items that they experienced directly. A total sum score of trauma events was calculated based on responses.c
Daily stressors. This scale includes 25 items measuring daily stressors in Bangladesh in the last month and (ever) in Myanmar. Most items were taken from the Humanitarian Emergency Settings Perceived Needs Scale (HESPER) [15]. Two items about harassment by security forces and the local population were also added based on piloting and focus group discussion. Participants were asked if they had a serious problem with. . . (food, water, shelter, etc.). Response options included “yes” or “no.” The 12 stressors included food, water, shelter, sanitation facilities, income, physical health, safety, education, fair access to aid, travel, harassment by police, and harassment by locals. A total environmental stressors score was calculated using the sum of the number of stressors endorsed.
PTSD scale. This scale includes 16 items pulled from the PTSD symptom subscale of the Harvard Trauma Questionnaire (HTQ) [14]. Participants were asked how much these symptoms had bothered them in the previous week, with response options ranging from 1 (not at all) to 4 (extremely). Cronbach’s ⍺ indicated good internal consistency (.94). A total symptom severity score was calculated by averaging all items in the scale for each participant.
Depression and anxiety scales. This scale includes 29 items, 25 of these are from the anxiety and depression scales of the 25 item Hopkins Symptoms Checklist (HSCL-25), including ten anxiety symptom items and 15 depression symptom items [14]. An additional four items were developed by investigators based on focus group feedback: “bodily pain from distress/tension,” “feeling humiliated/subhuman,” “feeling disrespected,” and “feeling helpless.” The bodily pain item was included in the anxiety scale, but the remainder of the investigator-created items were examined individually. One item regarding suicidal ideation, “thoughts of ending life,” was removed from analysis due to apparent interviewer effects.d Response options for all items ranged from 1 (not at all) to 4 (extremely). Cronbach’s ⍺ indicated good internal consistency for both depression (.92) and emotional distress (.96) subscales. An emotional distress symptom score was calculated by averaging depression and anxiety items.
Functioning. This investigator-developed scale includes a total of five items. Four items focus on difficulties in daily functioning in the previous two weeks, and one item focuses on respondent perception of the reason for the difficulties (“physical health,” “mental health,” “current living situation,” or “other’’ with an option to explain; more than one response option could be selected). Four items were created following focus group feedback about typical daily tasks. Two of these items are typically gender specific, so separate examples were created for men and women. Response options for all items ranged from 1 (not at all) to 4 (extremely).
Results.e Data analysis was conducted using IBM SPSS software. Mean imputation was used to address missing data, in order to retain power and avoid potential bias that can occur with list-wise deletion of data [16]. Mean imputation was used on relatively few items, on average less than one item per survey (0.65). In cases where large amounts of data were missing (an entire scale, or several items on a scale), no mean imputation was used, instead the entire scale in question was excluded from analysis. Analysis of the data was conducted both with and without mean imputation. Mean imputation did not change the direction of any of the primary findings.f A few extreme outliers (more than 3.0 standard deviations from the mean) were Winsorized to the nearest score within 3.0 SD above/below the mean [17]. These adjustments did not change the pattern of any of the primary findings, so results are reported with outliers modified.
For open-ended qualitative survey responses two coders worked with the data. Two rounds of reviews of responses were conducted, resulting in a set of standardized categories. Qualitative responses were then sorted into these categories by the two coders and analyzed. Responses that were unclear or unintelligible were categorized as unspecified “other.” Following the completion of the coding, thematic categories were analyzed for frequency.
Specific regression models were investigated based on theoretical frameworks linked to previous research with Rohingya, in addition to focus group discussions and key informant interviews and taking into account initial correlations between variables of interest. Models examined predictors of mental health outcomes, functioning, and desire to return to Myanmar. In determining the most parsimonious set of final ‘predictor’ variables in each model, typically only those with a beta greater than .1 were included. The exception to this was for some variables that have a strong theoretical basis for inclusion (e.g., trauma history and PTSD symptoms).
