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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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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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Ferrajão P, Frias F, Ramos J, Elklit A. A latent class analysis of adverse childhood life events in Ugandan adolescents. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Francisco Frias
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Joana Ramos
- 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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Rasmussen A, Leon M, Elklit A. Cross-Cultural Measurement Invariance of the Harvard Trauma Questionnaire Across Nine Adolescent Samples. Assessment 2022:10731911221101912. [PMID: 35699448 DOI: 10.1177/10731911221101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma researchers often make claims about the severity of posttraumatic stress disorder (PTSD) across populations, and yet cross-cultural measurement invariance (MI) is rarely assessed. Nine youth samples with Harvard Trauma Questionnaire (HTQ) responses were grouped based on sampling strategy used into two sets: representative (Denmark, the Faroe Islands, Iceland, and Lithuania, n = 1,457), and convenience (Greenland, India, Kenya, Malaysia, and Uganda, n = 2,036). Confirmatory factor analysis (CFA) was used to gauge whether configural, metric, scalar, and residual invariance of different models held between national samples within the two sets. Configural invariance held for most PTSD models in convenience samples, not in representative samples. Metric invariance was less common, and scalar and residual in general did not hold. Cultural similarity between samples seemed to be associated with invariance. Findings suggest that although PTSD symptoms may cluster similarly across culturally distal groups, comparisons of the severity of symptoms using the HTQ across adolescent samples are not likely valid.
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Affiliation(s)
| | | | - Ask Elklit
- University of Southern Denmark, Odense, Denmark
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Ainamani HE, Weierstall-Pust R, Bahati R, Otwine A, Tumwesigire S, Rukundo GZ. Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda. Eur J Psychotraumatol 2022; 13:2007730. [PMID: 35028113 PMCID: PMC8751492 DOI: 10.1080/20008198.2021.2007730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda. METHODS In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables. RESULTS In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005). CONCLUSION Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children.
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Affiliation(s)
- Herbert E Ainamani
- Department of Mental Health, Kabale University-School of Medicine, Kabale, Uganda
| | - Roland Weierstall-Pust
- Medical School of Hamburg Department of Clinical Psychology and Psychotherapy, Germany and Oberberg Group, Berlin, Germany
| | - Ronald Bahati
- Department of Public Health and Bio Medical Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Anne Otwine
- Department of Public Health and Bio Medical Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Sam Tumwesigire
- Department of Pediatrics, Kabale University School of Medicine, Kabale, Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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Ferrajão P, Elklit A. Attachment and social support mediate associations between polyvictimization and psychological distress in early Uganda and Kenya adolescents. CHILD ABUSE & NEGLECT 2021; 121:105271. [PMID: 34425466 DOI: 10.1016/j.chiabu.2021.105271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is strong evidence that the experience of several potentially traumatic events (polyvictimization) is a risk factor for posttraumatic stress disorder (PTSD) and psychological distress among adolescents. The identification of the variables that influence the link between polyvictimization and PTSD and other psychiatric symptoms is warranted. OBJECTIVE We analyzed the associations between polyvictimization, PTSD symptoms (PTSS) and psychiatric symptoms in Kenya and Uganda adolescents, and explored the mediating roles of attachment orientations and perceived social support in the associations between polyvictimization, PTSS and psychiatric symptoms among adolescents from lower-middle-income countries (LALMIC). PARTICIPANTS AND SETTING A sample of 481 Kenyan adolescents (M = 16.28; SD = 1.878) and a sample of 408 Uganda adolescents (M = 15.95; SD = 1.377) completed validated self-report questionnaires. METHODS Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). RESULTS Polyvictimization was related to higher PTSS and psychiatric symptoms. Importantly, polyvictimization was significantly linked to high attachment anxiety, which was linked with low perceived social support, which in turn was linked with high PTSS levels and psychiatric symptoms. CONCLUSIONS High levels of attachment anxiety might be connected with lack of perceived social support, which might be seen as a possible psychological distress mechanism subsequent to exposure to polyvictimization in adolescence from LALMIC.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia, Lisbon, Portugal.
