Summary of key components of the 16 reviewed studies
| Author, year | Research question(s) | Study population | Mental health outcomes investigated | Tools used for psychological assessment related to FGM/C | Results (presence of mental health consequences for FGM/C) | Study quality |
| Ahmed et al, 201724 | What is the relationship between female genital mutilation (FGM) and psychiatric problems among adolescent girls? | Sample size: 204 (135 underwent FGM/C and 69 did not) adolescent girls ages between 14 and19 in Egypt. | Somatisation, depression, anxiety, hostility, phobic anxiety, obsessive–compulsive, interpersonal sensitivity, paranoid ideation, and psychoticism | Symptoms check list 90 (SCL-90) | This study did not stratify the results based on FGM/C type. Girls who underwent FGM/C had significantly higher scores than those in the non-FGM/C group for the following conditions: somatisation (33.5 vs 20.6), depression (31.7 vs 26.3), anxiety (32.1 vs 21.2), phobic anxiety (20.4 vs 14.6) and hostility (19.6 vs 16.4). Girls who underwent FGM/C had higher, but not statistically significant, scores than those in the non-FGM/C group for the following conditions: obsessive–compulsive (6.8 vs 6.6) and interpersonal sensitivity (5.5 vs 5.1). Both groups had the same mean score for paranoid ideation (3.8) and the non-FGM/V group had a higher mean score for psychoticism compared with the FGM/C group (3.2 vs 3.1). Further, there were significant differences in the three global distress indices between the FGM/C and non-FGM/C study groups, respectively: GSI (19.3% vs 7.2%), PSDI (16.3% vs 4.3%) and PST (17.0% vs 5.8%). | Fair |
| Akinsulure-Smith, 201429 | What are the experiences related to female genital cutting within an immigrant community? | Sample size: 23 (7 underwent FGM/C and 16 did not) women ages between 20 and 57 living in the USA. Countries of origin: Sierra Leone and Liberia. | PTSD and depression | PTSD: PTSD CheckList – Civilian Version. Depression: Center for Epidemiologic Studies Depression Scale. | This study did not stratify the results based on FGM/C type. The mean score for depression scale was higher among women who did not undergo FGM/C (37.5) compared with those underwent the practice (35.4). The mean score for PTSD scale was higher among women who underwent FGM/C (29.9) compared with those who did not undergo the practice (29.2). Both measures did not detect statistically significant differences between the two groups. | Poor |
| Applebaum et al, 200825 | What is the prevalence of PTSD symptoms and other psychiatric complaints among women who had undergone ritual female genital surgery compared with an age-matched control group of women who had not undergone ritual female genital surgery? | Sample size: 37 (19 underwent FGM/C and 18 did not) Bedouin women ages 30–81 in Israel. | PTSD, somatisation, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism | PTSD: PTSD Inventory (based on DSM) Other conditions: Symptom Checklist- 90 (SCL-90). | This study did not stratify the results based on FGM/C type. The mean PTSD symptom score was higher among the group that underwent FGM/C compared with the group that did not (57.3 vs 48.1). The mean score for obsessive–compulsive scale was also higher among those who underwent FGM/C (1.6 vs 1.4). The mean score for depression (1.8 vs 1.6), anxiety (1.4 vs 1.3) and hostility (0.8 vs 0.7) was higher among women who did not undergo FGM/C. The mean scores of the scales for somatisation (1.6), interpersonal sensitivity (1.1), phobic anxiety (0.8), paranoid ideation (0.7) and psychoticism (0.5) were similar in the two groups. Overall, all measures did not detect statistically significant differences between the two groups. | Fair |
| Behrendt and Moritz, 20057 | What is the relationship between FGM and psychiatric illnesses, especially PTSD? | Sample size: 47 (23 underwent FGM/C and 24 did not) girls and women ages 15–40 in Dakar, Senegal. | PTSD, affective disorder and anxiety. | Mini International Neuropsychiatric Interview. | This study did not stratify the results based on FGM/C type. Over 90% of the women who underwent FGM/C described feelings of intense fear, helplessness, horror and severe pain, and over 80% were still suffering from intrusive re-experiences of their circumcision. The prevalence of mental health consequences among women who underwent FGM/C was high: PTSD (30.4%), anxiety disorders (26.2%), and effective disorder (21.7%). In the control group, only one participant fulfilled the diagnostic criteria for an affective disorder. None of the women in the control group PTSD or other anxiety disorder. | Poor |
| Chibber et al, 201030 | What is the prevalence of female genital cutting among pregnant women and what is the possible association with adverse pregnancy and psychological outcomes? | Sample size: 4800 (1892 underwent FGM/C 2958 did not) girls and women ages 15–46 in Kuwait. | PTSD, affective disorder and anxiety | Mini International Neuropsychiatric Interview | This study stratified the results based on FGM/C type. Among women who underwent FGM/C types II and III, 80% continued to have flashbacks to the event; 58% had affective disorder (OR 24.6 (95% CI 1.9 to 22.2) compared with women who did not undergo FGM/C; 38% had other anxiety disorders and 30% had PTSD. None of the women who did not undergo FGM/C reported PTSD or anxiety disorders. | Fair |