Following these initial analyses, focus group discussions were held with Rohingya field researchers to cross-check and assist in interpretation of findings.
Demographics
Of the total households selected for inclusion, 168 (34%) were either not home or did not have an eligible respondent to complete the survey (often due to being a minor headed household, or because eligible respondents were not at home). In addition, 13 eligible respondents declined to participate in the survey. The final sample of participants included 264 women (53.3%) and 231 men (46.7%), which closely matches the camp population gender breakdown of 55.9% women and 44.1% men.
Table 1 HERE
Table 1
Number of camp blocks sampled | 33 |
Total sample size | 495 |
Household Inclusion | |
Households selected for inclusion that were not able to participate | 168 |
Households that declined to participate | 13 |
Gender | % |
Female | 53.3% |
Male | 46.7% |
Age | Years |
Minimum | 18 years |
Maximum | 75 years |
Mean | 36 years |
Median | 34 years |
Time since arrival in Bangladesh | Months |
Mean | 18 months |
Period of arrival | % |
Pre-October 2016 | 4.2% |
Between October 2016 and August 2017 | 4.4% |
Post August 2017 | 91.3% |
Country of birth | N |
Myanmar | 493 |
Bangladesh | 2 |
Township of origin | % |
Maungdaw | 66.3% |
Buthidaung | 28.4% |
Rathedaung | 4.7% |
Kyauktaw | 0.4% |
Sittwe | 0.2% |
Education level completed | % |
Less than primary | 64.6% |
Primary (1–4) | 12.3% |
Secondary (5–8) | 4.6% |
Tertiary (9–10) | 1.0% |
University | 0.2% |
Other/Religious education | 79% |
Religiosity (“How important are your religious beliefs to the way you live your life?”) | % |
Extremely | 99.2% |
Quite a bit | 0.4% |
A little | 0.0% |
Not at all | 0.4% |
strong>Focus group participants. The eight field researchers, who also served as focus group respondents, ranged in age from 29 to 40 years. All field researchers could speak, read, and write in multiple languages, and all had multiple years of experience working for I/NGOs in Rakhine State. Focus group data reflects experiences related to them by Rohingya participants while they were conducting the interviews.
Systematic Human Rights Violations
Table 2 HERE
Table 2
Systematic human rights violations by severity (1 = Not at all, 2 = A little, 3 = Quite a bit, 4 = Extremely)
| “Were Rohingya people in Rakhine State blocked/prevented from.. . | Average Score |
1 | Obtaining citizenship (for example were Rohingya people blocked from have the same citizenship status as other ethnic groups in Rakhine State) | 3.99 |
2 | Working in government positions | 3.99 |
3 | Obtaining official documentation (such as National Registration Card (NRC), etc.) | 3.99 |
4 | Using the name Rohingya (for example at work, school, or in front of officials, etc.) | 3.98 |
5 | Expressing thoughts and feelings (for example publicly expressing desire for changes in Rakhine State, freely speaking to the press about the situation in Rakhine, etc.) | 3.98 |
6 | Meeting in groups in public | 3.97 |
7 | Travelling (for example not being able to travel from one township to another without authorization or permission) | 3.96 |
8 | Religious practices (for example going to musjid, madrassa, burial rituals, call to prayer, etc.) | 3.96 |
9 | Voting | 3.96 |
10 | Legal Services (for example access to legal defense, court systems, etc.) | 3.95 |
11 | … Pressured to accept unwanted documentation (for example National Verification Card (NVC), or other unwanted documentation) | 3.95 |
12 | Building or repairing houses | 3.90 |
13 | Pursuing education (for example blocked from attending government schools, universities, or blocked from pursuing chosen field of study) | 3.90 |
14 | Marriage (for example by being denied authorization to marry by authorities, or charged large amounts of money for permission to marry by authorities) | 3.81 |
15 | Medical Services (for example being refused care at a medical facility, or being prevented from travelling to a medical facility for care?) | 3.80 |
16 | Working (for example prevented from accessing fields, fishing boats, etc., or prevented from going to work) | 3.78 |
17 | Having Children (for example because of restrictions on family size, difficulties legally registering new births, etc.)? | 3.65 |
18 | … Protected by security forces (for example, protected against violence from Rakhine people) | 1.14 |
19 | … Given same rights as other ethnic groups (for example did Rohingya people have the same rights and privileges as Rakhine people, Burmese people, and other ethnic groups) | 1.13 |
Response options: 1 = “Not at all”, 2 = “A little”, 3 = “Quite a bit”, and 4 = “Extremely.” |
Focus groups participants (Rohingya field researchers) provided clarity on the extent and nature of these restrictions. For example, being ‘blocked from marriage’ (3.81) was primarily due to registration restrictions, extortion, and fear of arrest. One respondent stated that,“Even if a person is over [the age of] 18, the immigration and village administration extort money for written permission for marriage.” “If you continue getting married [without permission] you could get arrested.” Another stated, “Many people didn’t get married because they couldn’t afford it, many people would flee to Bangladesh just to get married.”
