Assessing the Prevalence of Post-Traumatic Stress Disorder and Its Risk Factors among Adult Internally Displaced Persons in Sudan

Sayed Halaly *

Unit of Psychiatry, School of Medicine, Ahfad University for Women, Omdurman, Sudan / Taha Baasher Psychiatry Teaching Hospital, Khartoum, Sudan.

Anas Ibn Auf

Department of Psychiatry, Eastern Sudan College for Medical Sciences and Technology, Port Sudan, Sudan and Erada Mental Health Complex, Taif, Saudi Arabia.

Mohammad Almontaser Ahmed Mohammed

Department of Medicine, Abo Hamad General Hospital, Abo Hamad, Nahr Neel State, Sudan.

Adam Alnour Mouhammed

AL Mada’in College for Science and Technology, Omdurman, Sudan.

Rawia Alsayed Albasheer

Faculty of Medicine, University of Science and Technology, Omdurman, Sudan.

Wafaa Alsadig Abd Alrahman

Faculty of Medicine, Nile Valley University, Atbara, Nahr Neel State, Sudan.

Abdelgadir Hussein Osman

Department of Psychiatry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.

*Author to whom correspondence should be addressed.


Abstract

Background: Since the middle of April 2023, Sudan has experienced a large armed conflict, which resulted in millions of its people leaving their homes, being internally displaced persons (IDPs) inside the country and externally displaced to neighboring countries. A lot of them were exposed to different kinds of trauma, violence, and injuries, making them more vulnerable to psychological disorders, particularly post-traumatic stress disorder (PTSD). This study aimed to estimate the prevalence of PTSD and determine the associated risk factors among IDPs in Abo Hamad Town, Nahr Neel State, Sudan in December 2023. To our knowledge, few studies explored PTSD among IDPs in Sudan.

Materials and Methods: This is a cross-sectional community-based household study in Abo Hamad Town, Nahr Neel State, Sudan. A total of 118 adult IDPs were interviewed. A pre-tested and structured questionnaire assessed the participants' socio-demographic, clinical, and psychosocial characteristics and substance and displacement–related factors. The Short Post-traumatic Stress Disorder Rating Interview (SPRINT) scale was used to examine PTSD among them. Data were collected during two weeks by a well-trained team supervised by a consultant psychiatrist. Data were analysed using the SPSS version 22. Descriptive results were displayed using frequency tables. Bivariate and multivariate logistic regression was used to identify the association between the outcome and independent variables. A p-value equal or less than 0.05 was considered statistically significant at 95% CI.

Results: The study comprised 118 participants, 72.9% female and 27.1% male. The mean age was 29.94 years (SD+11.84). Most were educated; 57.6% were university graduates, and 22% had secondary education. Married individuals accounted for 46.6% of the sample, while 45.0% were single. More than half (53.4%) of the participants were unemployed. Over two-thirds (67.8%) had been displaced for over four months. A lack of social support was reported by half (50.9%) of the participants. While 16.9% had a chronic medical condition, 5.1% were identified as having a mental illness. The prevalence of PTSD among Internally displaced persons was found to be 70.3%, and a quarter (27.1%) had severe symptoms. The most frequent event was the participant located in an area prone to shooting, which was reported by 90.7% of respondents, followed by property destruction, difficulty lodging, forced detachment from family, and abnormal death of a family member or friend, reported by 53.4%, 50.8%, 37.3%, and 34.7% respectively. Experiencing multiple events was common, and more than half (52.5%) of the participants experienced four or more traumatic events. Related factors with significant association with PTSD were female gender, torture, witnessing the murder of a stranger, and multiple traumatic events experienced by the respondent.

Conclusion: This study showed an alarming high prevalence of PTSD among IDPs in an urban setting. Factors found to be significantly associated with PTSD were being female, experiencing torture, witnessing the murder of a stranger and exposure to multiple traumatic events. Further studies are required to investigate PTSD in IDPs, and psychological support services are of paramount importance to manage PTSD and reduce the suffering of IDPs.

