Community-Based Trauma Rehabilitation Completion and Mental Health Relapse in Post-Conflict Ethiopia: A Competing-Risks Analysis of Drought-Related Treatment Interruption

Drought shocks in post-conflict settings disrupt community-based trauma rehabilitation, yet the literature on treatment completion and relapse treats these outcomes as if they were governed by a single failure process. The framework is specified for a cohort of adults enrolled in community-based trauma rehabilitation in post-conflict Ethiopia, and the estimand is the cause-specific hazard of completion and of relapse under drought-related interruption. The central argument is that interruption is not a nuisance censoring mechanism but a competing event whose neglect biases completion estimates upward and relapse estimates downward, because participants removed from treatment during drought are systematically those with the least stable recovery trajectories. The paper derives the bias formally, specifies the subdistribution hazard that recovers the cumulative incidence of each endpoint, and identifies the conditions under which the naive Kaplan-Meier estimator and the naive cause-specific approach diverge. The contribution is a specification that makes drought-related interruption an explicit object of analysis rather than a residual, and that reframes rehabilitation completion as a conditional achievement rather than an unconditional success.