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BMC Psychiatry
Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? a cross-sectional community study in South Sudan

Authors: Touraj Ayazi, Lars Lien, Arne H Eide, Majok Malek Ruom, Edvard Hauff

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

Limited data exists on the association of war trauma with comorbid posttraumatic stress disorder (PTSD)-depression in the general population of low-income countries. The present study aimed to evaluate socioeconomic and trauma-related risk factors associated with PTSD, depression, and PTSD-depression comorbidity in the population of Greater Bahr el Ghazal States, South Sudan.

Methods

In this cross-sectional community study (n=1200) we applied the Harvard Trauma Questionnaire (HTQ) and MINI International Neuropsychiatric Interview (MINI) to investigate the prevalence of PTSD, depression, and PTSD-depression comorbidity. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, sociodemographic, and socioeconomic factors.

Results

PTSD only was found in 331 (28%) and depression only in 75 (6.4%) of the study population. One hundred and twelve (9.5%) of the participants had PTSD-depression comorbid diagnosis. Exposure to traumatic events and socioeconomic disadvantage were significantly associated with having PTSD or PTSD-depression comorbidity but not with depression. Participants with a comorbid condition were more likely to be socioeconomic disadvantaged, have experienced more traumatic events, and showed higher level of psychological distress than participants with PTSD or depression alone.