| Daneshkhah et al, 201731 | What are the consequences of female circumcision on sexual function of circumcised women? Also, what is the status of FGM, its prevalence, predominant method/type of female circumcision and attitude to this practice? | Sample size: 200 (140 underwent FGM/C and 60 did not) girls and women ages 15–49 in Iran. | Somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression | The General Health Questionnaire-28 item (GHQ-28) | This study did not stratify the results based on FGM/C type. The mean score for social dysfunction (7.30 vs 7.21) and severe depression (4.87 vs 4.30) scales were higher among women who underwent FGM/C while the mean score for somatic symptoms (6.58 vs 5.99), anxiety and insomnia (6.20 vs 5.98) were higher among women who did not undergo FGM/C. Overall, none of the measures detected statistically significant differences between the two groups. | Fair |
| Elnashar and Abdelhady, 200732 | What is the rate of female genital cutting among a sample of newly married women? Also, what are the differences between women who underwent FGM those who did not regarding long-term health problems including psychological symptoms? | Sample size: 264 (200 underwent FGM/C and 64 did not) newly married women (less than 5 years) ages 15–49 in Benha city, Egypt. | Symptoms of somatisation, depression, anxiety, hostility and phobia | Symptoms check list 90 (SCL 90) | This study did not stratify the results based on FGM/C type. The mean scores of mental health symptoms were higher among the group that underwent FGM/C for all conditions: somatisation (33.2 vs 21.7), depression (30.1 vs 29.9), anxiety (31.5 vs 22.3), hostility (18.7 vs 16.9) and phobia (22.5 vs 15.3). Results of symptoms of somatisation, anxiety and phobia were statistically significant. | Poor |
| Kizilhan, 201126 | Is there an association between FGM and psychiatric illnesses, PTSD in particular? | Sample size: 140 (79 underwent FGM/C and 61 did not (30 from the same geographic area and 31 from a different area)) Kurdish girls, ages 8–14 in Northern Iraq. | PTSD, depression, anxiety, somatoform disorders, personality disorder and somatic disturbance. | PTSD: Arabic version of Child PTSD Reaction Index. Depression: Arabic version of the Children’s Depression Index The Cooper Smith Self-Esteem Inventory | This study did not stratify the results based on FGM/C type. Over 78% of the girls who underwent FGM/C described feelings of intense fear, helplessness, severe pain and horror. Over 74% were still suffering from intrusive re-experiences of their circumcision. The study reports significantly higher mean score of PTSD symptoms (44.3 vs 14.50 vs 13.61) and depression disorder symptoms (33.6 vs 11.07 vs 12.09) among girls who underwent FGM/C compared with the mean scores of the two comparison groups of girls who did not undergo the practice. Further, girls who underwent FGM/C reported higher prevalence of multiple mental health outcomes compared with the control group of girls who did not undergo the practice but lived in the same area including: anxiety disorder (45.6% vs 6.7%), somatoform disorders (21.5% vs 3.3%), personality disorder (13.9% vs 0%) and somatic disturbance (36.7% vs 26.7). | Fair |
| Knipscheer et al, 201533 | What kind of mental health problems are reported by circumcised immigrant women from Africa? And which factors are associated with the presented psychopathology? | Sample size: 66 Immigrant women ages 18–69 in the Netherlands. Countries of origin: Somalia, Sudan, Eritrea, Ethiopia and Sierra Leone. | PTSD, depression and anxiety | PTSD: Harvard Trauma Questionnaire-30 item (HTQ-30). Depression and anxiety: Hopkins Symptom Checklist (HSCL-25). | This study stratified the results based on FGM/C type. Of the research participants, 36% scored above the cut-off level for indicators of psychopathology. 20% met the criteria for PTSD. 33% met the criteria for depression. 30% met the criteria for an anxiety disorder. 18% scored above the cut-off level for all three psychopathology indicators. Women who underwent FGM/C type III reported a vivid memory of the circumcision and coped with their symptoms in an avoidant way, and reported experiencing severe consequences of genital circumcision | Fair |