Focus group participants noted that being ‘blocked from having children’ (3.65), was primarily due to the fear of children being “blacklisted.” “Children get blacklisted if they are born outside of a registered marriage.” “Blacklisted children can’t do anything, they can’t attend school, they are not included on the official family list (official documentation that is needed for several different aspects of life in Rakhine), they can’t open a business or travel.”
Trauma Events
Table 3 HERE
Table 3
| Bangladesh | Myanmar |
Average number of trauma events experienced by Rohingya refugees in Bangladesh and Myanmar | 1.0 | 19.4 |
Trauma event endorsement rate | | |
Exposure (i.e., hearing and/or seeing) to frequent gunfire | 1.6% | 98.6% |
Witnessed destruction/burning of villages | 2.0% | 97.8% |
Repeatedly exposed to violent images against Rohingya on websites (i.e., Facebook, RVision, TV, WhatsApp, etc.) | 88.7% | 95.3% |
Forced to do things against religion (e.g., eat pork, remove cap/niqab/veil, burn/cut beard, etc.) | 0.0% | 94.9% |
Threats against your ethnic group | 0.6% | 93.3% |
Home destroyed | 0.6% | 93.1% |
Witnessed dead bodies | 2.8% | 91.8% |
Witnessed physical violence against others | 1.4% | 90.4% |
Confiscation/looting of personal property | 1.2% | 88.2% |
Murder of extended family or friend | 0.2% | 86.2% |
*Follow-up to above item: Family member was killed by security forces | N/A | 100.0% |
Threats against you or your family | 1.6% | 83.7% |
Forced to flee under dangerous conditions | 0.4% | 83.7% |
Extortion (i.e., paying money due to force or threats) | 2.8% | 83.1% |
Forced to hide because of dangerous conditions | 1.0% | 75.5% |
Death of family or friends while fleeing or hiding (e.g., not from violent injury like shooting or stabbing, but because of illness, lack of food, drowning etc.) | 2.0% | 70.6% |
Witnessed sexual violence/abuse of others | 0.8% | 67.3% |
Unjust detainment | 1.4% | 63.3% |
Present while security forces forcibly searched for people or things in your home (or the place where you were living) | 1.2% | 56.9% |
Torture (i.e., while in captivity you received deliberate and systematic infliction of physical or mental suffering) | 1.4% | 55.5% |
Forced labor (i.e., forced to do work that you could not decline, for example, patrolling, working for security forces, etc.) | 0.2% | 48.6% |
Beaten by non-family member | 1.6% | 46.1% |
Turned back while trying to flee | 0.2% | 46.1% |
Sexual abuse, sexual humiliation, or sexual exploitation (e.g., coerced sexual acts, inappropriate touching, forced to remove clothing, etc.) | 1.0% | 33.3% |
Murder of immediate family member (i.e., father, mother, sister, brother, husband/wife, or children) | 0.0% | 29.5% |
*Follow-up to above item: Family member was killed by security forces | N/A | 99.3% |
Physical injury from being intentionally stabbed or cut with object (e.g., knife, axe, sword, machete, etc.) | 1.8% | 29.4% |
Disappearance of family member | 0.2% | 19% |
Beaten by spouse or family member | 3.0% | 14.5% |
Other serious physical injury from violence (e.g., shrapnel, burn, landmine injury, etc.) | 0.2% | 9.2% |
Forced Abortion (only female) | 0.0% | 5.4% (of female respondents) |
Physical Injury from being shot (bullet wound) | 0.2% | 5.1% |
Rape by security forces (i.e., forced to have unwanted sexual relations with security forces)g | 0.0% | 1.6% |
Rape by others (i.e., forced to have unwanted sexual relations with a stranger, acquaintance, or family member) | 0.0% | 1.2% |
