Prevalence of Posttraumatic Stress Disorder and Depression Among Internally Displaced Persons in Mogadishu-Somalia

Prevalence and associated factors of depression and posttraumatic stress disorder among trauma patients: multi-centered cross-sectional study

Background

Stress-related disorders, such as post-traumatic stress disorder (PTSD), are expected to be the leading cause of global mortality and morbidity by 2030. However, there is limited information on the prevalence of depression and PTSD among trauma patients in Ethiopia. Our study was aimed at determining the prevalence of depression and PTSD and factors affecting it among trauma patients.

Methods

A hospital-based, multi-centered, cross-sectional study was conducted among 621 patients who visited the trauma outpatient clinic from April to June 2023. The stratified random sampling technique was used to select participants. Data were collected using standardized and pretested structured questionnaires and face-to-face interviews. Post-traumatic stress disorder was measured by the posttraumatic stress disorder checklist for DSM-5 (PCL-5), and depression was assessed by the Patient Health Questionnaire (PHQ-9). Data were analyzed using STATA version 14.1. Bivariable and multivariable logistic regression models were used to examine the association between outcome and independent variables. P-values less than 0.05 were considered statistically significant.

Results

In this study, 621 study participants were involved, with a response rate of 100%. More than half (55%) of the participants were male. The participants' median age was 32 years, and the interquartile range (IQR) ranged from 25 to 43 years. The prevalence of depression was 35.4% (95% CI: 31.65-39.2), and the prevalence of PTSD was 14.2% (95% CI: 11.4-16.9). In multivariable analysis, being female (AOR = 1.58, 95% CI: 1.05-2.35), having no formal education (AOR = 1.7, 95% CI: 1.01- 2.85), having a low income (AOR = 4.5, 95% CI: 1.93-10.70), and having poor social Support (AOR=2.04, 95% CI 1.34-3.10) and multiple traumatic events (AOR=7.2, 95% CI: 4.1-12.7) were significant predictors of depression. For post-traumatic stress disorder, being female (AOR=2.7, 95% CI 1.46-5.06), no formal education (AOR=2.61, 95% CI: 1.25-5.46), urban residency (AOR=2.11, 95% CI: 1.14-3.90), having depression (AOR=7.01, 95% CI: 3.65-13.46), and multiple traumatic events (AOR=8.08, 95% CI: 2.83-23.14) were the associated factors identified.

Conclusion and recommendation

The study revealed high levels of depression and post- traumatic stress disorder among trauma patients. Targeted interventions addressing socio-demographic disparities, such as income and education levels, alongside psychosocial support, are imperative.

Depression, anxiety and its predictor among internally displaced person in metekel Ethiopia, 2023: using a structural equation model

Introduction

These individuals face psychological and physical trauma, loss of jobs, and emotional isolation, which may lead to the development of depression and anxiety. In 2022, 120 countries had over 71 million IDPs, a 20% increase from the previous year. In sub-Saharan Africa, natural disasters accounted for 40% of all new IDPs worldwide.

Method

An institutional-based cross-sectional study was conducted in Ethiopia. A systematic random sampling method was used to select 997 respondents. Data were collected using a structured interview questionnaire. STATA Version 17 and Amos Version 21 were used for the analysis. Descriptive statistics were summarized using frequency, percentage, table, graph, chart, figure, and summary statistics. Structural equation modeling was employed to assess the relationship.

Result

The overall prevalence of depression and anxiety was 79.64% (95% CI: 77.02 82.03) and 74.62% (95% CI =71.83%, 77.23%) respectively. age (adjusted β = 0.0034, 95% CI: 0.0012, 0.0056), history of the death of a loved one (adjusted β = 0.132, 95% CI: 0.0803, 0.185), had formal education (β = -0.164, 95% CI: -0.229, -0.098) occupation other (adjusted β = -0.183, 95% CI: -0.261, -0.105), Not having medically confirmed mental illness (adjusted β = -0.185, 95% CI: (-0.325, -0.045), PTSD score (adjusted β = 0.0082, 95% CI: 0.0048, 0.012) associated with anxiety.

Conclusion

Displacement medically confirmed mental illness, death of a loved one, and post-traumatic stress disorder (PTSD) significantly impact anxiety. Policymakers should provide greater access to mental health management and prevention services, and medical practitioners should understand the connection between depression and anxiety.

