The mental health burden of cumulative trauma in a setting of chronic insecurity: a large community-based study in the Eastern Democratic Republic of Congo

Background The Democratic Republic of the Congo (DRC) has faced decades of socio-political instability and armed conflict. Populations have been exposed to repeated trauma on a massive scale, in an environment marked by poverty, forced displacement, and collapsing public services. Few studies have documented the psychological consequences of this cumulative trauma. This study aims to: (1) measure the prevalence and severity of Post-Traumatic Stress Disorder (PTSD), depression, and anxiety; (2) examine suicidal thoughts and behaviours; (3) assess the association between cumulative trauma exposure and sociodemographic factors with mental health. Methods Data were drawn from the first wave (2024) of the Psycavi longitudinal project in North Kivu. The sample included 1629 adults recruited from the community and the University of Goma. Face-to-face interviews in French and Swahili used validated instruments (PCL-5, PHQ-9, GAD-7, LEC). Descriptive statistics, mixed-effects models, and dominance analyses were used to examine associations between trauma exposure, sociodemographic factors, and mental health outcomes. Findings Psychological disorders were highly prevalent: 41% probable PTSD, 34% depression, and 23% anxiety. Suicidal thoughts were reported by 24% of participants. Cumulation of trauma exposure (mean = 6.8 different event types) was most strongly associated with mental health outcomes, showing a dose–response relationship. Interpretation Among the communities sampled in North Kivu, mental health appears substantially compromised, highlighting the burden of accumulated trauma in a context of prolonged insecurity. Findings underscore the urgent need to strengthen psychological support and integrate mental health into both humanitarian and long-term stabilization responses. Funding Funding for this study was awarded by the Social Sciences and Humanities Research Council of Canada, though the Partnership program.