Handicap International experience in Afghanistan - CBM

Figure 12: Distribution of Persons with Disability HavingCommunication Difficulties According to Main Types of Disability9080• Physical Disability • Sensorial Disability • Mental Disability• Associated Disability • Epilepsy/Seizures706050403020100Difficulty toRememberDifficulty toTalk to OthersDifficulty toUnderstand PeopleDifficulty toMake OneselfUnderstoodDifficulty toHear ClearlyDifficulty toSee ClearlyDepression and Anxiety SignsAfter more than two decades of conflict, anxiety and depression related disorders are widespread throughoutthe country’s population. Nevertheless, the corresponding symptoms appear to be much more frequentamong the persons with disabilities. Ten items can be used to characterise these disorders: “want to staylocked up inside the house”, “feel very sad or cry without reason”, “do not feel hungry for long period oftime”, “feel afraid for no reason”, “sit for a long time thinking”, “want to live somewhere else”, “have rapidchanges of mood”, “feel oppressed for no reason”, “feel suffocated for no reason”, “feel angry and resentfulfor no reason”. In order to look at the signs, the surveyors were trained to emphasise “for no reason” aftereach item.The existenceof anxiety anddepression signsis common inthe populationof physicallydisabled andeven moreamong thesensorialcategoryFor each item, persons with sensorial or physical disabilities seem to show less signs of depression andanxiety. Yet, a significant proportion has the following signs of depression: “feeling sad/ crying without reason”(proportion of persons with sensorial and physical disability 25.0%), “sitting for a long time and thinking”(24.2% and 30.3% for the same), “feeling oppressed without reason” (28.1% and 42.8%), and “feelingsuffocated without reason” (32.3% and 42.8% respectively). The existence of anxiety and depression signs iscommon in the population of physically disabled and even more among the sensorial category. This suggeststhat not only the trauma of impairment and of its causes (war, accident, disease…) is highly affecting themental health of these people, but also that hopelessness and frustration are probably taking their toll ontheir mental health.The situation is extremely worrying for persons with mental disability, epilepsy and associated disability. Outof the ten symptoms, the proportion of persons with mental disability that have experienced them recentlyranges above 40% for all of them, and above 70% for half of them: “feel sad/cry” (74.6%), “sit and think”(79.4%), “feeling oppressed” (72.6%), “feeling suffocated” (77.8%), “feeling angry and resentful” (69.8%).While family is the major value in the Afghan culture, more than half of the people with mental or intellectualdisability would “like to live away from their family”, followed distantly by the proportion of people withassociated disability (29.1%) and people with epilepsy/seizures (21.5%). 6 out of 10 signs are presentin more than half the proportion of people with epilepsy/seizures or with associated disability: respectively68.9% and 65.5% by “feel sad/cry”, 56.3% and 69.1% by “sit and think”, 66.7% and 63.0% by “rapidchanges of mood”, 51.1% and 65.5% by “feeling oppressed”, 79.3% and 65.5% by “feeling suffocated”,48.1% and 58.2% by “feeling angry and resentful”. As for persons with epilepsy/seizures, these findingsmay indicate that a certain portion of these may also present some additional mental problems such asdepression.24 Understanding the Challenge Ahead