Impact of climate change, biodiversity loss, and pollution on the incidence and manifestation of depressive and anxiety disorders

PURPOSE OF REVIEW

Climate change, biodiversity loss, and pollution present a major threat to health. Although emphasis has been put on physical health impacts, evidence on the mental health consequences is now also accumulating quickly. Given the rapid developments in the field, this article provides an expert opinion on the emerging research.

RECENT FINDINGS

Umbrella reviews are adding more high-level evidence on the associations of environmental crises and mental health. Individual studies are focusing on specific aspects of environmental crises and mental health, shedding light on potential direct links between climate change and mental health. Further studies are aiming to quantify individual burden and societal cost of the environmental crises and mental health nexus and to identify those most at risk for negative mental health outcomes. Many studies focus on eco-emotions, attempting to characterize them further, provide tools for quantification, and to determine their effect on functioning.

SUMMARY

Although the accumulating research on the impacts of environmental change on depression and anxiety is filling important knowledge gaps, important questions remain, for example concerning the risk factors for the development of mental health disorders caused by ecological crises, tailored preventive strategies, and concerning the effects of biodiversity loss on mental health. Health systems need to further develop responses to these environmental crises.

Prevalence and correlates of post-traumatic stress disorder among internal displaced people in Qoloji Camps, Somali regional state, Eastern Ethiopia

OBJECTIVES

This study assessed the prevalence and correlates of post-traumatic stress disorder (PTSD) among internally displaced people (IDP) in the Qoloji Camp, Somali Regional State, Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from October 20 to November 5, 2021. The study utilized systematic random sampling to identify 410 IDP participants from the Qoloji Camp. PTSD was measured using the PTSD Check-list for DSM-5 (PCL-5). Bivariate analysis was performed to determine the crude odds ratio, and multivariate analysis was used to calculate adjusted odds ratios for associations between PTSD and independent variables.

RESULTS

A total of 404 participants were interviewed (98.5% response rate). The estimated prevalence of PTSD symptoms was 41.1%. In the multivariate logistic regression analysis, several factors were significantly associated with PTSD: being female (AOR = 2.5, 95% CI = 1.39-4.44), lack of food and water (AOR = 2.2, 95% CI = 1.17, 4.23), destruction of personal property (AOR = 3.1, 95% CI = 1.62-6.09), and experiencing torture or beatings (AOR = 1.8, 95% CI = 1.01-3.28).

CONCLUSION

This study found a high prevalence of PTSD symptoms among IDPs, with factors such as female sex, property destruction, deprivation of essential goods and services, and experiences of torture or beatings significantly associated with those symptoms. To address these findings, prioritizing the well-being of IDPs with a specific focus on women, on-site screening, and the establishment of a referral system to facilitate access to specialized care are essential to enhance the overall mental health of such persons.

Prevalence and associated factors of depression among refugees in East Africa: a systematic review and meta-analysis

INTRODUCTION

Depression is a common and debilitating mental health issue among refugees in East Africa, who face numerous challenges. However, there is a lack of systematic reviews and meta-analyses that have explored the pooled prevalence and associated factors of depression among refugees in East Africa. This study aims to investigate the pooled prevalence of depression and its associated factors among refugees living in East Africa.

METHODS

A systematic search was conducted across several databases, including PubMed/MEDLINE, CINAHL, ScienceDirect, African Journals of Online (AJOL), and Google Scholar. The quality of the included studies was assessed using a Joanna Briggs Institute (JBI) quality appraisal tool. Statistical analysis was carried out using STATA-17 software packages, and a meta-analysis was conducted using a random-effects model. Heterogeneity among the studies was assessed using the I2 statistic. Publication bias was evaluated using the DOI plot, Luis Furuya Kanamori (LFK) index, and Egger's test. For associated factors of depression, effect sizes (odds ratio) with 95% confidence intervals were analyzed.

RESULT

A total of eight studies involving 6,388 participants were included in this systematic review and meta-analysis, all of which were assessed to have a low risk of bias. The pooled prevalence of depression was 50.60%, with a 95% CI (35.49%, 65.71). Regarding factors associated with depression; being female [(OR = 2.01; 95% CI (1.06, 3.82)], having poor social support [OR 5.88; 95% CI (2.53, 13.67)], and experienced eight or more traumatic events [OR = 3.31;95% CI (1.74, 6.31) were positively associated factors with depression.

