Abstract
BackgroundExposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs).MethodsData were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms.ResultsThe most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria.ConclusionsNearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.
Highlights
Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD)
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; [5]), the 12-month prevalence of PTSD among North American adults is about 3.5%, while in European, Asian, African, and Latin American countries this has been found to range between 0.5%– 1.0%
A recent systematic review showed that estimates of PTSD are considerably higher among children and adolescents living in low-and middle-income countries (LMICs) than among those living in high-income countries [12], ranging from as low as 0.2% to as high as 87%
Summary
Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). A review of the first methodologically sound studies appearing in the 80’s and early 90’s on exposure to traumatic events and PTSD among children and adolescents reported that up to 36% of trauma-exposed children may develop PTSD [7]. The rates of those developing PTSD could be lower in community samples [8] and higher among children experiencing specific human-induced or natural disasters [9]. A recent systematic review showed that estimates of PTSD are considerably higher among children and adolescents living in low-and middle-income countries (LMICs) than among those living in high-income countries [12], ranging from as low as 0.2% to as high as 87%
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