**3. Results**

A total of 795 participants participated in the study, and all of them responded. Men made up the majority of the 412 responders (51.8%). The responders were, on average, 21.98 (2.22) years old. Urban areas produced the bulk of responses (517, or 65.1%) (**Table 1**).



#### **Table 1.**

*Description of socio-demographic factors among people from conflict affected setting in South Ethiopia, 2021 (n = 795).*

Regarding the COVID-19-related factors, 93(11.5%) of respondents had a history of possible or proven positive for COVID-19. Out of the total respondents, 17(2.1%) had experienced death in the household and most of the respondents 598(75.2%) had Sufficient familiarity with COVID-19. With regard to clinical characteristics, 122 (15.3%) of the respondents had ever been treated for a known psychiatric illness. Of a total study participants, 150(18.9%) were khat users within 3 months. With respect to psychosocial characteristics of respondents, more than one-third of respondents 306(38.5%) had a poor social assistance (**Table 2**).

Out of the total participants, 461(57%) of participants reported aversion to safety and 358(45%) observe firing house materials around them. Whereas, more than one-third (68%) of participants family's houses were destroyed during conflict (**Table 3**). The prevalence of mental distress among conflict-affected people from conflict-affected settings were determined to be 49.4% in this study, with a 95% confidence interval of (47–52.9%). Multivariate logistic regression revealed significant correlations between respondents' mental distress and sexual assault, house fires when present, female gender, residing in the host community, and living alone, all with a P value of 0.05.

Sexual assault victims were 4.1 times more likely than their peers to experience mental distress (AOR = 4.1, 95% CI 2.37–6.94). When compared to their counterparts, people who had their homes fired upon during hostilities or war had a 3.49 higher risk of developing mental distress (AOR = 3.49, 95% CI 1.61, 5.44). Females were 3.01 times more likely than males to experience mental distress (AOR = 3.01, 95% CI 1.61–5.44). Those living in the host community were 1.8 times more likely to have mental distress (AOR = 1.8, 95%CI 1.97, 3.35), and participants living alone were 3.57 times more likely to have mental distress (AOR = 3.57, 95%CI 2.06, 6.19) (**Table 4**).

#### *COVID-19 Pandemic, Mental Health and Neuroscience - New Scenarios for Understanding…*


#### **Table 2.**

*Description of COVID related, psychosocial, clinical and behavioral factors of participants from conflict affected setting in South Ethiopia, 2021 (n = 795).*

## *Conflict Settings and COVID-19's Effects on Psychological Health DOI: http://dx.doi.org/10.5772/intechopen.107466*


#### **Table 3.**

*Trauma and conflict related events from conflict affected setting in South Ethiopia, 2021 (n = 795).*



#### **Table 4.**

*Multivariable logistic regression analysis showing an association between factors and mental distress among people from conflict affected setting in South Ethiopia, 2021 (n = 795).*

### **4. Discussion**

The prevalence of mental distress was found to be 49.4% in this study, with a 95% confidence interval of (47–52.9%) among conflict-affected people, according to the findings of this study. The prevalence found in this study resembles that found in Saudi Arabia (58.1%) [9], and Pakistan 57.6% [33]. On the other hand, the results of the present investigation were lower than those of a Pakistani study, which registered 68.4 [34]. The gap may be because of different methodologies utilized in Pakistan to conduct an online cross-sectional survey, which could have produced results that were more subjective and biased than those acquired through the in-person interviews used in this study. Financial, cultural, or environmental disparities could also have a role. Nevertheless, the prevalence found in this study was higher than that seen in earlier studies conducted in Canada 39.5% [35, 36], Malaysia 30.7% [34], China 27% [37], Croatia 19.4% [38], and Ethiopia 21.2% [6] 51.3% of the students at Addis Ababa were from Ethiopia [9], followed by Gondar 46.3% [39], 47% from students in Europe [40], and Pakistan 48% [41]. This study was conducted in a conflict-affected

environment during the COVID-19 era, however, specific participants from conflictaffected environments were not included in the earlier investigations. Each country may have a distinct level of understanding and perception of COVID-19, which measures people's capacity to cope with stress.

Participants who experienced firing house materials when present were 3.49 times more likely than those who did not experience firing household materials during the conflict/war to experience emotional distress. People, like other creatures, become anxious or terrified when exposed to or seeing a terrible scenario. The possible reason might be, the participants feel that those types of losses will be difficult, if not impossible, to replace, resulting in increased psychological distress. Also following a traumatic event like the destruction of personal property, acute stress is a typical response, if this problem persists may become a risk to develop PTSD. This finding is supported by a study done in northwestern Nigeria [42–44].

Being a female was found to be one of the strongest predictors of mental distress. Mental distress was three times more common in females than in males. According to the report, girls suffer more harm than boys because they are more likely to experience sexual assault on school property or because their parents keep them at home when the security situation deteriorates. According to research, girls usually quit school after it is full, and their educational outcomes in countries afflicted by violence are frequently worse than boys'. One of the reasons is a fear of sexual assault in the classroom [45]. During times of war, gender inequality is entrenched and women are disproportionately disadvantaged in terms of personal safety, resource access, and human rights. Girls who live in a nation that is experiencing conflict are about 2.5 times more likely to be out of school, and adolescent girls are almost 90% more likely to have dropped out of secondary school [46]. This collectively worsens people's mental health in a situation of conflict.

When compared to their counterparts, those who were living alone were 3.57 times more likely to have mental distress. These findings are in line with the studies done in Arbaminch town, Ethiopia, in Harar, and southeast Nigeria [47–50]. The answer could be that parents are more concerned about their daughters than their friends and relatives, which can reduce the likelihood of sexual abuse which in turn influences the mental health of thechildren who live with them in conflict areas during the era of COVID-19.

The odds of having mental distress among participants living in a host community due to internal displacement were 1.8 times higher as compared to their counterpart. Sexual abuse followed by mental distress in the past year and throughout the course of one's lifetime is strongly correlated with displacement. Those who have experienced displacement and living in a host community are 9–10% more likely to experience sexual violencewhich negatively influences their mental health at some point in their lives and 6–8% more likely to experience past years sexual violence [51–53].

When compared to counterparts, those who had sexual assault were 4.1 times more likely to have mental distress. The disparity could explain the observed disparities in tool, socioeconomic, environmental, and study design (in Croatia, for example, an 8-wave longitudinal study was used). In addition to the prevalence of wartime rape and sexual violence committed by people outside the home, rates of intimate partner violence are significantly higher in conflict settings [54]. For survivors of sexual and other gender-based violence, there can be a number of detrimental effects, including social ramifications and poor health [55]. A study found a considerable frequency of psychological distress and other mental issues among survivors of sexual and genderbased violence in areas of armed conflict. Anxiety disorders (including Posttraumatic

Stress Disorder (PTSD), major depressive disorder, medically unexplained problems, substance use disorders, and suicidal ideation are among the mental disorders reported [56].