CONCLUSION

The pooled prevalence of depression among refugees in East Africa was found to be significantly high. Female participants, poor social support, and experienced eight or more traumatic events were factors affecting depression among refugees in East Africa. Therefore, policymakers and health personnel in East Africa should prioritize addressing the needs of female participants, individuals with poor social support, and those who have experienced eight or more traumatic events.

Anxiety, depression and access to mental health services among internally displaced persons in Mogadishu, Somalia: a cross-sectional survey

OBJECTIVE

The study aims to evaluate anxiety and depression levels and access to mental health services among internally displaced persons (IDPs) in Mogadishu, Somalia.

DESIGN

A community-based, cross-sectional survey was carried out in IDP camps. Face-to-face interviews were conducted using a modified Hospital Anxiety and Depression Scale. Data were analysed using SPSS V.25.0, incorporating univariate and logistic regression analyses.

SETTING

The study was conducted in 10 IDP camps located in the districts of Daynile and Kahda in the Banadir region of Somalia between November and December 2023.

PARTICIPANTS

The study included 522 randomly sampled individuals aged 18-70 years living in the selected IDP camps.

RESULTS

The study revealed high prevalence rates of anxiety (43.7%) and depression (35.8%) among IDPs in the selected districts. Of those with anxiety, 54% were categorised as borderline cases and 46% as severe cases. Similarly for depression, 72.7% were classified as borderline cases and 27.3% as severe cases. Significant associations were found between anxiety symptoms and variables such as camp residence (OR: 3.872, 95% CI 2.333 to 6.424), female gender (OR: 2.387, 95% CI 1.604 to 3.552), young age (OR: 6.319, 95% CI 4.309 to 9.267), marriage contract (OR: 4.569, 95% CI 2.850 to 7.325), lack of education (OR: 1.92, 95% CI 1.349 to 2.737) and past experiences of trauma (OR: 5.207, 95% CI 3.274 to 8.281). Depressive symptoms were significantly associated with younger age (OR: 1.536, 95% CI 1.069 to 2.208), lack of formal education (OR: 1.661, 95% CI 1.153 to 2.395) and history of trauma (OR: 3.695, 95% CI 2.529 to 5.400). Additionally, the study highlighted a grave shortage of mental health and psychosocial support (MHPSS) services. User evaluations of MHPSS services varied, indicating room for improvement.

CONCLUSION

The study revealed elevated levels of anxiety and depression among IDPs in the districts of Kahda and Daynile in the Banadir region of Somalia, underscored by a critical shortage of MHPSS services, emphasising the need for tailored mental health interventions.

Prevalence of Post-Traumatic Stress Disorder and Depression and Associated Factors Among Internally Displaced Persons in Al-Galgala, Sudan

Purpose

Conflict and war can have profound psychological and physical consequences, including the displacement of civilians. Sudan currently has the greatest child displacement crisis and the highest number of displaced individuals worldwide. Stressors, such as unemployment, poor socioeconomic conditions, and lack of social integration can increase the risk of developing mental health conditions and worsen pre-existing ones. This study aims to determine the prevalence of PTSD and depression and to investigate the association of sociodemographic and displacement characteristics with both PTSD and depression.

Patients and Methods

An observational descriptive cross-sectional community-based study was conducted among 143 IDPs, in Al-Galgala village, Sudan. The data was collected by seven, well-trained individuals over 2 weeks. The PTSD Checklist - Civilian version (PCL-C) scale was used for PTSD symptoms, and the Patient Health Questionnaire 9 (PHQ-9) scale was used for depression symptoms. The diagnostic criteria for PTSD and depression symptoms were based on the Diagnostic and Statistical Manual (DSM-IV). Descriptive statistics and Binary Logistic Regression analysis were adopted to determine the predictors for PTSD and depression symptoms. A P-value of 0.05 or lower was considered statistically significant.

Results

The prevalence of PTSD symptoms was found to be 25% based on DSM-IV symptoms' criteria and that of depression was 62%. Moreover, 23.1% of the participants had comorbid depression and PTSD symptoms. Being female (AOR = 8.434, 95% CI [1.026-69.325]), and having depression increased the risk of developing PTSD (AOR = 45.631, 95% CI [7.125-292.232]). Whereas, being older (40-59 years) (AOR = 6.473, 95% CI [1.054-39.766]) and having PTSD (AOR = 24.736, 95% CI [4.928 -124.169]) increased the risk of developing depression.

