Assessment of full and subsyndromal PTSD and quality of life of internally displaced older adults in northern Nigeria

Abstract

ObjectivesTo determine the lifetime prevalence of full and subsyndromal PTSD, associated factors, and the quality of life (QOL) of internally displaced older adults in Riyom, Nigeria. MethodA cross sectional study using a multistage sampling technique was used to recruit 200 internally displaced older adults in a rural community in Nigeria. Lifetime DSM-IV PTSD diagnosis was made using the CIDI. The similarities between DSM-IV and DSM-5 made it possible to closely approximate DSM-5 diagnosis using DSM-IV symptoms and the CIDI measures of these symptoms were used to approximate DSM-5 criteria. A semi structured questionnaire was used to assess the sociodemographic and putative risk factors and QOL was assessed using the WHOQOL-BREF. Associations between full and subsyndromal PTSD and the putative risk factors were analyzed using logistic regression with significant value at p-value less than 0.05 and confidence interval (CI) of 95%. ResultsMean age of participants was 69.4 ± 10.1 years. Lifetime prevalence were 61.5% and 59.0% for full PTSD, and an additional lifetime prevalence of subsyndromal PTSD were 21.5% and 35.5% using DSM-IV and DSM-5, respectively. Lower average monthly income was associated with increased odds of endorsing full and subsyndromal PTSD using DSM-IV and DSM-5. In addition, the factors associated with increased odds of having full PTSD using DSM-IV include participants who were farmers, insurgent attacks as nature of the traumatic event (TE), TE experienced by a close relative, and lack of someone to confide in after the TE (OR = 3.299, CI = 1.236–8.805, p = 0.017); (OR = 1.180, CI = 1.002–1.390, p = 0.047); (OR = 3.190, CI = 1.200–8.478, p = 0.020); and (OR = 1.654, CI = 1.200–2.250, p = 0.020), respectively. The factors associated with increased odds of developing full PTSD using DSM-5 include participants who directly witnessed the TE (OR = 9.511, CI = 2.524–35.850, p = 0.001) and nature of trauma (OR = 1.311, CI = 1.090–1.577, p = 0.004). Participants who had poor access to health care after the TE and who had a diagnosis of a medical illness had increased odds of subsyndromal PTSD using DSM-5 (OR = 11.952, CI = 1.630–87.623, p = 0.015; (OR = 0.024, CI = 0.002–0.373, p = 0.008) . There was demonstrable impairment in the psychological, social, and environmental domains of QOL in participants who met the diagnosis for full and subsyndromal PTSD with variance in results across DSM-IV and DSM-5. ConclusionTraumatized older adults showed high prevalence of full and subsyndromal PTSD with substantial impairment in their QOL. Participants with low socioeconomic status, who directly witnessed the TE, had close relatives murdered, and lacked someone to confide in after the TE had higher likelihood of being diagnosed with full and subsyndromal PTSD across both diagnostic systems.