Keywords: Post-traumatic stress disorder, prevalence of PTSD, risk factors, adult internally displaced persons, Abo Hamad, Sudan


How to Cite

Halaly, Sayed, Anas Ibn Auf, Mohammad Almontaser Ahmed Mohammed, Adam Alnour Mouhammed, Rawia Alsayed Albasheer, Wafaa Alsadig Abd Alrahman, and Abdelgadir Hussein Osman. 2024. “Assessing the Prevalence of Post-Traumatic Stress Disorder and Its Risk Factors Among Adult Internally Displaced Persons in Sudan”. Journal of Advances in Medicine and Medical Research 36 (7):337-47. https://doi.org/10.9734/jammr/2024/v36i75508.

Downloads

Download data is not yet available.

References

The Information Office, Abo Hamad Locality, Abo Hamad, Nahr Neel State, Sudan. Personal contact; 2023.

Innab A, Bahari G. Post-Traumatic Stress Disorder and Associated Factors among Caregivers of Patients with COVID-19 in Saudi Arabia: A Cross-sectional Study, Journal of Pharmaceutical Research International. 2022;34(13A):33–40. DOI: 10.9734/jpri/2022/v34i13A35572.

Bahadur Thapa, Tek, Mohammad Delwer Hossain Hawlader, Md. Akhter Hossain, Ariful Bari Chowdhury, Mohammad Hayatun Nabi, Sanjana Zaman GU. Ahsan. Status of Post-Traumatic Stress Disorder (PTSD) and Its Associated Factors Among Secondary School Students After Fifteen Months of Earthquake in Bhaktapur District, Nepal. Asian Journal of Medicine and Health. 2017;7(4):1-9. Available:https://doi.org/10.9734/AJMAH/2017/36819.

Roberts B, Ocaka KF, Browne J, Oyok T, Sondorp E. Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC psychiatry. 2008; 8:1-9.

Hamid AA, Musa SA. Mental health problems among internally displaced persons in Darfur. International Journal of Psychology. 2010;45(4):278-85.

The Social Welfare Office, Abo Hamad Locality, Abo Hamad, Nahr Neel State, Sudan. Personal contact; 2023.

Madoro D, et al. Post-traumatic Stress Disorder and associated Factors Among the Internally Displaced People in South Ethiopia: A Cross-sectional Study. Neuropsychiatr Dis Treat. 2020;16:2317-2326. DOI:102147/NDT. S267307.

Shultz JM et al. Internal Displacement in Colombia: fifteen distinguishing features. Disaster Health. 2014;2(1):13-24. DOI:10.4161/dish.

IDMC. 2018. Available:www.international-displacement.org/sites/default/files/…/2018-mid-year Ethiopia.

Harlem GB. Mental Health of refugees, internally displaced persons and other populations affected by conflict. Acta Psychiatr Scand. 2000;102:159.

Murthy RS, and Lakshaminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry. 2006;5(1):25.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://doi.org/ HYPERLINK Available:"https://doi.org/10.1176/appi.books.9780890425596"10.1176 HYPERLINK Available:"https://doi.org/10.1176/appi.books.9780890425596"/appi.books. HYPERLINK Available:"https://doi.org/10.1176/appi.books.9780890425596"9780890425596.

Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Lippincott Williams & Wilkins; 2011.

Porter M, Haslam N. Predisplacement and post displacement factors associated with the mental health of refugees and internally displaced persons: a meta-analysis. JAMA. 2005;294(5):602–612. DOI: 10.1001/jama.294.5.602.

Roberts B, Browne J. A systematic review of factors influencing the psychological health of conflict-affected populations in low-and middle-income countries. Glob Public Health. 2011;6(8):814–829. DOI: 10.1080/17441692.2010.511625.

Kang TS, et al. Disability and post-traumatic stress disorder symptoms in the Ukrainian General Population during the 2022 Russian Invasion. Epidemiol Psychiatric Sci. 2023;32:e21.DOI:10.1017/S204579602300015X.

Roberts B et al. Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan. BMC Psychiatry. 2009;9: 7. DOI:10.1186/1471-244X-9-7.

Ali M. et al. The Prevalence of Posttraumatic Stress Disorder and Depression among Internally Displaced Persons in Mogadishu, Somalia. Neuropsychiatric Disease and Treatment. Available:https://doi.org/ HYPERLINK Available:Available:"https://doi.org/10.2147/NDT.S398423"10.2147 HYPERLINK Available:"https://doi.org/10.2147/NDT.S398423"/NDT.S HYPERLINK Available:"https://doi.org/10.2147/NDT.S398423"398423.