Conclusion

The estimated prevalence of PTSD and depression among IDPs in Al-Galgala, Sudan was found to be relatively high. This study revealed that depression, gender, occupation, education, and with whom you are currently staying were significantly associated with PTSD. In contrast, factors associated with depression were PTSD, age, and the duration of exposure to the armed conflict. The mental health among IDPs needs to be prioritized by implementing effective programs and providing psychosocial support to civilians residing in post-conflict regions.

Factors associated with depression among war-affected population in Northeast, Ethiopia

BACKGROUND

Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia.

METHOD

A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association.

RESULT

The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression.

CONCLUSION

This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.

Post-traumatic stress disorder and associated factors among internally displaced persons in Africa: A systematic review and meta-analysis

BACKGROUND

Internally displaced people (IDPs), uprooted by conflict, violence, or disaster, struggle with the trauma of violence, loss, and displacement, making them significantly more vulnerable to post-traumatic stress disorder (PTSD). Therefore, we conducted a systematic review and meta-analysis to assess the prevalence and associated factors of PTSD among IDPs in Africa.

METHODS

A comprehensive search of electronic databases was conducted to identify relevant studies published between 2008 and 2023. The search included electronic databases such as PubMed, CABI, EMBASE, SCOPUS, CINHAL, and AJOL, as well as other search sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted using Microsoft Excel, and analysis was performed using STATA 17 software. The quality of the included studies was assessed using the JBI quality appraisal tool. A random-effects model was used to estimate the pooled prevalence of PTSD and its associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics was used to assess heterogeneity. The protocol for this review has been registered with PROSPERO (ID: CRD42023428027).

RESULTS

A total of 14 studies with a total of 7,590 participants met the inclusion criteria. The pooled prevalence of PTSD among IDPs in Africa was 51% (95% CI: 38.-64). Female gender (OR = 1.99, 95% CI: 1.65-2.32), no longer married (OR = 1.93, 95% CI: 1.43-2.43), unemployment (OR = 1.92, 95% CI: 1.17-2.67), being injured (OR = 1.94, 95% CI: 1.50-1.50), number of traumatic events experienced [4-7(OR = 2.09, 95% CI: 1.16-3.01), 8-11 (OR = 2.09, 95% CI: 2.18-4.12), 12-16 (OR = 5.37, 95% CI: 2.61-8.12)], illness without medical care (OR = 1.92, 95% CI: 1.41-2.29), being depressed (OR = 2.97, 95% CI: 2.07-3.86), and frequency of displacement more than once (OR = 2.13, 95% CI: 1.41-2.85) were significantly associated with an increased risk of PTSD.

CONCLUSIONS

The findings of this systematic review and meta-analysis highlight the alarming prevalence of PTSD among IDPs in Africa. Female gender, marital status, number of traumatic events, ill health without medical care, depression, and frequency of displacement were identified as significant risk factors for PTSD. Effective interventions and the development of tailored mental health programs are needed to prevent PTSD among IDPs, focusing on the identified risk factors.

Prevalence of depression and associated factors among community hosted internally displaced people of Tigray; during war and siege

BACKGROUND

Displacement is a psychologically stressful event. Since the war began, the people of Tigray were subjected to stressful events such as torture, rape, the killing of a family member, forced displacement, and even ethnic cleansing in their home countries. Especially displaced individuals are faced mental health problems. This study aimed to assess the prevalence of depression and associated factors among community internally displaced people due to the war on Tigray, in 2021.

METHODS

The community-based cross-sectional study design was applied from August 06 to 30, 2021 in all Weredas of Tigray. A total of 1,990 cIDP were recruited through a two-stage sampling technique. A structured and standardized questionnaire was used to collect data. Both bivariate and multivariable logistic regression was applied to identify associated risk factors and AOR with 95% confidence interval was used to select statistically significant variables.

RESULTS

The prevalence of depression among internally displaced people was 81.2% (95% CI: 79.4-83%), with more than 60% categorized as moderate and severe depression. The married and divorced marital status, being government employee, having family size >  = 4, destruction of household fixed assets, looting of cereals, and having disabled family members due to the war were the significantly associated risk factors of depression.

