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Kassa MA, Fenta S, Anbesaw T, Tesfa NA, Zemariam AB, Kassaw GM, Abate BB, Semagn EG. Post-traumatic stress disorder and associated factors among high school students who experienced war in Woldia town. Front Psychiatry 2024; 15:1359370. [PMID: 39081535 PMCID: PMC11286586 DOI: 10.3389/fpsyt.2024.1359370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/31/2024] [Indexed: 08/02/2024] Open
Abstract
Background The experience of war in recent time is very common around the world, and the impact is profound on the mental health of the victims, especially among the young population. The most implicated mental health problem is post-traumatic stress disorder, which comes after an exposure to trauma as a severe and long-term result of the traumatic event. Studies in developed countries revealed this finding, but there is insufficient information in developing countries, where much of war and conflict exist and young population live including Ethiopia. Therefore, this study aims to assess the prevalence and associated factors of post-traumatic stress disorder among high school students who experienced war. Objective We assessed the prevalence and factors associated with post-traumatic stress disorder among high school students who experienced war. Methods A multi-centered school base cross-sectional study was conducted from May 23 to June 08, 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression was used to identify the independent factors associated with post-traumatic stress disorder. Results A total of 338 of the 410 students participated in this study (94.5% response rate). The prevalence of post-traumatic stress disorder was 39.2%. In the multivariable analysis, poor social support (AOR = 3.40, 95% CI: 1.45, 7.95), depression (AOR = 3.24, 95% CI: 1.69,6.21), high level of perceived stress (AOR = 2.98, 95% CI: 1.61, 5.50), being in war fighting situation (AOR = 2.85, 95% CI: 1.40, 5.78), and witnessing the murder of family members or friends (AOR = 3.05, 95% CI: 1.47, 6.32) were factors significantly associated with post-traumatic stress disorder at a p-value <0.05. Conclusions and recommendations In this study, around two in five of high school students had post-traumatic stress disorder. Independent factors of PTSD were depression, high stress levels, poor social support, witnessing the murder of family members/friends, and being in war fighting situation. We recommend that the Ministry of Education and the Ministry of Health collaborate to integrate mental health services into schools. This focuses on the early detection of students at risk of PTSD, such as those with depression, high perceived stress levels, and exposure to murder or war, and provides necessary social support to prevent PTSD.
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Affiliation(s)
- Mulat Awoke Kassa
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sefineh Fenta
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Genanew Mulugeta Kassaw
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Elsabet Gezmu Semagn
- Department of Veterinary Parasitology, School of Veterinary Medicine, Wollo University, Dessie, Ethiopia
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Ferrajão PC, Tourais B, Faria I, Dias J, Elklit A. A Latent Class Analysis of Adverse Life Events for Kenyan Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:261-273. [PMID: 38938956 PMCID: PMC11199438 DOI: 10.1007/s40653-023-00603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 06/29/2024]
Abstract
Extant evidence indicates that exposure to adverse childhood experiences (ACE) tend to cluster among children and adolescents. Considering that adolescents from African countries present higher risk of being exposed to multiple ACE compared to other countries, the identification of victimization profiles in this population is clearly warranted. The aim of this study was to determine meaningful clusters of individuals with similar experiences of ACE in a sample of Kenyan adolescents. Latent class analysis (LCA) was conducted to identify latent classes of exposure to ACE. In addition, the relationships between the latent classes and gender, parental education, living arrangements and diagnosis of post-traumatic stress disorder (PTSD) were estimated. A three-class solution was found to be the best description of ACE, and the classes were labelled ''Low Risk'', ''Intermediate Risk'', and ''High Risk''. Compared with the Low-Risk class, the High-Risk class was found to be significantly more likely to have a diagnosis of PTSD and being a female may be an antecedent risk factor for high exposure to ACE. The Intermediate Risk class was significantly less likely to have parents with high school or college education. This paper indicates that Kenyan adolescents present higher risk of being exposed to multiple ACE and that trauma research may turn its focus on the individual as the unit of analysis rather than traumatic events.