Regarding torture (endorsed by 55.5% of respondents), focus group respondents commented that torture has been a common practice by security forces in Northern Rakhine, “[If] any Rohingya were arrested, they tortured [them] to get anything they wanted them to say, as well as to get money.” “The norm of being taken into custody for the Rohingya includes being beaten with a rod.”
Forced abortion was endorsed by 5.4% of female respondents. Focus group respondents stated that women felt forced to get an abortion due to fear of violating the two-child policy enforced on Rohingya living in Rakhine, “One woman knew that her family lists would be checked, and she was pregnant with her third child. She was afraid of being arrested and tortured, so she got an abortion.” Focus group respondents reported that this was related to the fear of having children that would be blacklisted and therefore barred from registration, education, livelihood opportunities, etc.
Violence of a religious nature in Rakhine was also endorsed, “Forced to do things against religion” (94.9%). Focus group respondents commented on some of the specific ways this occurred; “While a Rohingya cross[es] the check post on the way, Rohingya mullahs are forced to take off their caps from heads and women to take off their veils or niqab.” Another respondent commented that “Myanmar security forces always enter into the mosques and urinate inside, tear the Quran and other religious books.” “Rohingya people on pilgrimage are often abused physically and their beards are burnt after they are arrested.”
Daily Stressors
Table 4 HERE
Bangladesh Daily Stress: "During the past month have you had a serious problem. . ."
|
%
|
Myanmar Daily Stress: “In Myanmar did you generally have a serious problem. . .”
|
%
|
“Because you do not have enough income, money, or resources to live”
|
95%
|
“Because you do not have enough income, money, or resources to live”
|
30%
|
“Food, for example, because you do not have enough food, or good enough food, or because you are not able to cook food”
|
79%
|
“Food, for example, because you do not have enough food, or good enough food, or because you are not able to cook food”
|
24%
|
“Because your family are not in school, or are not getting a good enough education”
|
72%
|
“Because your family are not in school, or are not getting a good enough education”
|
84%
|
“Move between places, for example, problems with travel due to checkpoints, extortion, being turned back while trying to travel to a place, etc.”
|
66%
|
“Move between places, for example, problems with travel due to checkpoints, extortion, being turned back while trying to travel to a place, etc.”
|
96%
|
“Suitable place to live in, for example because of inadequate shelters or amount of space”
|
62%
|
“Suitable place to live in, for example because of inadequate shelters or amount of space”
|
7%
|
“Safe access to clean toilet and sanitation facilities”
|
62%
|
“Safe access to clean toilet and sanitation facilities”
|
11%
|
“Physical health, for example, because you have a physical illness, injury, or disability”
|
62%
|
“Physical health, for example, because you have a physical illness, injury, or disability”
|
42%
|
“Water that is safe for drinking or cooking”
|
60%
|
“Water that is safe for drinking or cooking”
|
17%
|
“Fair access to the aid that is available from agencies working in the area”
|
47%
|
“Fair access to the aid that is available from agencies working in the area”
|
44%
|
“Not safe or protected where you live now, for example, because of conflict, violence or crime in your community”
|
14%
|
“Not safe or protected where you lived, for example, because of conflict, violence or crime in your community”
|
66%
|
“Harassment by the local population, for example being threatened, insulted, or extorted, etc.”