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Mbwayo AW, Mathai M, Khasakhala LI, Kuria MW, Vander Stoep A. MENTAL HEALTH IN KENYAN SCHOOLS: TEACHERS' PERSPECTIVES. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2020; 7:155-163. [PMID: 32864296 PMCID: PMC7449150 DOI: 10.1007/s40609-019-00153-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them. METHOD The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes. RESULTS Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems. CONCLUSION Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems.
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Affiliation(s)
- Anne Wanjiru Mbwayo
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - Muthoni Mathai
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - L I Khasakhala
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - Mary Wangari Kuria
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - Ann Vander Stoep
- Child Health Institute, University of Washington, P.O. Box 354920, Seattle, Washington USA 98195
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Mbwayo AW, Mathai M, Harder VS, Nicodimos S, Vander Stoep A. Trauma among Kenyan School Children in Urban and Rural Settings: PTSD Prevalence and Correlates. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:63-73. [PMID: 32318229 PMCID: PMC7163810 DOI: 10.1007/s40653-019-00256-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study estimated the prevalence and correlates of PTSD in Kenyan school children during a period of widespread post-election violence. The UCLA PTSD Reaction Index was administered to 2482 primary and secondary school students ages 11-17 from rural and urban communities. A high proportion of school children had witnessed people being shot at, beat up or killed (46.9%) or had heard about the violent death or serious injury of a loved one (42.0%). Over one quarter (26.8%, 95% CI = 25.1% - 28.7%) met criteria for PTSD. Correlates of PTSD included living in a rural (vs urban) area (AOR = 1.72, 95% CI = 1.41-2.11), attending primary (vs secondary) school (AOR = 2.25, 95% CI = 1.67-3.04) and being a girl (with girl as referent AOR = .70, 95% CI = .57-.86). We recommend training Kenyan teachers to recognize signs of emotional distress in school children and psychosocial counselors to adapt empirically-supported mental health interventions for delivery in primary and secondary school settings.
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Affiliation(s)
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Semret Nicodimos
- Child Health Institute, University of Washington, Seattle, WA USA
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences and Department of Epidemiology, University of Washington, Box 354920, Seattle, WA 98195 USA
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Doric A, Stevanovic D, Stupar D, Vostanis P, Atilola O, Moreira P, Dodig-Curkovic K, Franic T, Davidovic V, Avicenna M, Noor M, Nussbaum L, Thabet A, Ubalde D, Petrov P, Deljkovic A, Antonio ML, Ribas A, Oliveira J, Knez R. UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries. Eur J Psychotraumatol 2019; 10:1605282. [PMID: 31105904 PMCID: PMC6507911 DOI: 10.1080/20008198.2019.1605282] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.
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Affiliation(s)
- Ana Doric
- Department of Psychology (Center for Applied Psychology), Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Dejan Stevanovic
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Dusko Stupar
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Panos Vostanis
- School of Psychology, Leicester University, Leicester, UK
| | - Olayinka Atilola
- Department of Behavioural Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria
| | | | - Katarina Dodig-Curkovic
- Medical Faculty Osijek, Faculty for Dental Medicine and Health, University Health Center Osijek, Osijek, Croatia
| | - Tomislav Franic
- Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia
| | - Vrljicak Davidovic
- Department of Psychiatry, Clinical Hospital Centre Split, Split, Croatia
| | - Mohamad Avicenna
- Faculty of Psychology, State Islamic University Syarif Hidayatullah, Jakarta, Indonesia
| | - Multazam Noor
- Psychiatry department, Dr Soeharto Heerdjan Mental Hospital Jakarta, Jakarta, Indonesia
| | - Laura Nussbaum
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Abdelaziz Thabet
- School of Public Health, Al Quds University, Gaza Branch, Palestine
| | - Dino Ubalde
- Department of Psychology, St. Dominic College of Asia, City of Bacoor, Philippines
| | - Petar Petrov
- Department of Child and Adolescent Psychiatry, University Hospital St. Marina, Varna, Bulgaria
| | | | | | - Adriana Ribas
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rajna Knez
- Department of Women´s and Children´s health, Skaraborgs Hospital, Skövde, Sweden.,Department of Psychiatry and Psychological Medicine, Medical School, University of Rijeka, Rijeka, Croatia.,University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Göteborg, Sweden