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Affiliation(s)
- Paulo Correia Ferrajão
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
| | - Bárbara Tourais
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Inês Faria
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Joana Dias
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Ask Elklit
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
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Hooshyari Z, Mohammadi MR, Salmanian M, Ahmadi N, Khaleghi A, Garakani A. Lifetime prevalence, comorbidities, and Sociodemographic predictors of post-traumatic stress disorder (PTSD): the National Epidemiology of Iranian Children and adolescents Psychiatric disorders (IRCAP). Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02441-7. [PMID: 38656607 DOI: 10.1007/s00787-024-02441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The aims of this study were to (a) evaluate the lifetime prevalence of post-traumatic stress disorder (PTSD) according to sociodemographic characteristics, (b) determine sociodemographic factors associated with PTSD, (c) estimate the lifetime prevalence rates of comorbidities by age and gender, and (d) assess the proportion of traumatic events in the non-PTSD sample and the PTSD sample, according to gender. METHODS The data used for the present study were obtained from the IRCAP study which was a cross-sectional, community-based study on 29,250 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Trained psychologists conducted diagnostic interviews with parents, children, and adolescents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS In this study, the prevalence of PTSD across the sample population was 0.6% (95% CI, 0.5-0.7%). Higher rates of PTSD were observed among girls (0.7%, CI 0.5-0.8%), adolescents aged 15-18 years (0.8%, CI 0.6-1.0%), and participants who had unemployed (1.5%, CI 0.8-2.8%), or farmer fathers (1.1%, CI 0.5-2.5%). Of the participants with PTSD, 65.1% met the criteria for at least one other psychiatric disorder. PTSD had a high rate of comorbidity with oppositional defiant disorder (22.9%, CI 17.5-29.4%), generalized anxiety disorder (20.8%, CI 15.7-27.1%), separation anxiety disorder (20.3%, CI 15.2-26.6%), and major depressive disorder (19.8%, CI 14.8-26.0%). We found 9.5% of non-PTSD sample experienced at least one traumatic event. Witness to domestic violence was the most common traumatic event experienced by 32.8% of PTSD sample. CONCLUSION Our results in the prevalence, comorbidities, and sociodemographic factors associated with PTSD supported findings of previous studies that used a structured diagnostic interview. It is recommended to use purposive sampling and to investigate comorbidities of PTSD and type of traumatic events in a large clinical population.
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Affiliation(s)
- Zahra Hooshyari
- School of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Salmanian
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nastaran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Garakani
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
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Manafe N, Ismael-Mulungo H, Ponda F, Dos Santos PF, Mandlate F, Cumbe VFJ, Mocumbi AO, Oliveira Martins MR. Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study. Front Public Health 2024; 12:1371598. [PMID: 38689772 PMCID: PMC11058794 DOI: 10.3389/fpubh.2024.1371598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Fábio Ponda
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Flávio Mandlate
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Vasco F. J. Cumbe
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Maria R. Oliveira Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Ferrajão P, Tourais B, Elklit A. Attachment Anxiety and Dissociation Mediate Associations Between Polytrauma and Somatization in Kenyan Adolescents. J Trauma Dissociation 2024; 25:83-98. [PMID: 37401367 DOI: 10.1080/15299732.2023.2231958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/12/2023] [Indexed: 07/05/2023]
Abstract
The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais E Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Bárbara Tourais
- Faculdade de Ciências Sociais E Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Mathai M, Mbwayo A, Concepcion T, Mutavi T, Njeru M, Waruinge S, Dorsey S, Schafer A, Pedersen GA, Sinha M, Kohrt BA, Collins PY. Sustainable Partnerships to Ensure Quality in Psychological Support (EQUIP) for Adolescents. Psychiatr Serv 2023:appips20220200. [PMID: 36625140 DOI: 10.1176/appi.ps.20220200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Ensuring that sustainable and effective mental health services are available for children and adolescents is a growing priority for national governments. However, little guidance exists on how to support service implementation. In Kenya, partnerships were formed among regional government, nongovernmental organizations, and universities to implement Ensuring Quality in Psychological Support (EQUIP)-Nairobi, a pilot project to train and supervise nonspecialists delivering psychological support to adolescents. Lessons were learned about integrating psychological services into existing health services by using the EQUIP platform to assess competencies, engaging partners for supervision and quality improvement, and involving youth stakeholders. The partnerships facilitated a rapid transition to remote services during the COVID-19 pandemic. The EQUIP-Nairobi project results offer lessons for partnerships in other low-resource settings.