|
13%
|
“Harassment by the local population, for example being threatened, insulted, or extorted, by Rakhine, Hindu, or Dinet, etc.”
|
97%
|
“Harassment by police or security forces, for example being threatened, insulted, or extorted, etc.”
|
4%
|
“Harassment by police or security forces, for example being threatened, insulted, or extorted, etc.”
|
98%
|
Posttraumatic Stress Symptoms
Table 5 HERE
#
|
Symptom
|
Average Score
|
1
|
“Recurrent thoughts or memories of the most hurtful or terrifying events”
|
3.56
|
2
|
“Feeling as though the event is happening again”
|
3.42
|
3
|
“Feeling as if you don’t have a future”
|
2.91
|
4
|
“Recurrent nightmares”
|
2.83
|
5
|
“Feeling detached or withdrawn from people”
|
2.83
|
6
|
“Less interest in daily activities”
|
2.82
|
7
|
“Sudden emotional or physical reaction when reminded of the most hurtful or traumatic events, for example: sudden anxiety/stress or suddenly feeling heart racing, rapid breathing, etc.”
|
2.82
|
8
|
“Inability to remember parts of the most hurtful or traumatic events”
|
2.78
|
9
|
“Avoiding activities that remind you of the traumatic or hurtful event”
|
2.74
|
10
|
“Feeling on guard”
|
2.68
|
11
|
“Avoiding thoughts or feelings associated with the traumatic or hurtful events”
|
2.68
|
12
|
“Trouble sleeping”
|
2.60
|
13
|
“Difficulty concentrating”
|
2.60
|
14
|
“Feeling jumpy, easily startled”
|
2.53
|
15
|
“Feeling irritable or having outbursts of anger”
|
2.53
|
16
|
“Unable to feel emotions”
|
2.50
|
Although the PTSD subscale of the HTQ has not been validated for use with the Rohingya population, a composite cut-off score of > 2.5 on the PTSD subscale of the HTQ has typically been used to indicate scores that are diagnostic of PTSD [18]. Instructions for analysis of the HTQ recommend using this cut-off score even in populations where the scale has not been validated; however, they also warn that some individuals with scores < 2.5 could likely meet PTSD criteria [18]. Using the cut-off score of > 2.5, 61.2% of participants endorsed posttraumatic stress symptoms typically diagnostic of PTSD, with the average score for all participants being 2.80. However, these results should be considered with caution; because this instrument has not been normed and validated for use with this population other factors may explain such results (e.g. translation limitations, a tendency to over endorse items linked to resource expectations or other anticipated outcomes, interviewers encouraging endorsement of higher scores for similar reasons). However, such alternative explanations are unlikely considering steps the research team took in advance to address such concerns. In addition, issues such as stigma associated with mental health symptoms, common in Rohingya communities, suggests a bias towards under not over-endorsing of symptoms [8].
