Posttraumatic stress symptoms and structure among orphan and vulnerable children and adolescents in Zambia

Matching the Symptom Profile of Adolescent Disaster Survivors with Changing Diagnostic Criteria of Posttraumatic Stress Disorder: Focus on ICD-11

BACKGROUND

Considering recent changes in the diagnostic guidelines for posttraumatic stress disorder (PTSD), it has become imperative to review their influence, especially on the symptoms related to children and adolescent victims of disasters. We intended to assess the profile of posttraumatic stress symptoms (PTSS) of adolescents following an earthquake, especially the gender differences, in relation to the changing diagnostic guidelines, particularly ICD-11.

METHODS

In a cross-sectional study, PTSS and functional impairments were evaluated in school-going adolescents in Nepal, one year after the 2015 earthquake, using the Child Posttraumatic Stress Scale (CPSS).

RESULTS

A considerable proportion of adolescent survivors of the earthquake had PTSS. Most common ones were intrusive thoughts (46.7%), avoiding thoughts, conversations and feelings about the disaster (44.2%), decreased interest in activities (40.0%), distress with reminders (35.6%), and concentration problems (35.6%). Females had a higher prevalence for all the PTSS compared with males, except for avoiding thought, conversations, feelings, and being overly careful/vigilant. Proportion of adolescents who met symptomatic criteria for PTSD diagnosis in different systems ranged from 14.7% in DSM-5 to 15.6% in ICD-11 three-factor model, and 22.2% in DSM-IV and 31.7% in ICD-10. Inclusion of the criterion of significant functional impairment changed the proportions to 10.0%, 10.3%, 12.8%, and 16.4%, respectively. In all of the diagnostic systems, higher proportions of females had possible PTSD.

CONCLUSION

Adolescent females had a higher prevalence for most of the PTSS and at the diagnostic level. It appears that for adolescents, diagnosis of PTSD in ICD-11 has become more robust with a focus on core symptoms and having a functional impairment criterion.

Measuring Symptoms of Psychopathology in Zambian Orphans and Vulnerable Children: Scale Validation and Psychometric Evaluation

There is a paucity of validated mental health measures for assessing psychological well-being among HIV-affected youth. We sought to explore the psychometric properties and validity of the Achenbach Youth Self-Report and Child Posttraumatic Stress Disorder Symptom Scale among orphans and vulnerable children (OVC) living in Lusaka, Zambia. These scales were administered to 210 OVC aged 13 to 17 years via audio computer-assisted self-interview. Confirmatory factor analysis was used to assess scale structure, Cronbach's alpha for internal consistency, and correlations between scales related to mental or psychosocial health for construct validity. A known-groups validation was conducted using local identifications of youth with and without significant psychosocial problems, and test-retest reliability was assessed. Scales exhibited good internal reliability (α > .80), adequate criterion validity (area under the curve > .70), and moderate test-retest reliability (.62-.68). Findings support the utility of these symptom scales for identifying OVC experiencing significant psychosocial problems in Zambia.