Conclusions

In individuals exposed to war trauma, attention should be given to those who may fulfill criteria for a diagnosis of both PTSD and depression.
Appendix
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Literature
1.
Brady KT, Killeen TK, Brewerton T, Lucerini S: Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry. 2000, 61 (Suppl 7): 22-32.PubMed
2.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Post-traumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995, 52: 1048-1060. 10.1001/archpsyc.1995.03950240066012.CrossRefPubMed
3.
Elhai JD, Grubaugh AL, Kashdan TB, Frueh BC: Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. J Clin Psychiatry. 2008, 69: 597-602. 10.4088/JCP.v69n0411.CrossRefPubMed
4.
Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P: Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry. 1998, 21 (2): 626-632.CrossRef
5.
Momartin S, Silove D, Manicavasagar V, Steel Z: Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. J Affect Disord. 2004, 80 (2–3): 231-238.CrossRefPubMed
6.
Mollica RF, McInnes K, Sarajlic N, Lavelle J, Sarajlic I, Massagli M: Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. J Am Med Assoc. 1999, 282: 433-439. 10.1001/jama.282.5.433.CrossRef
7.
Dubois V, Tonglet R, Hoyois P, Sunbaunat K, Roussaux JP, Hauff E: Household survey of psychiatric morbidity in Cambodia. Int J Soc Psychiatry. 2004, 50 (2): 174-185. 10.1177/0020764004043125.CrossRefPubMed
8.
Oquendo M, Brent DA, Birmaher B, Greenhill L, Kolko D, Stanley B, Zelazny J, Burke AK, Firinciogullari S, Ellis SP, Mann JJ: Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. Am J Psychiatry. 2005, 162 (3): 560-566. 10.1176/appi.ajp.162.3.560.CrossRefPubMed
9.
O' Donnell M, Creamer M, Pattison P: Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry. 2004, 161: 1390-1396. 10.1176/appi.ajp.161.8.1390.CrossRef
10.
Kaltman S, Green BL, Mete M, Shara N, Miranda J: Trauma, Depression, and Comorbid PTSD/Depression in a Community Sample of Latina Immigrants. Psychol Trauma. 2010, 1:2 (1): 31-39.CrossRef
11.
Johnson H, Thompson A: The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev. 2008, 28 (1): 36-47. 10.1016/j.cpr.2007.01.017.CrossRefPubMed
12.
Murthy RS: Mass violence and mental health–recent epidemiological findings. Int Rev Psychiatry. 2007, 19 (3): 183-192. 10.1080/09540260701365460.CrossRefPubMed
13.
Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA: Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005, 3,294 (5): 571-579.CrossRef
14.
Fazel M, Wheeler J, Danesh J: Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005, 365 (9467): 1309-1314. 10.1016/S0140-6736(05)61027-6.CrossRefPubMed
15.
Miller KE, Rasmussen A: War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med. 2010, 70 (1): 7-16. 10.1016/j.socscimed.2009.09.029.CrossRefPubMed
16.
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M: Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009, 302 (5): 537-549. 10.1001/jama.2009.1132.CrossRefPubMed
17.
de Jong JT, Komproe IH, Van Ommeren M: Common mental disorders in postconflict settings. Lancet. 2003, 21;361 (9375): 2128-30.CrossRef
18.
Silove D: The psychosocial effects of torture, mass human rights violations, and refugee trauma. J Nerv Ment Dis. 1999, 187: 200-207. 10.1097/00005053-199904000-00002.CrossRefPubMed
19.
Riddle JR, Smith TC, Smith B, Corbeil TE, Engel CC, Wells TS, Hoge CW, Adkins J, Zamorski M, Blazer D, for the Millennium Cohort Study Team: Millennium Cohort: the 2001–2003 baseline prevalence of mental disorders in the U.S. military. J Clin Epidemiol. 2007, 60 (2): 192-201. 10.1016/j.jclinepi.2006.04.008.CrossRefPubMed
20.
Brewin CR, Andrews B, Valentine JD: Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000, 68: 748-766.CrossRefPubMed
21.
Ahern J, Galea S: Social context and depression after a disaster: the role of income inequality. J Epidemiol Community Health. 2006, 60 (9): 766-70. 10.1136/jech.2006.042069.CrossRefPubMedPubMedCentral
22.
Rivière S, Albessard A, Gardette V, Lapierre-Duval K, Schwoebel V, Lang T, AZF Epidemiological Follow-up Committee: Psychosocial risk factors for depressive symptoms after the AZF chemical factory explosion in Toulouse, France. Eur J Public Health. 2010, 20 (6): 625-30. 10.1093/eurpub/ckq081.CrossRefPubMed
23.
Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M: Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003, 15;157 (2): 98-112.CrossRef
24.
Roberts B, Felix Ocaka K, Browne J, Oyok T, Sondorp E: Factors associated with the health status of internally displaced persons in northern Uganda. J Epidemiol Community Health. 2009, 63 (3): 227-232. 10.1136/jech.2008.076356.CrossRefPubMed
25.
Araya M, Chotai J, Komproe IH, de Jong JT: Effect of trauma on quality of life as mediated by mental distress and moderated by coping and social support among postconflict displaced Ethiopians. Qual Life Res. 2007, 16 (6): 915-927. 10.1007/s11136-007-9201-9.CrossRefPubMed
26.
Roberts B, Damundu EY, Lomoro O, Sondorp E: The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern Sudan. BMC Publ Health. 2010, 27;10: 518-CrossRef
27.
28.
Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T: Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry. 2004, 25: 4-34.
29.
Karunakara UK, Neuner F, Schauer M, Singh K, Hill K, Elbert T, Burnha G: Traumatic events and symptoms of post-traumatic stress disorder amongst Sudanese nationals, refugees and Ugandans in the West Nile. Afr Health Sci. 2004, 4 (2): 83-93.PubMedPubMedCentral
30.
Roberts B, Damundu EY, Lomoro O, Sondorp E: Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan. BMC Psychiatry. 2009, 4: 9-7.
31.
32.
33.
World Health Organization Department of Immunization Vaccines and Biologicals: Immunization coverage cluster survey - Reference manual. 2005, Geneva: World Health Organization, Report No.: WHO/IVB/04.23
34.
Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C, Iwata N, Karam AN, Kaur J, Kostyuchenko S, Lépine JP, Levinson D, Matschinger H, Mora ME, Browne MO, Posada-Villa J, Viana MC, Williams DR, Kessler RC: Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011, 26: 9-90.
35.
Warren CW, Jones NR, Peruga A, Chauvin J, Warren CW, Jones NR, Peruga A, Chauvin J, Baptiste JP, Costa De Silva V, el Awa F, Tsouros A, Rahman K, Fishburn B, Bettcher DW, Asma S: Centers for Disease Control and Prevention (CDC): Global youth tobacco surveillance, 2000–2007. MMWR CDC Surveill Summ. 2008, 57 (1): 1-28.
36.
Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere K, de Girolamo G, Haro JM, Jin R, Karam EG, Kovess-Masfety V, Levinson D, Medina Mora ME, Ono Y, Ormel J, Pennell BE, Posada-Villa J, Sampson NA, Williams D, Kessler RC: Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry. 2009, 66 (7): 785-795. 10.1001/archgenpsychiatry.2009.36.CrossRefPubMedPubMedCentral
37.
38.
The Office of the High Commissioner for Human Rights: Training Manual on Human Rights Monitoring. 2001, Geneva, Switzerland: Professional Training Series No. 7, United Nations
39.
Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J: The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992, 180: 111-116. 10.1097/00005053-199202000-00008.CrossRefPubMed
40.
Silove D, Brooks R, Bateman Steel CR, Steel Z, Hewage K, Rodger J, Soosay I: Explosive anger as a response to human rights violations in post-conflict Timor-Leste. Soc Sci Med. 2009, 69 (5): 670-677. 10.1016/j.socscimed.2009.06.030.CrossRefPubMed
41.
Cohen MH, Shi Q, Fabri M, Mukanyonga H, Cai X, Hoover DR, Binagwaho A, Anastos K: Improvement in posttraumatic stress disorder in postconflict Rwandan women. J Womens Health. 2011, 20 (9): 1325-1332. 10.1089/jwh.2010.2404.CrossRef
42.
Silove D, Manicavasagar V, Mollica R, Thai M, Khiek D, Lavelle J, Tor S: Screening for depression and PTSD in a Cambodian population unaffected by war: comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire with the structured clinical interview. J Nerv Ment Dis. 2007, 195: 152-157. 10.1097/01.nmd.0000254747.03333.70.CrossRefPubMed
43.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59 (suppl 20): 22-33. quiz 34–57PubMed
44.
Eytan A, Durieux-Paillard S, Whitaker-Clinch B, Loutan L, Bovier PA: Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees. J Nerv Ment Dis. 2007, 195 (9): 723-728. 10.1097/NMD.0b013e318142c9f6.CrossRefPubMed
45.
Goldberg P, Williams P: A User’s Guide to the General Health Questionnaire. 1998, Windsor, England: NFER-NELSON
46.
McDowell I, Newell C: Psychological well-being: The General Health Questionnaire. Measuring Health: A Guide to Rating Scales and Questionnaires. 1996, New York: Oxford University Press, 225-236. 2
47.
Osman AM, Elkordufani Y, Abdullah MA: The psychological impact of vitiligo in adult Sudanese patients. Afr J Psychiatry (Johannesburg). 2009, 12 (4): 284-286.
48.
Goldberg DP: Manual of the general health questionnaire. 1978, Windsor, England: NFER-Nelson Publishing
49.
George D, Mallery P: SPSS for Windows step by step: A simple guide and reference. 11.0 update (4th ed.). 2003, Boston: Allyn & Bacon
50.
Miller KE, Rasmussen A: Mental health and armed conflict: The importance of distinguishing between war exposure and other sources of adversity: A response to Neuner. Soc Sci Med. 2010, 71 (8): 1385-1389. 10.1016/j.socscimed.2010.07.020.CrossRef
51.
Neuner F: Assisting war-torn populations–should we prioritize reducing daily stressors to improve mental health? Comment on Miller and Rasmussen. Soc Sci Med. 2010, 71 (8): 1381-4. 10.1016/j.socscimed.2010.06.030.CrossRefPubMed
52.
Farhood L, Zurayk H, Chaya M, Saadeh F, Meshefedjian G, Sedani T: The impact of war on the physical and mental health of the family: the Lebanese experience. Soc Sci Med. 1993, 36: 1555-1567. 10.1016/0277-9536(93)90344-4.CrossRefPubMed
53.
Fernando GA, Miller KE, Berger DE: Growing pains: the impact of disaster-related and daily stressors on the psychological and psychosocial functioning of youth in Sri Lanka. Child Dev. 2010, 81 (4): 1192-210. 10.1111/j.1467-8624.2010.01462.x.CrossRefPubMed
54.
Miller KE, Omidian P, Rasmussen A, Yaqubi A, Daudzai H: Daily stressors, war experiences, and mental health in Afghanistan. Transcult Psychiatry. 2008, 45 (4): 611-38. 10.1177/1363461508100785.CrossRefPubMed
55.
Onder E, Tural U, Aker T, Kiliç C, Erdoğan S: Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES). Soc Psychiatry Psychiatr Epidemiol. 2006, 41 (11): 868-674. 10.1007/s00127-006-0107-6.CrossRefPubMed
56.
Sher L: The concept of post-traumatic mood disorder. Med Hypotheses. 2005, 65 (2): 205-210. 10.1016/j.mehy.2005.03.014.CrossRefPubMed
57.
Priebe S, Bogic M, Ajdukovic D, Franciskovic T, Galeazzi GM, Kucukalic A, Lecic-Tosevski D, Morina N, Popovski M, Wang D, Schützwohl M: Mental disorders following war in the Balkans: a study in 5 countries. Arch Gen Psychiatry. 2010, 67 (5): 518-528. 10.1001/archgenpsychiatry.2010.37.CrossRefPubMed
58.
Porter M, Haslam N: Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA. 2005, 294 (5): 602-612. 10.1001/jama.294.5.602.CrossRefPubMed
59.
Husain F, Anderson M, Lopes Cardozo B, Becknell K, Blanton C, Araki D, Vithana EK: Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka. JAMA. 2011, 3;306 (5): 522-31.
60.
Cardozo BL, Bilukha OO, Crawford CA, Shaikh I, Wolfe MI, Gerber ML, Anderson M: Mental health, social functioning, and disability in postwar Afghanistan. JAMA. 2004, 292 (5): 575-584. 10.1001/jama.292.5.575.CrossRefPubMed
61.
Southwick SM, Morgan CA, Nicolaou AL, Charney DS: Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm. Am J Psychiatry. 1997, 154: 173-177.CrossRefPubMed
62.
Metadata
Title
What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? a cross-sectional community study in South Sudan
Authors
Touraj Ayazi
Lars Lien
Arne H Eide
Majok Malek Ruom
Edvard Hauff
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-175

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