Depression And Anxiety Symptoms
Table 6 HERE
#
|
Depression Symptoms
|
Average Score
|
Anxiety Symptoms
|
Average Score
|
1
|
“Worry too much about things”
|
3.49
|
“Feeling tense or keyed up”
|
3.13
|
2
|
“Feeling sad”
|
3.40
|
“Faintness, dizziness, or weakness”
|
2.73
|
3
|
“Loss of interest in things you previously enjoyed doing”
|
3.04
|
“Bodily pain from distress/tension” (Investigator developed)
|
2.66
|
4
|
“Feeling hopeless about the future”
|
2.72
|
“Headaches”
|
2.57
|
5
|
“Feeling low in energy or slowed down”
|
2.68
|
“Nervousness or shakiness inside”
|
2.55
|
6
|
“Poor appetite”
|
2.66
|
“Feeling fearful”
|
2.52
|
7
|
“Feeling lonely”
|
2.65
|
“Heart pounding or racing”
|
2.48
|
8
|
“Feeling everything is an effort”
|
2.62
|
“Trembling”
|
2.47
|
9
|
“Feeling of worthlessness”
|
2.60
|
“Spell of terror or panic”
|
2.42
|
10
|
“Difficulty falling asleep or staying asleep”
|
2.55
|
“Feeling restless or can’t sit still”
|
2.35
|
11
|
“Crying easily”
|
2.52
|
“Suddenly scared for no reason”
|
2.25
|
12
|
“Feeling no interest in things”
|
2.34
|
|
|
13
|
“Feelings of being trapped or caught”
|
2.40
|
|
|
14
|
“Blaming yourself for things”
|
2.10
|
|
|
Response options: 1 = “Not at all”, 2 = “A little”, 3 = “Quite a bit”, and 4 = “Extremely.” |
Anxiety and depression symptom items were combined to provide a composite distress score. The higher the total score, the more likely it is that the respondent is experiencing significant emotional problems. Although the HSCL-25 has not been validated for the Rohingya population, a composite cut-off score of 1.75 for the combined anxiety and depression sub-scales has typically been used to indicate scores that are “checklist positive for some type of unspecified emotional distress” related to anxiety and depression [18].i Instructions for analysis of the HSCL-25 recommend using this cut-off score, even in populations where the scale has not been validated [18]. Using this cut-off score, 84.0% of respondents endorsed anxiety and depression symptoms typically indicative of emotional distress, with average score for all participants being 2.64. However, as mentioned above, these results should be used with caution, as this instrument has not been normed and validated for use with this population. The combined anxiety and depression subscales were used, rather than the depression subscale alone. This was done to more comprehensively capture the mental health symptoms experienced by Rohingya refugees, as represented by the high average endorsement rates of both anxiety and depression symptoms.
Table 7
Investigator developed items (1 = Not at all, 2 = A little, 3 = Quite a bit, 4 = Extremely)
# | Item | Average Score |
1 | 2.69 |
2 | “Bodily pain from distress/tension” j | 2.66 |
3 | 2.54 |
4 | 2.47 |
Response options: 1 = “Not at all”, 2 = “A little”, 3 = “Quite a bit”, and 4 = “Extremely.” |
Table 8
Percentage of respondents reaching diagnostic cutoff scores
Scale | Mental health composite score results | % |
PTSD | Respondents who scored higher than the typically diagnostic cutoff score of 2.5 | 61.2% |
Emotional Distress (Anxiety and Depression) | Respondents who scored higher than the typically diagnostic cutoff score of 1.75 | 84.0% |
Functioning
Table 9
Functioning difficulties (1 = Not at all, 2 = A little, 3 = Quite a bit, 4 = Extremely)k
# | Item | Average Score |
1 | Daily Tasks: “How difficult is it for you to perform daily tasks? For Women: For example, tasks like cooking, caring for children, carrying water, etc. For Men: For example, tasks like working to earn money, collecting items from the market, collecting firewood, etc.” | 2.87 |
2 | Hygiene: “How difficult is it for you to care for your hygiene? For example, by bathing, washing hands, brushing teeth, washing clothes, etc.” | 2.67 |
3 | Social: “How difficult is it for you to engage in social activities? For example, activities like meeting with friends or family to spend time together.” | 2.39 |
4 | Religious: “How difficult is it for you to engage in religious activities? For Women: For example, activities like praying Namaz, reciting the Quran, etc. For Men: For example, activities like praying Namaz, going to musjid, reciting the Quran, etc.” | 1.60 |
Response options: 1 = “Not at all”, 2 = “A little”, 3 = “Quite a bit”, and 4 = “Extremely.” |
Table 10
Functioning difficulties attribution
# | “What do you attribute these difficulties to?” | % |
1 | Current living situation | 71.6% |
2 | Mental health | 62.3% |
3 | Physical health | 48.2% |
4 | Specify (Lack of income, capital, opportunity) | 5.9% |
5 | Specify (Displacement, being stateless, lack of rights) | 1.8% |
6 | Specify (Monsoon season) | 1.5% |
7 | Other | 8.4% |
Prediction Models
A series of initial multiple linear regression models were conducted in order to identify the strongest predictors to be used in a final regression model. Generally, predictors were chosen that exceeded a β cutoff of .1; however, some variables with less than a β of .1 were included based on their broadly documented relationship with outcome variables, as well as their clinical and cultural significance in relation to outcome variables.
