Psychiatric disorders among war abducted and non-abducted adolescents in Gulu District, Uganda: A comparative study

Gulu University, Uganda.
African Journal of Psychiatry (Impact Factor: 0.73). 12/2007; 10(4):225-31. DOI: 10.4314/ajpsy.v10i4.30260
Source: PubMed


Objective:We aimed to assess the nature and patterns of psychiatric disorders among adolescents who had been war-abducted in the war in northern Uganda, compared to non-abducted adolescents living in Gulu district, Uganda.Method: A cros sectional study that used an unmatched case-control design compared 82 abducted and 71 non-abducted adolescents for scores on measures of psychological distress and for selected psychiatric diagnoses using the Strength and Difficulties Questionnaire (SDQ) and the Mini International Neural-Psychiatric Interview for Children and Adolescents English version 2.0 (M.I.N.I-KID). Results: More than 90% of adolescents reported exposure to severe trauma, either through direct or indirect experiences. Significantly more war abducted adolescents reported PTSD (26.8%v.12.7%) (p=0.03) major depression (19.5%v.4.2%) (p=0.004), and generalised anxiety disorder (13.4v.4.2%) (p=0.049) than non abducted adolescents. By contrast, non-abducted adolescents reported more past suicidality (p=0.004, chi(2)=8.2) than adolescents who were abducted. However, despite high rates of psychiatric disorder, these adolescents had good psychosocial adjustment. Conclusion: Adolescents in war affected areas whether warabducted or not have varied and clinically significant emotional responses to different kinds of traumatic exposure. In a war-affected area, the development of a sustainable service for adolescents that tries to address the full range of mental health problems may be more appropriate than a psychological trauma service that focuses on one diagnosis.

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Available from: Seggane Musisi, Oct 08, 2015
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    • "Also, none of the studies measured PTSS rates in a comparable control sample of nonchild soldiers. One study that did use a control group to look at specific war events and psychological distress found that children who had been abducted by armed militias in Uganda showed higher rates of PTSD (26.8% vs. 12.7%), major depression (19.5% vs. 4.2%), and generalized anxiety disorder (13.4% vs. 4.2%) than their nonabducted peers (Okello, Onen, & Musisi, 2007). This finding was supported by Kohrt et al. (2008) who found that Nepalese child soldiers had greater levels of depression and PTSD than their nonconscripted peers even after adjustment for traumatic exposures and other covariates. "
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    ABSTRACT: This article outlines the impact of conflict and war-related sexual exploitation on young people's mental health and explores some of the predisposing factors which contribute to this psychological distress. It then outlines how a lack of valid measures of psychological distress, limited research, diverse services, treatments and cultural practices, previous trauma, and a multitude of competing agencies can hamper mental health delivery in war-affected countries before explaining how using non-Western measures of distress, extensive preresearch preparation, cultural respect tinged with scepticism, a duty of care, and involving stakeholders in decision-making can mitigate these problems. Lastly, this article outlines one study that overcame the logistical, security, and educational challenges of service delivery and calls for further research on psychosocial interventions, dismantling studies of cognitive behavioral therapy (CBT) interventions, and hybrid inventions which target both mental health and psychosocial need and fruitful partnerships between academic institutions and civil society organizations.
    Journal of Cognitive Psychotherapy 08/2014; 28(3). DOI:10.1891/0889-8391.28.3.211
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    • "A recent study compared the mental health status of former child soldiers with that of children who have never been conscripts of armed groups. The results showed that all participants experienced at least one type of trauma, but the majority of them experienced more than one traumatic event (Okello et al., 2007; Kohrt et al., 2008). The same studies also show that the prolonged exposure to traumas caused complex psychological alterations to all children. "
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    ABSTRACT: Studies of children with atypical emotional experience demonstrate that childhood exposure to high levels of hostility and threat biases emotion perception. This study investigates emotion processing, in former child soldiers and non-combatant civilians. All participants have experienced prolonged violence exposure during childhood. The study, carried out in Sierra Leone, aimed to examine the effects of exposure to and forced participation in acts of extreme violence on the emotion processing of young adults war survivors. A total of 76 young, male adults (38 former child soldier survivors and 38 civilian survivors) were tested in order to assess participants' ability to identify four different facial emotion expressions from photographs and movies. Both groups were able to recognize facial expressions of emotion. However, despite their general ability to correctly identify facial emotions, participants showed a significant response bias in their recognition of sadness. Both former soldiers and civilians made more errors in identifying expressions of sadness than in the other three emotions and when mislabeling sadness participants most often described it as anger. Conversely, when making erroneous identifications of other emotions, participants were most likely to label the expressed emotion as sadness. In addition, while for three of the four emotions participants were better able to make a correct identification the greater the intensity of the expression, this pattern was not observed for sadness. During movies presentation the recognition of sadness was significantly worse for soldiers. While both former child soldiers and civilians were found to be able to identify facial emotions, a significant response bias in their attribution of negative emotions was observed. Such bias was particularly pronounced in former child soldiers. These findings point to a pervasive long-lasting effect of childhood exposure to violence on emotion processing in later life.
    Frontiers in Psychology 09/2013; 4:523. DOI:10.3389/fpsyg.2013.00523 · 2.80 Impact Factor
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    • "The same study found that even children who escaped from the rebel group- Lord’s Resistance Army a long time prior to the study continued to suffer from PTSD-like symptoms several years later [8]. In a comparative study of psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district in Uganda, Okello and others reported that the rates of PTSD among the abducted group were more than twice that of the non-abducted group [9]. "
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    ABSTRACT: Child and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda OBJECTIVE: To determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda. Four districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3--19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents. The prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14--19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education. The prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda.
    Child and Adolescent Psychiatry and Mental Health 07/2013; 7(1):21. DOI:10.1186/1753-2000-7-21
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