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Affiliation(s)
- Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Tessa Concepcion
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Teresia Mutavi
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Michael Njeru
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Stella Waruinge
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Shannon Dorsey
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Alison Schafer
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Gloria A Pedersen
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Moitreyee Sinha
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Brandon A Kohrt
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Pamela Y Collins
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
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Teshome AA, Abebe EC, Mengstie MA, Seid MA, Yitbarek GY, Molla YM, Baye ND, Yazie TS, Ayehu GW, Taye MJ. Post-traumatic stress disorder and associated factors among adult war survivors in Northwest Ethiopia: Community-based, cross-sectional study. Front Psychiatry 2023; 14:1083138. [PMID: 37113553 PMCID: PMC10126353 DOI: 10.3389/fpsyt.2023.1083138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder in low and middle-income countries such as Ethiopia. However, armed conflict, abuse of human rights, and violence motivated by race are becoming more commonplace. This study aimed to assess the prevalence of PTSD and associated factors among war survivors in Nefas Meewcha Town, South Gondar Zone, Ethiopia, 2022. Methods A community based cross-sectional study was carried out. 812 study participants were chosen using a multi-stage sampling process. A face-to-face interview used a post-traumatic stress disorder checklist (PCL-5) to evaluate PTSD. The association between PTSD and other demographic and psychosocial characteristics was investigated using bivariate and multivariable binary logistic regression analysis. A P-value of 0.05 was declared as statistical significance. Result The prevalence of PTSD in this study was 40.8% with a 95% CI of 36.2 to 46.7. The likelihood of developing PTSD was significantly associated with the fallowing factors. A close family member killed or seriously injured (AOR = 4.53, 95% CI = 3.25-6.46), being female (AOR = 1.98, 95% CI = 1.3-3.0), moderate (AOR = 3.51, 95% CI = 2.52-4.68) and high perceived stress (AOR = 5.23, 95% CI = 3.47-8.26), depression symptoms (AOR = 4.92, 95% CI = 3.57-6.86), anxiety disorder symptoms (AOR = 5.24, 95% CI = 3.72-7.63), a chronic medical illness (AOR = 3.51, 95% CI = 2.52-5.41), physical assault (AOR = 2.12, 95% CI = 1.05-3.72) and being in a war fighting situation (AOR = 1.41, 95% CI = 1.21-3.14). Conclusion This study reported that the prevalence of PTSD was high. Being female, having a previous history of chronic medical illness, depressive symptoms, anxiety symptoms, history of a family member or friend was injured or killed, poor social support, high perceived stress, physical assault, and being in a war fighting situation were statistically associated with PTSD. Hence, regular patient assessment by mental health organizations for those with a history of trauma and facilitation of ways to support such residents is highly recommended.