The five final models, presented here, predict –
- PTSD symptoms,
- emotional distress (anxiety and depression),
- functioning, and
- desire to return to Myanmar. l
As a reminder, the variable ‘Myanmar systematic human rights violations’ is a sum score that combines most of the items on the systematic human rights violations scale.m ‘Trauma history’ is a sum score that combines the lifetime trauma events endorsed by a respondent in both Myanmar and Bangladesh, although nearly all events endorsed occurred in Myanmar. ‘Bangladesh daily stressors’ is a sum score that combines all the daily stressors endorsed in Bangladesh in the last month, while ‘Myanmar daily stressors’ is a sum score of the same stressors, except faced when the participants previously lived in Myanmar. ‘Depression symptoms’ is the composite score of HSCL depression items,
PTSD Symptoms. The final model predicting PTSD symptoms included age, sex/gender, Bangladesh daily stressors, Myanmar daily stressors, trauma history, Myanmar systematic human rights violations, feeling humiliated/subhuman, and feeling helpless.n The full regression model was significant in predicting PTSD scores F(8, 469) = 82.05; p < .001, and R2 = .58. Older age (β = .097, p < .01), being a woman (β = − .094, p < .05), a higher number of lifetime trauma events (β = .185, p < .001), higher levels of systematic human rights violations in Myanmar (β = .095, p < .01), a higher number of daily stressors in Myanmar (β = .000, p < .05), higher levels of feeling humiliated/subhuman (β = .313, p < .001), and higher levels of feeling helpless (β = .366, p < .001), significantly predicted higher PTSD scores.
Table 11
Model 1. predicting PTSD symptoms R2 = .583, F (8, 469) = 82.05 p < .001
Variables | B | Std. Error | β | t | Sig. | 95% CI |
1. Bangladesh daily stressors | .000087 | .012 | .000 | .007 | .994 | − .023, .024 |
2. Myanmar daily stressors | .036 | .014 | .000 | 2.461 | .014* | .007, .064 |
3. Sex | − .151 | .061 | − .094 | -2.488 | .013* | − .270, − .032 |
4. Systematic human rights violations | .041 | .015 | .095 | 2.756 | .006** | .012, .070 |
5. Age | .006 | .002 | .097 | 3.147 | .002** | .002, .010 |
6. Trauma history | .038 | .007 | .185 | 5.417 | .000** | .024, .051 |
7. Feeling humiliated/subhuman | .195 | .028 | .313 | 6.885 | .000** | .139, .251 |
8. Feeling helpless | .246 | .028 | .366 | 8.807 | .000** | .191, .301 |
*p < .05, **p < .01 |
Emotional Distress (Anxiety and Depression). The final model predicting emotional distress (anxiety and depression) symptoms included age, sex/gender, Bangladesh daily stressors, Myanmar daily stressors, trauma history, and Myanmar systematic human rights violations. The full model was significant in predicting distress scores F(6, 471) = 48.47; p < .001, and R2 = .38. Older age (β = .109, p < .01), a higher levels of daily stressors in Bangladesh (β = .105, p < .01), higher levels of daily stressors previously in Myanmar (β = .337, p < .001), a higher number of lifetime trauma events (β = .341, p < .001), and higher levels of systematic human rights violations in Myanmar (β = .160, p < .001) significantly predicted higher emotional distress scores.
