Stigmatization Is Associated With Increased PTSD Risk After Traumatic Stress and Diminished Likelihood of Spontaneous Remission–A Study With East-African Conflict Survivors

Abstract

Studies in conflict population have repeatedly documented that the number of traumatic event types experienced (trauma load) increases the risk to develop posttraumatic stress disorder (PTSD) in a dose-dependent manner. Misconceptions about survivors' experiences and actions during the war, as well as mental health symptoms frequently lead to stigmatization by their own families and the community, which might render them even more vulnerable for PTSD development and prevent successful recovery. We therefore investigated whether stigmatization affects trauma-related psychopathology beyond the well-known effect of trauma load. The study sample comprised N = 1131 survivors of the rebel war led by the Lord's Resistance Army (LRA) in Northern Uganda, including a large proportion of formerly abducted individuals and child soldiers. We investigated how the experience of stigmatization affects PTSD risk and the likelihood of spontaneous remission, taking trauma load into account. Further, the association of stigmatization with treatment outcome was determined in a subsample of N = 284 individuals with PTSD who received trauma-focused psychotherapy. More than one third of the total sample, and almost two-thirds of the therapy subsample, reported experiences of stigmatization. The main reasons for stigmatization were related to an association with a rebel group (e.g., being called a rebel), followed by mental health problems/PTSD symptoms and HIV/AIDS. Stigmatization was strongly associated with a higher prevalence of lifetime and current PTSD, a diminished probability of spontaneous remission and higher PTSD symptoms before and after trauma-focused psychotherapy, beyond the effect of trauma load. In sum, our results support the assumption that stigmatization aggravates trauma-related psychopathology and impede symptom improvement. In post-conflict regions, community and family interventions which aim at reducing stigmatization and discrimination might therefore complement individual psychotherapy in order to allow survivors to recover and reintegrate into society.

Understanding Stigmatisation: Results of a Qualitative Formative Study with Adolescents and Adults in DR Congo

“…This resonates with conclusions drawn on 'former child soldiers' in Uganda, where stigma was driven by fear of contamination of 'abnormal behaviour' (Ertl et al 2014) and on girls formerly associated with armed forces in eastern DRC, where they were thought to badly influence their peers (Tonheim 2012). Although the general population did not indicate they held the CAAFAG responsible for experienced violence, as in Uganda (Schneider et al 2018), fear of current violence was perceived. Stereotyping substance abuse of CAAFAG was identified, comparable to addictions described as a challenge for former child soldiers in DRC (Johannessen and Holgersen 2014) and consistent to references of ill mental health in Uganda (Schneider et al 2018).…”

Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD?

“…Accordingly, it is important to consider further individual risk and resilience factors that might influence treatment effectiveness. Important candidates represent genetic risk factors , social emotions (guilt, shame) and social support, stigmatization, physical health or comorbid mental health disorders (Andrews, Brewin, & Rose, 2003;Bowler et al, 2017;Corrigan, 2004;Corrigan & Watson, 2002;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995;Pace & Heim, 2011;Pacella, Hruska, & Delahanty, 2013;Schneider et al, 2018). Yet, the results of this study clearly show that studies investigating factors associated with trauma therapy outcome need to consider trauma load in their analyses as this factor strongly influences PTSD symptom severity.…”

“…Trauma exposure was assessed with a 62-items event list that has been used in previous studies (Conrad et al, 2017;Schneider et al, 2018;Wilker et al, , 2015Wilker et al, , 2018. The list included general traumatic events (e.g.…”

Trauma, Aggression, and Post Conflict Perpetration of Community Violence in Female Former Child Soldiers—A Study in Eastern DR Congo

“…For example, female former child soldiers explained to our research group that they frequently trapped other women and girls in situations where they could be raped by men, or even participated in the physical restraint of other women and girls, the motivation apparently being to reduce the number of women and girls who had not been raped in order to diffuse the stigma and social exclusion that they themselves were experiencing as known victims of rape. Social stigma and marginalisation is commonly encountered by returning female child soldiers ( 53 ), and the lack of social acknowledgement and community exclusion may further impact on psychopathology and recovery ( 54 ).…”