CONCLUSIONS

The prevalence of depression among community internally displaced people during the war on Tigray is very high compared to other studies conducted elsewhere. Almost 8 of 10 IDPs are developed depression and this is a very series health issue that needs immediate intervention by local, international organizations and communities around the world.

A post-traumatic stress disorder among internally displaced people in sub-Saharan Africa: a systematic review

Introduction

Despite the prevalence of post-traumatic disorder in internally displaced persons, which is well established, and the fact that respective international organizations are working on the issues, little attention is given in the context of sub-Saharan Africa, This study aims to review the available data about the prevalence and determinants of post-traumatic stress disorders among internally displaced people in sub-Saharan Africa.

Methods

Studies published in the English language that have a clear outcome of interest and are available in full text were included. Six electronic databases were searched to identify published studies on the prevalence and determinants of posttraumatic stress disorder among IDPs in sub-Saharan Africa. This includes PubMed/MEDLINE, Scopus, EMBASE, PsychInfo, and the Web of Science. All relevant studies till June, 2023 were assessed. The review was done as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD420222997111).

Results

Originally, 33,138 articles were found in six databases, and finally, eleven studies were reviewed. The prevalence of post-traumatic stress disorder in sub-Saharan African countries was disproportionately presented in this review, ranging from 12.3% in Central Sudan to 85.5% in Nigeria. From a total of 11 studies, eight of them reported more than 50% of the magnitude of post-traumatic stress disorder, pointing to a higher magnitude of the prevalence of post-traumatic stress disorders in the region. The study identified numerous factors that contributed to post-traumatic stress disorder among the internally displaced population. Female gender, depression, anxiety, stress, being single, low level of educational status, experiencing or witnessing traumatic events, and psychological trauma were evidenced for their association with post-traumatic stress disorder.

Conclusion

These results demonstrate a higher prevalence of post-traumatic stress disorder compared to other regions of the world. The participants' socio-demographic characteristics, including age, being single, being female, and a low level of education, were identified as factors contributing to PTSD. Moreover, the review identified that depression, anxiety, and experiencing or witnessing traumatic events were also influencing factors for PTSD among IDPs. The concerned bodies need to reinforce the monitoring and evaluation of the mental health programs of IDPs in the region.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299711, CRD42022299711.

Prevalence of mental disorders and psychological trauma among conflict- affected population in Somalia: a cross-sectional study

Background

Despite the longstanding psychosocial impact of the interactable conflict in Somalia for the last 30 years, there is lack of epidemiological studies of mental health conditions, especially at the population level.

Objectives

The aim of this study is to fill the epidemiological gap and provide population based data on mental health conditions in the South-Central region of Somalia. The specific objectives were: (1) To determine the epidemiological patterns of mental disorders in three sites; Baidoa, Dolow and Kismayo, (2) Understand the socio-demographic characteristics associated with mental health conditions in the study sites, and (3) To assess the correlates between psychological trauma and the mental wellbeing of the population.

Methods

This was a cross-sectional study of 713 respondents recruited from the three sites namely Dolow, Baidoa and Kismayo. Data on sociodemographic characteristics and mental disorders were collected using the MINI and sociodemographic questionnaire. Basic descriptive statistics were used to summarize sociodemographic characteristics. Univariable and multivariable logistic regressions were used to examine factors associated with common mental disorders. Statistical significance was considered at a value of p <0.05.

Results

Participants' mean age was 32.6 (±10.7) years. More than half (58.5%) of the respondents were male. The overall prevalence of common mental disorders was 557 (78.1%) with panic disorder (39.3%), generalized anxiety disorders (34.9%), major depressive episode current (32.1) and PTSD (29.9%). According to the multivariable logistic regression analysis, being male AOR = 1.74 (95%CI = 1.25, 2.42), having a family size of more than 10 members AOR =1.37 (95% CI = 1.00, 1.89), being unemployed AOR = 1.90 (95%CI = 1.18, 3.06), experienced starvation AOR =3.46 (95%CI = 2.23, 5.37), khat use AOR = 5.87 (955 CI, 1.75-19.65), were identified as predicting factors for the common mental disorders among the study participants.

Conclusion

There is a high prevalence of mental disorders with anxiety disorders being the commonest. Findings reflect earlier studies that showed higher rates in conflict and post-conflict settings. It also aligns with past studies in Somalia. As such, there is an urgent need to integrate mental health and psychosocial support within the primary healthcare and other service sectors such as education considering the vast majority of the population are young.