POST-TRAUMATIC STRESS DISORDERS AMONG SOMALI URBAN REFUGEES IN

EASTLEIGH NAIROBI.

Presnters:Abdulkadir H. Warsame, Mary Kuria, Dalmas Kathuku.

PCAF Regional Psychotrauma Conference: 13th to 16th July

Venue: Catholic University, Nairobi

Background Information

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder (DSM4) that can occur following the experience or witnessing of a traumatic event.

Symptoms include: re-experiencing, avoidance, hyper arousal and social occupational dysfunction which are preceded by a traumatic event.

A refugee is a person who has been forced to leave his home and seek refuge elsewhere for fear of being persecuted.

Background Ctd

The Somali people have been in a situation of armed conflicts for more than 24 years resulting to long-term physical and psychological harm to children and adults.

Objectives To investigate the prevalence of PTSD

among Somali refugees patients attending Tawakal primary health care centre in Eastleigh from 1st May to 31st July 2013 and the association between socio-demographic variables and PTSD.

Problem statement

Death as a result of wars is simply the "tip of the iceberg". The aim of this study was to contribute to the understanding of how this prolonged conflict affected the Somali psyche and in particular investigate the prevalence of post-traumatic-stress-disorder among urban refugees of Somali decent.

Methods

Design: Cross sectional descriptive survey using quantitative and qualitative methods.

Study population: Somali refugees above the age of 18 years who had come for treatment in Tawakal medical clinic in Eastleigh Nairobi from 1st May to 31st July 2013.

Sampling: A total of 450 were screened for PTSD using impact of event scale-revised (IES-R) randomly selected from Tawakal Clinic. Every 3rd client was requested to participate.

Methods Ctd

Data collection: Socio demographic and traumatic events questionnaire was used to compile personal, family information from the respondents and Impact of event scale revised (IES-R) was used to asses the presence of PTSD

Ethical clearance was sought from Kenyatta National Hospital Ethics Committee

SPSS version 16.0 was used to analyze data. Chi-square was used to test associations.

Study limitations

The study was limited in scope and time. It only looked at one clinic in Eastleigh and one ethnic group. Similarly the study could not look at younger children because of the nature of the instrument.

For the same reasons, it only tried to determine the presence or absence of PTSD which did not correlate to other variables collected in the socio demographic questionnaire. It may however be the interest of the author to choose to re-use this data in the near future.

Results

Sample descriptionSocial demographic characteristics: The mean age of the respondents in

years was 24.06, 34% (n=151) were males. Range 18-57, 86.9%, n=391 aged between 18-29 years.

No education 13.3% (n=57), Primary 31.3% (n=134), Secondary 55.2% (n=283) and College and above 0.2% (n=1)

Prevalence of PTSD

Prevalence of PTSD: 262 subjects out of 450 met the diagnostic criteria for PTSD (based on the postulation of Weiss 1997). This represents 58.2% prevalence.

Factors associated with PTSD

28.2% (76 cases) were males; 71.8% (186 cases) were females

Females were 1.9 times more likely to suffer from PTSD than males (O.R 1.9;C.I=1.26–2.79).

69% (n=40) of the cases had not gone to school; 53% (n=73) had primary education and 60% (n=144) secondary and above

There was no significant association of PTSD and education level.

Factors associated with PTSD

52.9% (n=208) prevalence among patients aged between 18 and 29 years and prevalence of 87.1% (n=27) among those aged 31 to 40 years

There was a statistical significant association between age and PTSD as age increases the likelihood of suffering from PTSD increases(χ² (3)= 35.2, p<0.05)

Association of PTSD and past traumatic Experiences

79.5% (n=159)of the patients who had lost property tested positive for PTSD. They were 5.4 times more likely to suffer from PTSD than those who had not.(O.R.=0.84;C.I= (0.12– 0.28).

Displacement accounted for 69.9%(n=230). They were 6.6 times more likely to suffer from PTSD (O.R.= 0.15;C.I= (0.093 – 0.244).

Association of PTSD and past traumatic Experiences CTD

Violence accounted for 65.9% (n=238). They were 1.2 times more likely to suffer from PTSD (OR=0.84; C.I=0.107 – 0.317).

Loss of friends accounted for 65.3% (n=243). They were 5.4 times more likely to suffer from PTSD (OR=0.184;C.I=0.103 – 0.327).

Accidents accounted for 52.8% (n=150). They were 2 times more likely to suffer from PTSD OR=0.499 (0.331 – 0.751)

PTSD and past traumatic experiences

Violence

Displacement of persons

Accidents or injuries

Loss of property

Loss of friends/family

0 10 20 30 40 50 60 70 80 90

65.9

69.9

52.8

79.5

65.3

Prevalence of PTSD +

Prevalence of PTSD +

Traumatic experience impact on refugees

Measured by IES-R based on the postulation of Weiss (1997)

12.2% (55 cases) did not have any impact as a result of the traumatic events.

17.1% (77 cases) had little impact 27.6% (124 cases) great impact. 43.1% (194cases) severe impact.

No impact Little impact Great impact Severe Impact0

5

10

15

20

25

30

35

40

45

12.2

17.1

27.6

43.1

Distribution of refugees by the impact of thier PTSD condition

Impact based on the score

Pro

port

ion o

f re

fugees (

%)

Conclusion

The study identified risk factors associated with PTSD among the refugees namely;

Gender females are more likely to suffer from PTSD than Males

Age: the risk of PTSD increases with increase in age. Past traumatic events are one to the risk of developing

PTSD.The prevalence of PTSD is high among the urban refugees

therefore; recommendation is hereby given to the Kenya Professional Counselors Association to prioritize psychosocial support for the Somali urban refugees majority of who the study has revealed are suffering from severe case of PTSD due to the past traumatic experiences.