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Lifetime Events and Posttraumatic Stress Disorder in 4 Postconflict Settings
Joop T. V. M. de Jong, MD,PhD;
Ivan H. Komproe, PhD;
Mark Van Ommeren, PhD;
Mustafa El Masri, MD;
Mesfin Araya, MD;
Noureddine Khaled, PhD;
Willem van de Put, MA;
Daya Somasundaram, MD,MRCPsych
JAMA. 2001;286:555-562.
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.
Author Affiliations: Transcultural Psychosocial Organisation (TPO) WHO Collaborating Centre, Amsterdam, the Netherlands (Drs de Jong, Komproe, and Van Ommeren); the Vrije Universiteit, Amsterdam (Drs de Jong and Komproe); Centre for Victims of Torture, Kathmandu, Nepal (Dr Van Ommeren); Société Algeriénne de Recherche en Psychologie (SARP)/TPO Algeria, Algiers (Drs El Masri and Khaled);Gaza Community Mental Health Program (GCMHP), Gaza (Dr El Masri); TPO Ethiopia, Addis Ababa, Ethiopia (Dr Araya); TPO Cambodia, Phnom Penh, Cambodia (Mr van de Put and Dr Somasundaram); HealthNet International, Amsterdam (Mr van de Put); and University of Jaffna, Jaffna, Sri Lanka (Dr Somasundaram).
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