The International Organization for Migration (IOM)Report; 2024.

Jonathon RT. Davidson The Short Post Traumatic Stress Disorder Rating Scale; 1997.

Ullman SE et al. Exploring the relationships of women's sexual assault disclosure, social reactions, and problem drinking. J Interpers Violence. 2008;23(9): 1235-57. DOI: 10.1177/0886260508314298. Epub 2008 Feb 28. PMID: 18309039; PMCID: PMC3863580.

Jacques-Tiura A et al. Disclosure of sexual assault: characteristics and implications for posttraumatic stress symptoms among African American and Caucasian survivors. J Trauma Dissociation. 2010;11(2):174-92. DOI: 10.1080/15299730903502938. PMID: 20373205; PMCID: PMC2862213.

Koshe et al. A post-traumatic stress disorder among internally displaced people in sub-Saharan Africa: a systematic review. Front Psychiatry. 2023;14:1261230, Published online. 2023;3. DOI:10.3389/fpsyt.2023.1261230.

Salah TTM et al. The Mental Health of internally displaced persons: an epidemiological study of adults in two settlements in central Sudan. Int J Soc Psychiatry. 2013;59:782-8. DOI: 10.1177/0020764012456810.

Hamid AA, Musa SA. Mental Health problems among internally displaced persons in Darfur. Int J Psychol. 2010; 47:278-85. DOI: 10.1080/0020759/00369220.

Ranasinghe PD, Levy BR. Prevalence of and sex disparities in posttraumatic stress disorder in internally displaced Sri Lankan People 6 months after the 2004 Tsunami. Disaster Med Public Health Prep. 2007; 1(1):34-41. DOI: 10.1097/DMP.0b013e318068fbb7.

Sheikh TL, et al. Psycho-trauma, psychosocial adjustment, and systematic post-traumatic stress disorder among internally displaced persons in Kaduna, Northwestern Nigeria. Front Psychiatry. 2014;5:127. DOI:10.3389/fpsyt.2014.00127.

Makhashvili N et al. Mental disorders and their associations with disability among internally displaced persons and returnees in Georgia. J Trauma stress. 2014;27(5): 509-518. DOI: 10.1002/jts.21949.

Al Shawi A. Prevalence of posttraumatic stress disorders among a sample of internally displaced persons in Iraq. A preliminary study. J Community Med Health Educ. 2018;8(599):2161-0711. 1000599. DOI:10.4172/ 2161-0711.

Roberts B et al. Factors associated with the health status of internally displaced persons in northern Uganda. J Epidemiol Community Health. 2009;63(30;227-232. DOI:10.1136/jech.2008.076356.

Richards A, et al. Posttraumatic stress disorder; anxiety and depression symptoms, and psychosocial treatment needs in Colombians internally displaced by armed conflicts: a mixed-method evaluation. Psychol Trauma. 2011;3(4): 384. DOI: 10.1037/a0022257.

Taru MY et al. Post-traumatic stress disorder among internally displaced victims of Bokoharam terrorism in Northeastern Nigeria. J Med. 2016;12. DOI:10.4314/JJM.v1211-2.

Tesfaye AH et al. Post-traumatic stress disorder and associated factors among internally displaced persons in Africa: A systematic review and meta-analysis. PLoS One. 2024;19(4): eo3oo894. Published online; 2024. Doi: 10.1371/journal.pone.0300894..

Roberts B, et al. Factors associated with post-traumatic stress disorder and depression among internally displaced persons in northern Uganda. BMC Psychiatry. 2008;8:38. DOI: 10.1186/1471-244x-8-38.

Murad ZK. Assessment of post-traumatic stress disorder among Shengalian internally displaced persons. J Arch Nurs Care. 2019;2:4. DOI:10.4172/2378-5756-c7-053.

Aysazci-caker F et al. A systematic review of prevalence and correlates of post-traumatic stress disorder, depression and anxiety in displaced Syrian population. J Affect Disorders Rep. 2022; 10:100397. DOI: 10.10f6/j.jadr.2022.100397.

Elklit A, et al. Social support, coping and post-traumatic stress symptoms in young refugees, Yugoslavia. Torture. 2012;22 (1):11-23.