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Affiliation(s)
- Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
- *Correspondence: Assefa Agegnehu Teshome,
| | - Endeshaw Chekol Abebe
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbarek
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yalew Melkamu Molla
- Department of Paediatrics and Child Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nega Dagnaw Baye
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molla Jemberie Taye
- Department of Human Anatomy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Kwobah EK, Misra S, Ametaj AA, Stevenson A, Stroud RE, Koenen KC, Gelaye B, Kariuki SM, Newton CR, Atwoli L. Traumatic experiences assessed with the life events checklist for Kenyan adults. J Affect Disord 2022; 303:161-167. [PMID: 35167925 PMCID: PMC7612412 DOI: 10.1016/j.jad.2022.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/23/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Life Events Checklist (LEC-5) has been widely used to assess for exposure to potentially traumatic life events (PTEs), but its psychometric properties have not been evaluated in Kenya. The objectives of this study were to determine the frequency and types of PTEs within this setting and to examine the construct validity of LEC-5 in Kenya. METHODS The LEC-5 was administered to 5316 participants in the ongoing multisite case-control study of Neuropsychiatric Genetics of African Populations-Psychosis. We used exploratory factor analysis to assess LEC-5 structure, and conducted confirmatory factor analyses to compare these results with two other models: a six-factor model based on the only prior EFA of the LEC and a theoretical seven-factor model. RESULTS The majority (63.4% overall and 64.4% of cases and 62.4% of controls) of participants had experienced at least one PTE in their lifetime. Results of the exploratory factor analyses for LEC-5 yielded a seven-factor solution with eigenvalues greater than one, accounting for 55.3% of the common variance. Based on confirmatory factor analyses, all three models had good fit for our sample, but the theoretical seven-factor model had the best fit. LIMITATIONS The study did not assess if the participants perceived experiences as traumatic, we did not carry out test retest reliability or and we did not consider cultural variations in perception of trauma. CONCLUSION This study provides evidence of a high prevalence of traumatic life events and for the construct validity of LEC-5 in assessing PTE exposures in a Kenyan setting.
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Affiliation(s)
- Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
| | - Amantia A Ametaj
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Anne Stevenson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Rocky E Stroud
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Symon M Kariuki
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya; Department of Public Health, Pwani University, Kilifi, Kenya; Department of Psychiatry, University of Oxford, United Kingdom
| | - Charles R Newton
- Neuroscience Unit, Kenya Medical Research Institute - Wellcome Trust Research Program, Kilifi, Kenya; Department of Public Health, Pwani University, Kilifi, Kenya; Department of Psychiatry, University of Oxford, United Kingdom
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya; Brain and Mind Institute and Medical College East Africa, Aga Khan University Nairobi, Kenya
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Mbwayo A, Kumar M, Mathai M, Mutavi T, Nungari J, Gathara R, McKay M, Ssewamala F, Hoagwood K, Petersen I, Bhana A, Huang KY. Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022; 9:37-53. [PMID: 35330916 PMCID: PMC8939896 DOI: 10.1007/s40609-021-00204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 06/14/2023]
Abstract
Background Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. Methods The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. Conclusion Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.
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Affiliation(s)
- Anne Mbwayo
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Manasi Kumar
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Muthoni Mathai
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Teresia Mutavi
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | | | | | - Mary McKay
- Washington University in St. Louis, St. Louis, USA
| | | | | | | | - Arvin Bhana
- South African Medical Research Council, Cape Town, South Africa
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10
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Slone M, Peer A. Children's Reactions to War, Armed Conflict and Displacement: Resilience in a Social Climate of Support. Curr Psychiatry Rep 2021; 23:76. [PMID: 34613521 DOI: 10.1007/s11920-021-01283-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW The aim of this review was to unravel recent evidence for children's reactions to war and armed conflict focusing on resilience factors mitigating adverse psychological and psychiatric consequences. RECENT FINDINGS Three categories of mitigating resilience factors emerged from the literature - personal, family, and community factors. In addition, a unifying model of moderating resilience factors emerged, proposing a higher-tier environmental dimension conceptualized here as social climate of support. Wars and armed conflict affect children both by direct exposure to threats, and by disruption of the social fabric supporting development. The notion of producing a climate of social support can direct policy toward service provision and resilience-based programs that both build individual capacities and encompass development of the resources of families, schools, community, and societal structures supportive of children's adjustment and wellbeing. Future research should shift toward systems thinking within a socio-ecological nesting of individual, familial, community, and societal systems.
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Affiliation(s)
- Michelle Slone
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel.
| | - Ayelet Peer
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
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