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PTSD, severe distress rates high in areas of previous mass conflict

Researchers found recurrent social and political violence resulted in a dramatic increase in posttraumatic stress disorder and severe distress in two locations previously exposed to communal violence in Timor-Leste in Southeast Asia.

Research was conducted in two communities and involved surveying residents aged 18 years or older at their homes after exposure to mass conflict during the Indonesian occupation after independence in 2004 (baseline), and again from June 2010 to June 2011 (follow-up), after a period of internal conflict involving warring factions.

Researchers utilized two questionnaires, the Harvard Trauma Questionnaire and Kessler-10, to measure symptoms of PTSD, depression and anxiety.

In the district capital of Dili and a rural village, Hera, all adults were interviewed at baseline and researchers aimed to follow-up with every respondent, even tracing those who had moved, in the follow-up study. After accounting for missing data and those unavailable for interview, 1,022 adults were studied, 549 of whom were females.

Using baseline data, a previous factor analysis by the researchers reported five potentially traumatic event domains: human-rights trauma, witnessing murder, natural disaster, severe deprivation of health care and conflict-related trauma.

“At follow-up, participants were asked to identify the worst injustice they had experienced for each of three historical periods: the Indonesian occupation and humanitarian emergency (1975-1999), the internal conflict (2006-2007), and in their present lives (2008-2010),” the researchers wrote.

Compared with the period of internal conflict, the Indonesian occupation resulted in greater levels of the five traumatic event domains.

Of the participants, more people lived in the rural location. Mean age increased from 33 years to 41 years at follow-up. A greater portion of participants were married, and education level increased between the two study periods.

From baseline to follow-up, researchers reported a sevenfold increase in the prevalence of PTSD (2.3% to 16.7%) and a nearly threefold increase in severe distress (5.6% to 15.9%). PTSD at follow-up was associated with indicators of disability, including days out of role, ability to do housework, ability to work or study (P<.0001), ability to care for family (P<.0001) and engagement in social activities (P<.0001).

Factors associated with PTSD included being a woman (OR=1.63; 95% CI, 1.14-2.32), exposure to human rights trauma (OR=1.25; 95% CI, 1.07-1.47) and murder during the Indonesian occupation (OR=1.71; 95% CI, 1.38-2.1), conflict-related and human rights trauma during the period of internal conflict (OR=1.46; 95% CI, 1.04-2.03), family or community conflict occurring between 2008 and 2010 (OR=1.8; 95% CI, 1.15-2.8) and “distressing preoccupations” with injustice for one, two or three historical periods (OR=4.06; 95% CI, 2.63-6.28), according to the researchers.

Severe distress was associated with the following factors: experience of health stress (OR=1.47; 95% CI, 1.14-1.9), exposure to murder (OR=1.57; 95% CI, 1.27-1.95) and natural disaster during the Indonesian occupation (OR=1.65; 95% CI, 1.03-2.64), conflict-related trauma during the internal conflict (OR=1.33; 95% CI, 1.02-1.74), continuing poverty from 2008 to 2010 (OR=1.53; 95% CI, 1.36-1.72), and preoccupations with injustice for two or three historical periods (OR=2.09; 95% CI, 1.25-3.50), the researchers reported.

“It … seems likely that the overall effects of the internal conflict on the morale, sense of communal cohesion, and security of the population created a general underlying vulnerability to psychological distress. This underlying vulnerability was probably affected by the specific risk factors we measured, increasing the prevalence of mental disorder at follow-up” the researchers concluded.

Disclosure: The researchers reported no relevant financial disclosures.