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Le MTH, Holton S, Romero L, Fisher J. Polyvictimization Among Children and Adolescents in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2018; 19:323-342. [PMID: 27461094 DOI: 10.1177/1524838016659489] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Most of the world's children and adolescents live in low- and lower-middle-income countries (LALMIC), but there is limited evidence about polyvictimization (experiences of multiple forms of victimization) among them. The aims of this article were to systematically review the evidence from LALMIC about the overall prevalence of polyvictimization and to identify the associations between polyvictimization and health and well-being among children and adolescents. METHOD A systematic search of the English-language peer-reviewed literature to identify empirical, quantitative studies conducted in LALMIC between 2005 and 2015, assessing at least four forms of victimization among young people aged up to 19 years. Where prevalence of any victimization and of polyvictimization were reported, meta-analyses were performed. RESULTS A total of 30/8,496 articles were included in the review. Evidence was available from 16/84 LALMIC and methodology and quality varied. Pooled prevalence of experiences of any victimization was 76.8% (95% confidence interval (CI) [64.8%, 88.9%]). Prevalence of polyvictimization ranged from 0.3% to 74.7% with an overall estimate of 38.1% (95% CI [18.3%, 57.8%]). None of the studies examined the associations between polyvictimization and physical or reproductive health or quality of life. Polyvictimization was associated with increased likelihood of mental health problems and involvement in health risk behaviors. CONCLUSIONS Experiences of polyvictimization among children and adolescents in LALMIC are more prevalent than in high- and upper-middle-income countries and contribute to the burden of poor health among children and adolescents. Most LALMIC lack local data, and research is required to address this knowledge gap.
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Affiliation(s)
- Minh T H Le
- 1 Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Sara Holton
- 1 Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Lorena Romero
- 2 The Ian Potter Library, the Alfred Hospital, Melbourne, Victoria, Australia
| | - Jane Fisher
- 1 Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Othieno CJ, Okoth R, Peltzer K, Pengpid S, Malla LO. Traumatic experiences, posttraumatic stress symptoms, depression, and health-risk behavior in relation to injury among University of Nairobi students in Kenya. Int J Psychiatry Med 2016; 50:299-316. [PMID: 26561275 DOI: 10.1177/0091217415610310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the prevalence and types of injuries in relation to traumatic experiences, posttraumatic stress symptoms, depression, and health-risk behaviors among university students in Kenya. METHOD A cross-sectional study collected data on a random sample of university students using a questionnaire to record sociodemographic variables while injuries experiences recorded using the Centers for Disease control criteria and Breslau's seven-item screener was used to identify post-traumatic stress disorder (PTSD) symptoms. Depressive symptoms were measured using Center for Epidemiological Studies Short Depression Scale. RESULTS Nine hundred and twenty-three students (525 male and 365 female) were included in the study, mean age 23 years (SD 4.0). Serious injury in the previous 12 months was reported by 29.00% of the students. PTSD was present in 15.67% (men 15.39% and women 16.1%). Out of the total, 41.33% of the students had depressive symptoms (35.71% mild-moderate symptoms and 5.62% severe). In the multivariable logistic regression being poor, binge drinking, tobacco use, ever been diagnosed with HIV, physically abused as a child, high PTSD score, and depression (adjusted odds ratio 5.49, 95% confidence interval 4.32-13.21) were significantly (p value<5%) associated with injury in the last 12 months. CONCLUSION Unintentional injuries and PTSD symptoms are common in this student population and are positively linked to depression and other risky behaviors. Measures aimed at improving the mental health, such as early identification and treatment of depression, may be useful in reducing the prevalence of such injuries among the youth.
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Affiliation(s)
| | | | - Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Thailand HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Thailand Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
| | - Lucas O Malla
- Kenya Medical Research Institute, Wellcome Trust, Nairobi, Kenya
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12
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Jenkins R, Othieno C, Omollo R, Ongeri L, Sifuna P, Mboroki JK, Kiima D, Ogutu B. Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13494-509. [PMID: 26516877 PMCID: PMC4627045 DOI: 10.3390/ijerph121013494] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 12/03/2022]
Abstract
This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.