| Köbach et al, 201827 | Is FGM associated with a heightened risk of PTSD and trauma-related shutdown dissociation? Also, is it associated with depression, anxiety, substance abuse and dependence, suicidality and psychosis? | Sample size: 167 (87 underwent FGM/C type II/III, 60 underwent FGM/C type I and 18 did not) girls and women between the ages 13–80 in Jijiga, Ethiopian Somali Region. | PTSD, depression, anxiety, substance abuse and dependence, suicidality and psychosis | PTSD diagnosis: PTSD Symptom Scale-Interview Shutdown syndrome: Shutdown Dissociation Scale (ShuD) Depression and anxiety symptoms: Hopkins Symptom Checklist-25 (HSCL-25) Major depression diagnosis: Mini-International Neuropsychiatric Interview. | This study stratified the results based on FGM/C type. Regardless of the level of physical invasiveness, almost all women who underwent FGM/C reported having felt intense fear and/or helplessness. FGM/C types II/III, the more invasive forms, were associated with a statistically significant greater vulnerability to symptoms of PTSD, shutdown dissociation, depression and anxiety. Of the women who underwent FGM/C types II/III, 18.4% were diagnosed with PTSD, 12.6% with major depression, 4.6% with substance dependence, 1.1% with substance abuse, 10.3% with suicidal ideation and 2.3% psychotic disorder. Among women who underwent FGM/C type I, 1.7% were diagnosed with substance abuse and 8.3% with suicidal ideation. None were diagnosed with PTSD, major depression or psychotic disorder. Among women who did not undergo FGM/C, 5.4% were diagnosed with PTSD and 11.1% with substance dependence. None were diagnosed with major depression substance abuse, suicidal ideation or psychotic disorder. | Good |
| Koolaee et al, 201234 | How does marital satisfaction, mental health and sexual satisfaction compare between genital mutilated females and those who are not? | Sample size: 200 (100 underwent FGM/C and 100 did not) girls and women between the ages 15–35 in Kermanshah, Iran. | Somatic symptoms, sleep disorder and depression | GHQ-28. | This study did not stratify the results based on FGM/C type. The mean score of somatic symptoms (7.10 vs 5.86), depression (4.68 vs 3.75) and sleep disorder (7.84 vs 5.84) symptoms was higher among the group that underwent FGM/C. Only the results on sleep disorder were statistically significant. | Poor |
| Lever et al, 201828 | What is the mental health status of FGM/cutting (FGM/C)-affected women who are seeking asylum primarily due to their FGM/C status, as well as other gender-based persecutions? | Sample size: 13 women > 18 years of age who were seeking asylum in the USA primarily due to FGM/C. Countries of origin included: Burkina Faso, Djibouti, The Gambia, Guinea, Liberia, Nigeria and Sierra Leone. | Depression, anxiety and PTSD | Depression and anxiety: Hopkins Symptom Checklist-25 (HSCL-25). HTQ Revised-Part IV. | This study did not stratify the results based on FGM/C type. Of the 13 women, checklist positive scores indicated anxiety in 12 of 13 (92%), and depression in 13 of 13 (100%) respondents, respectively. All seven women (100%) screened for PTSD had checklist positive scores, indicating they met the criteria for PTSD. | Fair |
| Mahmoudi and Hosseini, 201735 | Do couples in which the female underwent FGM/C vary from couple in which the female did not undergo the practice on relationship characteristics such as relationship satisfaction, sexual satisfaction, intimacy, spousal support and mental health? | Sample size: 414 couples (206 women underwent FGM/C and 208 in couples where women did not undergo the practice) in Kermanshah in Iran. | Overall psychological consequences | Symptom Checklist- 25 (SCL-25). | This study did not stratify the results based on FGM/C type. A significant difference was observed in mental health between women who underwent FGM/C (mean score=30.90) in comparison to women who did not (mean score=22.76). | Fair |
| Pereda et al, 201236 | What is the impact of FGM in the variable of mental health (focusing on the psychological and sexual areas) among adult immigrant women living in a European country? | Sample size: three women ages 35–45 in Spain. County of origin: Mauritania | Overall psychological consequences | Not specified | This study did not stratify the results based on FGM/C type. The psychological assessment did not reveal any significant problems. | Poor |
| Vloeberghs et al, 201237 | Does FGM/C lead to mental, social and/or relational problems? And if so, what is the nature of these problems, and which factors contribute to the development of problems? Also, what are the coping mechanisms these migrant women develop in relation to their problems and the above-mentioned factors? | Sample size: 66 Immigrant women ages 18–69 in the Netherlands. Countries of origin: Somalia, Sudan, Eritrea, Ethiopia and Sierra Leone. | PTSD, depression, and anxiety | For PTSD: HTQ-30. For depression and anxiety: Hopkins Symptom Checklist (HSCL-25). | This study stratified the results based on FGM/C type. Of the participants, 17.5% met the criteria for PTSD, 34.9%met the criteria for depression, 31.7% met the criteria for an anxiety disorder. The mean score for HTQ-30 and HSCL-25 (psychological assessment tools) increased as the severity of FGM type increased. | Fair |
| Vrachnis et al, 201238 | What are the effects and consequences of FGM/C in women that visited an oand gynaecology department at a hospital? | Sample size: seven women who underwent FGM/C ages 17–31, in Greece. Countries of origin are: Ethiopia, Egypt, Eritrea and Somalia | Overall psychological consequences | Not specified | This study did not stratify the results based on FGM/C type. The study did not provide quantitative results of psychological assessment. | Poor |
DSM, Diagnostic and Statistical Manual; PTSD, post-traumatic stress disorder.