Arango Diana et al. Forced displacement and violence against women; 2019.

Basheti IA, Ayasrah SM, AL-Qudah RA. Post-traumatic stress disorders among Syrian refugees residing in non-camp settings in Jordan. Saudi Med J. 2023; 44:91-105. DOI: 10.15537/smj,2023.44.1.20220701,

Bhan Sudan Kong WG et al. Prevalence of rape and its predictors among female students attending elementary schools: in the case of Kula refugee camp, Ambella Southwest Ethiopia- a cross-sectional study. Int Reproduc Med. 2023:1-8. DOI:10.1155/2023/5559246.

Keane TM et al. Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annu Rev Clin Psychol. 2006;2(1):161-197. DOI:10.1146/annurev.clinpsy.2.022305.095305.

Getnet B, Medhin G, Alem A. Symptoms of post-traumatic stress disorder and depression among Eritrean refugees in Ethiopia: identifying direct, meditating and moderating predictors from path analysis. BMJ Open. 2019;9(1):e021142. DOI: 10.1136/bmjopen.2017-021142.

Shevlin M et al. A comparison of DSM-5 and ICD-11 PTSD prevalence, comorbidity and disability: an analysis of the Ukrainian internally displaced person’s mental health survey. Acta Psychiatr Scand. 2018:137(2): 138-147. DOI: 10.1111/acps.12840.

Rwang GT. et al. Prevalence of post-traumatic stress disorder and symptoms, manifestation across demographic variable among internally displaced persons in JOS, Nigeria.

Abu Suhaiban H et al. Mental Health of Refugees and Torture Survivors: A Critical Review of Prevalence, Predictors, and Integrated Care. Int I Environ Res Public Health.2019, Jul;16(3):2309. Published online; 2019. DOI:10.3390/ijerph16132309.

Punamaki RL, et al. Nature of torture, PTSD, and somatic symptoms among political ex-prisoners. J Trauma Stress. 2010;23(4):532-6. DOI:10.1002/jts.20541.

Elklit A, Kurdahl S. The Psychological reactions after witnessing a killing in public in a Danish high school. Eur J Psychotraumatol.2013;4:10.3402/ejpt. v4i0.19826. Published online2013 Jan 9. DOI:10.3402/ejpt. V4i0.19826.

Schwarz ED, Kowalski JM. Malignant memories: PTSD in children and adults after a school shooting. J Am Acad Child Adolesc Psychiatry. 1991;30(6):936-44. DOI:10.1097/00004583-199111000-00011.

Foa EB, Rothman BA. Treating the trauma of rape: Cognitive Behavior Therapy for PTSD. New York Guilford Press; 1998.

Brewin CR, Dalgleish T, Joseph S. A dual representation theory of posttraumatic stress disorder. Psychol Rev. 1996; 104(4):670—86. DOI: 10.1037/0033-29x.103.4.670.

Ehlers AQ, Clark DM. A Cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38(4):319-45. DOI:10.1016/s0005-7967(99)00123-0.

Brewin CR, Holmes EA. Psychological theories of posttraumatic stress disorder. Clinical Psychology Rev. 2003;23(3):339-76. DOI: 10.1016/s0272-7358(03)00033-3.

Gold SR, et al. A Cross-validation study of the trauma symptom checklist. Journal of interpersonal violence. 9(1):12-26. DOI:10.1177/088626094001002.

Breslau N et al. Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the Detroit area survey of trauma. American Journal of Psychiatry. 156(6):902-907. DOI:10.1176/ajp. 156.6.902.

Brewin CR, et al. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of consulting and clinical psychology. 68(5): 748-766. DOI:10.1037/0022-006X.68.5.748.

Park J et al. The association between alexithymia and posttraumatic stress symptoms following multiple exposures to traumatic events in North Korean refugees. Journal of Psychosomatic Research. 78 (1):77-81. DOI:10.1016/j.jpsychores, 2014.09.007.

Kube T, et al. The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for cognitive link. Eur J Psychotrumatol. 2023;14(1):2165025- Published online 2023. DOI: 10.1080/20008066.2023.2165025.

Bojic M et al. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. BJP. 2012;200:216-223. DOI:10.1192/bjp.bp.110.084764.