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Affiliation(s)
- Rachel Jenkins
- Health Services and Population Research Department, Institute of Psychiatry, Kings College London, de Crespigny Park, London SE5 8AF, UK.
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, Kenya, Kenyatta National Hospital, Nairobi. P. O. Box 19676-00202.
| | - Raymond Omollo
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
| | - Linnet Ongeri
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
| | - Peter Sifuna
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
| | | | - David Kiima
- Ministry of Health, Nairobi P.O. Box 30016-00100, Kenya.
| | - Bernhards Ogutu
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
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Karsberg S, Armour C, Elklit A. Patterns of victimization, suicide attempt, and posttraumatic stress disorder in Greenlandic adolescents: a latent class analysis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1389-99. [PMID: 24806949 DOI: 10.1007/s00127-014-0890-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
AIM The current study had two main aims. The first was to identify groups of adolescents based on their similarity of responding across a number of victimizing and potentially traumatic events (PTEs). In doing so, we employed the statistical technique of Latent Class Analysis (LCA). The second aim was to assess the relationship between our resultant classes and the covariates of gender, suicide attempt, and PTSD. METHODS Two hundred and sixty-nine Greenlandic school students, aged 12-18 (M = 15.4, SD = 1.84) were assessed for their level of exposure to PTEs. In addition, adolescents were assessed for the psychological impact of these events. A LCA was performed on seven binary indicators representing PTEs. Logistic regression was subsequently implemented to ascertain the relationships between latent classes and covariates. RESULTS Three distinct classes were uncovered: a violence, neglect, and bullying class (class 1), a wide-ranging multiple PTE class (class 2), and a normative/baseline class (class 3). Notably, classes 1 and 2 were largely separated by the presence or absence of sexual PTEs. Individuals who reported having previously attempted suicide were almost six times more likely to be members of class 1 (OR = 5.97) and almost four times more likely to be members of class 2 (OR = 3.87) compared to the baseline class (class 3). Individuals who met the diagnostic criteria for PTSD were five times as likely to be members of class 1 and class 2 (OR = 5.09) compared to the baseline class. No significant associations were found between classes and gender. CONCLUSION The results underline the complexity of the interplay between multiple victimization experiences, traumatization, and suicide attempts.
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Affiliation(s)
- Sidsel Karsberg
- National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark,
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Atwoli L, Ayuku D, Hogan J, Koech J, Vreeman RC, Ayaya S, Braitstein P. Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in western Kenya. PLoS One 2014; 9:e89937. [PMID: 24625395 PMCID: PMC3953071 DOI: 10.1371/journal.pone.0089937] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/28/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) among orphaned and separated children in Uasin Gishu County, western Kenya. METHODS A total of 1565 (55.5% male) orphaned and separated adolescents aged 10-18 years (mean 13.8 years, sd 2.2), were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children's Institutions (CCIs), and 73 on the street. Posttraumatic stress symptom (PTSS) scores and PTSD were assessed using the Child PTSD Checklist. RESULTS Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8%), then households (15.0%) and CCIs (11.5%). PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse. CONCLUSION This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households. Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support.
