Lifetime Events and Posttraumatic Stress Disorder in 4 Postconflict Settings

• Published in: JAMA : the journal of the American Medical Association Vol. 286; no. 5; pp. 555 - 562
• Main Authors: de Jong, Joop T. V. M, Komproe, Ivan H, Van Ommeren, Mark, El Masri, Mustafa, Araya, Mesfin, Khaled, Noureddine, van de Put, Willem, Somasundaram, Daya
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01-08-2001
• Subjects: Adult; Algeria; Analysis. Health state; Biological and medical sciences; Cambodia; Developing Countries; Epidemiology; Ethiopia; Female; General aspects; Human rights; Humans; Israel; LDCs; Life Change Events; Logistic Models; Male; Medical research; Medical sciences; Post traumatic stress disorder; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Stress Disorders, Post-Traumatic - epidemiology; Survivors - psychology; Tropical medicine; Violence; Violence - psychology; War; Warfare; World; Algeria; Israel; Cambodia; Ethiopia; Human; Political conflict; Lifetime; Randomization; Prevalence; Risk factor; Traumatology; Epidemiology; Survival; Public health; Stress
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.286.5.555

CONTEXT Little is known about the impact of trauma in postconflict, low-income
countries where people have survived multiple traumatic experiences. OBJECTIVE To establish the prevalence rates of and risk factors for posttraumatic
stress disorder (PTSD) in 4 postconflict, low-income countries. DESIGN, SETTING, AND PARTICIPANTS Epidemiological survey conducted between 1997 and 1999 among survivors
of war or mass violence (aged ≥16 years) who were randomly selected from
community populations in Algeria (n = 653), Cambodia (n = 610), Ethiopia (n
= 1200), and Gaza (n = 585). MAIN OUTCOME MEASURE Prevalence rates of PTSD, assessed using the PTSD module of the Composite
International Diagnostic Interview version 2.1 and evaluated in relation to
traumatic events, assessed using an adapted version of the Life Events and
Social History Questionnaire. RESULTS The prevalence rate of assessed PTSD was 37.4% in Algeria, 28.4% in
Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. Conflict-related trauma after
age 12 years was the only risk factor for PTSD that was present in all 4 samples.
Torture was a risk factor in all samples except Cambodia. Psychiatric history
and current illness were risk factors in Cambodia (adjusted odds ratio [OR],
3.6; 95% confidence interval [CI], 2.3-5.4 and adjusted OR,1.6; 95% CI, 1.0-2.7,
respectively) and Ethiopia (adjusted OR, 3.9; 95% CI, 2.0-7.4 and adjusted
OR, 1.8; 95% CI, 1.1-2.7, respectively). Poor quality of camp was associated
with PTSD in Algeria (adjusted OR, 1.8; 95% CI, 1.3-2.5) and in Gaza (adjusted
OR, 1.7; 95% CI, 1.1-2.8). Daily hassles were associated with PTSD in Algeria
(adjusted OR, 1.6; 95% CI, 1.1-2.4). Youth domestic stress, death or separation
in the family, and alcohol abuse in parents were associated with PTSD in Cambodia
(adjusted OR, 1.7; 95% CI, 1.1-2.6; adjusted OR, 1.7; 95% CI, 1.0-2.8; and
adjusted OR, 2.2; 95% CI, 1.1-4.4, respectively). CONCLUSIONS Using the same assessment methods, a wide range of rates of symptoms
of PTSD were found among 4 low-income populations who have experienced war,
conflict, or mass violence. We identified specific patterns of risk factors
per country. Our findings indicate the importance of contextual differences
in the study of traumatic stress and human rights violations.