Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: a cross-sectional community study in South Sudan

Touraj Ayazi,Lars Lien,Edvard Hauff,Arne Eide,Leslie Swartz

doi:10.1186/1471-244x-14-6

Abstract

BackgroundThe negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables.MethodsIn this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors.ResultsThe participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD.ConclusionIn individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.

Highlights

IntroductionMost studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression
The negative effect of exposure to traumatic events on mental health is well known
Much of this research has focused on post-traumatic stress disorder (PTSD) and depression [5,6,7], with anxiety disorders studied to a lesser extent

Summary

Introduction

Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. A large body of research documents the association between exposure to armed conflict-related traumatic events and negative mental health outcomes such as post-traumatic stress disorder (PTSD), depression, and anxiety [1,2,3,4]. The current study aimed to examine the association between exposure to traumatic events and anxiety disorders in a post-conflict setting. Several studies of victims of terrorist attacks [14] and victims of natural disasters [11] have documented the association between panic disorder (PD) and exposure to traumatic events. Sexual and physical abuse are traumatic events that have been considered a risk factor for panic disorder [15] in a patient population of Cambodian refugees [16]

Objectives

Methods

Results

Discussion

Conclusion