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Affiliation(s)
- Lukoye Atwoli
- Department of Mental Health, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
- * E-mail:
| | - David Ayuku
- Department of Behavioural Sciences, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Joseph Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, United States of America
- USAID- Academic Model Providing Access To Healthcare (AMPATH) Consortium, Eldoret, Kenya
| | - Julius Koech
- USAID- Academic Model Providing Access To Healthcare (AMPATH) Consortium, Eldoret, Kenya
| | - Rachel Christine Vreeman
- USAID- Academic Model Providing Access To Healthcare (AMPATH) Consortium, Eldoret, Kenya
- Department of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Samuel Ayaya
- Department of Child Health and Pediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Paula Braitstein
- USAID- Academic Model Providing Access To Healthcare (AMPATH) Consortium, Eldoret, Kenya
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
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Carta MG, Oumar FW, Moro MF, Moro D, Preti A, Mereu A, Bhugra D. Trauma- and stressor related disorders in the tuareg refugees of a cAMP in burkina faso. Clin Pract Epidemiol Ment Health 2013; 9:189-95. [PMID: 24285982 PMCID: PMC3841965 DOI: 10.2174/1745017901309010189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/13/2013] [Accepted: 10/13/2013] [Indexed: 11/22/2022]
Abstract
Background: Post-traumatic stress disorder (PTSD) is reported to be common among refugees. We set out to explore risk of Trauma- and Stress-or-Related Disorders and the associated burden of psychological distress in a refugee camp of Malian Refugees in Burkina Faso. Methods: One out of five persons living in the camp was selected randomly and interviewed using the French version of the Short Screening Scale for PTSD and the validated K6 scale to measure psychiatric morbidity. Results: Around 60% of the interviewed sample (N=408) met the criteria for Trauma- and Stress-or-Related Disorders and also reported severe mental distress on K6 scores. Women aged 40 and over were found to be at higher risk of Trauma- and Stress-or-Related Disorders whereas young people (39 or younger) scored higher on K6 ratings. Around 83% of the surveyed subjects had a family member killed in the war, 91% a relative in the war, more than 80% had a family member suffering from physical injuries, and 90% reported problems with food and housing. The frequency of these life events was not surprisingly higher in persons with Trauma- and Stress-or-Related Disorders, with the death of a family member and severe problems with food being specifically related to them.Conclusion: These results point to important psychological suffering in a population that is often ignored by the media and international political authorities. Immediate steps are required to provide urgent legal and humanitarian protection to those who are forced to flee their homes and cross international borders because of disasters.
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Affiliation(s)
- M G Carta
- Department of Public Health, Clinical and Molecular Medicine, Cittadella, Universitaria di Monserrato, 09042 Monserrato, Calgiari, Italy
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Karsberg SH, Lasgaard M, Elklit A. Victimisation and PTSD in a Greenlandic youth sample. Int J Circumpolar Health 2012; 71:IJCH-71-18378. [PMID: 22973570 PMCID: PMC3427974 DOI: 10.3402/ijch.v71i0.18378] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/08/2012] [Accepted: 07/31/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite a growing number of studies and reports indicating a very high and increasing prevalence of trauma exposure in Greenlandic adolescents, the knowledge on this subject is still very limited. The purpose of the present study was twofold: To estimate the lifetime prevalence of potentially traumatic events (PTEs) and post-traumatic stress disorder (PTSD) and to examine the relationship between PTEs, estimated PTSD, and sociodemographic variables. METHODS In a Greenlandic sample from 4 different schools in 2 different minor towns in Northern Greenland, 269 students, aged 12-18 (M=15.4; SD=1.84) were assessed for their level of exposure to 20 PTEs along with the psychological impact of these events. RESULTS Of the Greenlandic students, 86% had been directly exposed to at least 1 PTE and 74.3% had been indirectly exposed to at least 1 PTE. The mean number of directly experienced PTEs was 2.8 and the mean number of indirectly experienced PTEs was 3.9. The most frequent direct events recorded were death of someone close, near drowning, threat of assault/beating, humiliation or persecution by others and attempted suicide. The estimated lifetime prevalence of PTSD was 17.1%, whereas another 14.2% reached a subclinical level of PTSD (missing the full diagnosis by 1 symptom). Education level of the father, and being exposed to multiple direct and indirect PTEs were significantly associated with an increase in PTSD symptoms. CONCLUSION The findings indicate substantial mental health problems in Greenlandic adolescents and that these are associated with various types of PTEs. Furthermore, the findings indicate that Greenlandic adolescents are more exposed to certain specific PTEs than adolescents in similar studies from other nations. The present study revealed that Greenlandic girls are particularly vulnerable towards experiencing PTEs. Indeed, in general, girls reported more experiences of direct and indirect PTEs. Furthermore, girls reported being more commonly exposed to specific types of PTEs compared to boys.
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Affiliation(s)
- Sidsel H Karsberg
- Institute of Psychology, Danish National Centre for Psychotraumatology, University of Southern Denmark, DK-5230 Odense, Denmark.
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