Post-traumatic stress disorder, psychiatric comorbidities and associated factors among refugees in Nakivale camp in southwestern Uganda

Abstract

Background: Armed conflict in Africa has led to displacement of over 24.2 million people, more than 1.4 million of whom are living in Uganda. Studies show that refugees living in Ugandan refugee settlements are at increased risk for post-traumatic stress disorder. However data on the prevalence of other mental health problems among refugees including depression, anxiety and substance use disorder among refugees in Uganda is lacking. Our aim was to determine the prevalence of post-traumatic stress disorder, its main psychiatric comorbidities and perceived psychosocial needs among refugees in Nakivale refugee camp. Methods: We conducted a cross-sectional survey of refugee camp residents (n = 387) from nine different countries of origin. Psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview (MINI) and perceived needs by the Humanitarian Emerging Settings Perceived Needs Scale (HESPER). Results: The prevalence of psychiatric disorders was high among refugees as was the level of perceived needs. The most prevalent psychiatric disorders were generalized anxiety disorders (73%), post-traumatic stress disorder (PTSD) (67%), major depressive disorder (58%) and substance use disorders (30%). There was a higher level of comorbidity between PTSD and substance use disorder (OR = 5.13), major depressive disorder (OR = 4.04) and generalized anxiety disorder (OR = 3.27). In multivariate analysis, PTSD was positively associated with the perception of stress as a serious problem (OR = 6.52; P-value = 0.003), safety and protection for women in the community (OR = 2.35; P-value = 0.011), care for family (OR = 2.00; P-value = 0.035) and Place to live in (OR = 1.83; P-value = 0.04). After applying the Bonferroni correction, the perception of stress remained significantly associated with PTSD. Conclusion: Our findings suggest a strong association between PTSD, its main comorbidities and basic needs in Nakivale refugee camps. Mental health support should include psychological interventions as well as social assistance to improve the health of refugees.

Social Support and Linkage to HIV Care Following Routine HIV Testing in a Ugandan Refugee Settlement

“…It is important to note that although the prevalence of mental health issues was relatively high in our study (approximately 43% of all participants screened positive for PTSD, 25% for depression and 23% for anxiety), these estimates are comparable or lower than that observed in other studies in similar and nearby regions. [28][29][30][31].…”

Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda

“…These schools were selected due to the fact that they are supported by not-for-profit organizations for purposes of educating orphans and vulnerable children with severe forms of child maltreat. This region is mainly inhabited by Bantu and non-Bantu ethnic groups with severe domestic violence and children orphaned by HIV (Satzinger, Kipp, & Rubaale, 2012 ; Schember et al, 2021 ), child maltreatment (Ainamani et al, 2021 ; Ssenyonga et al, 2019 ) and refugee crisis resulting from organized violence in the neighbouring countries (Ainamani et al, 2020 ; Bapolisi et al, 2020 ; Onyut et al, 2005 ).…”

“…Posttraumatic stress disorder (PTSD) and depression are the major psychiatric conditions studied within the vulnerable communities such as those exposed to violence and child maltreatment of all forms (Ainamani, Elbert, Olema, & Hecker, 2020 ; Bapolisi, Song, Kesande, Rukundo, & Ashaba, 2020 ; Cluver & Gardner, 2006 ; Horesh, Lowe, Galea, Uddin, & Koenen, 2015 ; O’Donnell, Creamer, & Pattison, 2004 ; Olema, Catani, Ertl, Saile, & Neuner, 2014 ; Thabet, Abed, & Vostanis, 2004 ). These mental disorders occur in different communities and across age groups including children and adolescents (Cao, Wang, Cao, Zhang, & Elhai, 2017 ; Telman et al, 2016 ).…”

“…Furthermore, children with PTSD may also exhibit excessive fear and sleep problems, compared to adults who may be able to describe typical features of PTSD (Cao et al, 2017 ; Margolin & Vickerman, 2007 ; Scheeringa, 2011 ). Previous studies on PTSD and depression in East Africa have largely focused on adult populations with little emphasis on maltreated children and adolescents (Ainamani, Elbert, Olema, & Hecker, 2017 ; Ainamani et al, 2020 ; Bapolisi et al, 2020 ). The few available studies on children and adolescents have concentrated on cognitive functioning of children living with HIV (Ashaba et al, 2018 ; Nakasujja et al, 2010 ; Nampijja et al, 2018 ) and other behavioural problems related to childhood maltreatment other than PTSD and depression (Hecker, Hermenau, Salmen, Teicher, & Elbert, 2016 ; Nkuba, Hermenau, Goessmann, & Hecker, 2018 ; Ssenyonga, Magoba Muwonge, & Hecker, 2019 ; Thabet et al, 2004 ).…”

Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya

“…In low-and middle-income countries (LMICs), 20.6% of Bosnian refugees had comorbid depression-PTSD symptoms (Mollica et al, 1999), and 70% of Syrian refugees with PTSD had comorbid PTSD-depression (Uygun, 2019). Among those in a Ugandan refugee camp, 70% of refugees meeting criteria for PTSD also met criteria for depression and 82% for anxiety (Bapolisi et al, 2020). In a sample of Palestinian children in refugee camps in the Gaza Strip, the 23.9% of children meeting criteria for PTSD had higher depression scores than those without PTSD, and five PTSD symptoms in particular (sleep disturbance, somatic complaints, constricted affect, impulse control, and difficulties in concentrating) were associated with higher depression scores (Thabet et al, 2012).…”