Table 12
Model 2. Predicting emotional distress R2 = .382, F (6, 471) = 48.47 p < .001
Variables | B | Std. Error | β | t | Sig. | 95% CI |
1. Sex | .060 | .069 | .037 | .868 | .386 | − .076, .195 |
2. Bangladesh daily stressors | .039 | .014 | .105 | 2.725 | .007** | .011, .068 |
3. Age | .007 | .002 | .109 | 2.911 | .004** | .002,.011 |
4. Systematic human rights violations | .069 | .018 | .160 | 3.890 | .000** | .034, .104 |
5. Myanmar daily stressors | .145 | .016 | .337 | 9.029 | .000** | .113, .176 |
6. Trauma history | .070 | .008 | .341 | 8.461 | .000** | .053, .086 |
*p < .05, **p < .01 |
Functioning Difficulties. The final model predicting functioning difficulties included the following predictor variables, age, sex/gender, Bangladesh daily stressors, trauma history, PTSD symptoms, and depression symptoms. The full regression model was significant in predicting functioning difficulties F(6, 483) = 66.26; p < .001, and R2 = .45. Higher number of Bangladesh daily stressors (β = .336, p < .001), higher levels of depression symptoms (β = .362, p < .001), and higher levels of PTSD symptoms (β = .140, p < .05) significantly predicted higher levels of functioning difficulty.
Table 13
Model 4. Predicting functioning difficulties R2 = .451, F (6, 483) = 66.26 p < .001
Variables | B | Std. Error | β | t | Sig. | 95% CI |
1. Age | − .004 | .008 | − .017 | − .471 | .638 | − .020, .012 |
2. Trauma history | .025 | .030 | .033 | .834 | .405 | − .034, .085 |
3. Sex | − .403 | .218 | − .065 | -1.850 | .065 | − .831, .025 |
4. PTSD symptoms | .539 | .270 | .140 | 1.996 | .047* | .008, 1.069 |
5. Depression symptoms | 1.476 | .299 | .362 | 4.939 | .000** | .889, 2.063 |
6. Bangladesh daily stressors | .482 | .052 | .336 | 9.258 | .000** | .379, .584 |
*p < .05, **p < .01 |
Desire to return to Myanmar. The final model predicting participants’ desire to return to Myanmar included the following predictor variables, age, sex/gender, Bangladesh daily stressors, Bangladesh trauma events, depression symptoms, feeling humiliated/subhuman, level of hatred for Rakhine people, and desire to live with Rakhine people. The full regression model was significant in predicting a desire to return to Myanmar. F(8, 483) = 16.48; p < .001, and R2 = .21. Being male (β = .160, p < .01), more severe depression symptoms (β = .152, p < .05), lower levels of hatred for Rakhine people (β = − .165, p < .01), and higher levels of desire to live with Rakhine people (β = .198, p < .001) significantly predicted higher levels of desire to return to Rakhine State.
Table 14
Model 5. Predicting desire to return R2 = .214, F (8, 483) = 16.48 p < .001
Variables | B | Std. Error | β | t | Sig. | 95% CI |
1. Feeling humiliated/subhuman | .003 | .040 | .005 | .076 | .939 | − .076, .082 |
2. Bangladesh trauma events | − .027 | .069 | − .016 | − .398 | .691 | − .163, .108 |
3. Age | − .002 | .003 | − .029 | − .695 | .488 | − .007, .003 |
4. Bangladesh daily stressors | .016 | .016 | .043 | 1.010 | .313 | − .015, .048 |
5. Depression symptoms | .162 | .068 | .152 | 2.399 | .017* | .029, .295 |
6. Hatred for Rakhine people | − .110 | .036 | − .165 | -3.027 | .003** | − .181, − .038 |
7. Sex | .235 | .075 | .146 | 3.128 | .002** | .087, .383 |
8. Desire to live together with Rakhine people | .137 | .037 | .198 | 3.705 | .000** | .064, .210 |
*p < .05, **p < .01 |