Lifetime events and posttraumatic stress disorder in 4 postconflict settings

Context Little is known about the impact of trauma in postconflict, low-inc ome countries where people have survived multiple traumatic experiences. Objective To establish the prevalence rates of and risk factors for posttra umatic 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 greater than or equal to 16 years) who were randomly selected from community populations i n Algeria (n=653), Cambodia (n=610), Ethiopia (n=1200), and Gaza (n=585). Main Outcome Measure Prevalence rates of PTSD assessed using the PTSD modul e of the Composite International Diagnostic Interview version 2.1 and evalu ated 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 af ter 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. Psychi atric history and current illness were risk factors in Cambodia (adjusted o dds 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 a ssociated with PTSD in Algeria (adjusted OR, 1.6; 95% CI, 1.1-2.4). Youth d omestic stress, death or separation in the family, and alcohol abuse in par ents 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 sym ptoms of PTSD were found among 4 low-income populations who have experience d war, conflict, or mass violence. We identified specific patterns of risk factors per country. Our findings indicate the importance of contextual dif ferences in the study of traumatic stress and human rights violations.