Determinants Of Posttraumatic Stress Disorder Research Articles

Determinants of Post-Traumatic Stress Disorder in Syrian Refugees living in Turkey's four cities

Circumstances of forced migrations are associated with increased post-traumatic stress disorder (PTSD). Research indicates that Syrian refugees are highly vulnerable and likely to experience various mental diseases due to forced migration and war-related traumatic events. Also, there are geographical-based differences in the psychological stress outcomes of refugees. The objective of the research is to examine the differences in self-reported PTSD due to circumstances of forced migration among Syrian refugees living in Turkey (N=777 respondents) by their living city. To explore which group of factors had the most significant influence on PTSD, I conducted multiple logistic regression analyses for 777 respondents. Considering logistic analysis results, self-reporting post-traumatic stress is more common among Syrian refugees who live in large cities (İstanbul/İzmir) and Syrian border conservative cities (Şanlıurfa), have poorer self-expressed health status, experience war-related situations, feel unsafe in their neighbourhood and receive less support from their families when faced with problems. These findings point to the importance of assessing self-reported PTSD due to the circumstances of refugees. Furthermore, these results show that refugees feel the burden of the experiences they carry differently.

Prevalence and determinants of post-traumatic stress disorder five months after the 2019 huge flooding in Iran

BackgroundDespite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019.MethodsAn analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants.ResultsOut of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7–28.8%) and was significantly higher in Lorestan province (39.7%, P < 0.001). Determinants of PTSD, were unemployment (adjusted odds ratio [AOR] = 3.53, CI 95%: 1.38-9.00), primary (AOR = 2.44, CI 95%: 1.10–5.41) or high school (AOR = 2.35, CI 95%: 1.25–4.40) education (vs. university), a history of mental disorders (AOR = 2.36, CI 95%: 1.22–4.58), high damage to assets (AOR = 2.29, CI 95%: 1.40–3.75), limited access to health care services after the flood (AOR = 1.95, CI 95%: 1.20–3.19), not receiving compensation for flood damage (AOR = 1.94, CI 95%: 1.01–3.83), high wealth index (AOR = 1.90, CI 95%: 1.23–2.93), and flooded house with a height of more than one meter (AOR = 1.66, CI 95%: 1.02–2.76).ConclusionResults show a notable prevalence of PTSD, especially in Lorestan province, among adults affected by floods. Determinants of PTSD include unemployment, lower education, psychiatric history, extensive property damage, limited post-flood healthcare access, lack of compensation, and increased flood exposure. We recommend adopting an inclusive screening approach for high-risk groups and developing appropriate therapeutic and supportive interventions.

Prevalence and determinants of post-traumatic stress disorder in patients with schizophrenia 2years after an earthquake in Turkey.

High rates of post-traumatic stress disorder (PTSD) have been observed in earthquake survivors even many years after the event. However, its prevalence among patients with schizophrenia is largely unknown. This study, which was conducted two years after the 2020 Elazığ earthquake, sought to identify risk factors of earthquake-related PTSD for patients with schizophrenia and healthy subjects. Adult patients with schizophrenia (N = 103) and healthy subjects (N = 103), who had all survived the earthquake, were recruited from affected areas in the Eastern Anatolian Region of Turkey, Elazığ. A detailed questionnaire of earthquake-related risk factors, Brief Coping Orientation to Problems Experienced (Brief COPE), Multidimensional Scale of Perceived Social Support (MSPSS), and Clinician-Administered PTSD scale for DSM-V (CAPS-5) scales were administered to participants. Twelve percent of the patients with schizophrenia and 25% of the healthy subjects had earthquake-related PTSD diagnoses two years after the 2020 Elazığ earthquake. Healthy subjects had a significantly higher rate of earthquake-related PTSD diagnosis when compared with patients with schizophrenia. Religious coping, self-blaming, less emotional support seeking, and going to a safer place on the night of the earthquake were found to be associated with PTSD diagnosis in patients with schizophrenia. History of traumatic events, self-blaming, and less social support from family were found to be associated with a PTSD diagnosis in healthy subjects. The earthquake in Turkey created a situation such that significant symptoms of PTSD remained present at two years following the event in both patients diagnosed with schizophrenia and healthy subjects. The patients with schizophrenia have different risk factors for the development of PTSD when compared with healthy subjects. Taking into consideration risk factors, coping strategies, and perceived social support, clinical interventions should be implemented to prevent earthquake-related PTSD.

Determinants of post-traumatic stress disorder among survivors of road traffic accidents in dessie comprehensive specialized hospital North-East Ethiopia

BackgroundPost-traumatic stress disorder is the most common mental disorder occurring among survivors of road traffic accidents. However, it remains under-explored and is not taken into account in the health policies of Ethiopia. Therefore, this study aimed to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident patients in Dessie Comprehensive Specialized Hospital, North-East Ethiopia.MethodsA facility-based unmatched case–control study design was employed from February 15 to April 25, 2021, in Dessie Comprehensive Specialized Hospital, with a total sample size of 139 cases and 280 controls selected by using a simple random sampling technique. Data were collected by pretested, interview with a structured questionnaire. The data were entered using Epi-Info, then exported and analyzed using STATA. The bi-variable and multivariable binary logistic regression model was used to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident. Adjusted odds ratio with a 95% confidence level was used as a measure of association. Variables with a p-value less than 0.05 were considered as statistically significant.ResultA total of 135 cases and 270 controls participated in this study, with a response rate of 97% and 96%, respectively. In the final multivariable analysis, being male [AOR = 0.43, 95% CI: 0.32–0.99], primary educational status [AOR = 3.4, 95% CI: 1.04–11], presence of personal psychiatric history [AOR = 2.12, 95% CI: 1.17–3.92], presence of fracture [AOR = 2.41, 95% CI: 1.2–4.8], witness of death [AOR = 2.25, 95% CI: 1.26–4.30], presence of comorbidity [AOR = 2.29, 95% CI: 1.28–4], good social support [AOR = 0.71, 95% CI: 0.12–0.68] were significantly associated with post-traumatic stress disorder among survivors of road traffic accident patients.ConclusionPTSD following road traffic accidents is common. A multi-disciplinary approach was therefore essential in the management of road traffic accident survivors at the orthopedic and trauma clinics. Patients with poor social support, bone fracture, witnessed death, comorbidity, and females should be routinely screened for post-traumatic stress disorder in all road traffic accident survivors.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice.

Introduction: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. Objective: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. Methods: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. Results: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. Conclusion: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

Prevalence and determinants of posttraumatic stress disorder and depression among survivors of motor vehicle accidents from a hilly Indian state

Background:Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected.Aim:The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs.Materials and Methods:An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann–Whitney, Kruskal–Wallis, and binary logistic regression).Results:The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92–3.06), loss of valuables (OR = 2.62; 95% CI = 0.78–9.04), self-blame (OR = 6.06; 95% CI = 1.15–31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89–46.85) acted as determinants in the occurrence of PTSD and depression.Conclusion:A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.

Prevalence and determinants of post-traumatic stress disorder among road traffic accident survivors: a prospective survey at selected hospitals in southern Ethiopia

BackgroundPost-traumatic stress disorder (PTSD) is prevalent among road traffic accident survivors (RTA), yet the psychological welfare of the persons has largely been ignored as health care professionals focus more on managing physical injuries. Many literatures from other parts of the world have addressed the issue of post-traumatic stress disorder among road traffic accident survivors, but such studies are mostly unavailable in sub-Saharan Africa, especially in Ethiopia. Therefore, this study examined the prevalence and determinants of PTSD among RTA survivors attending selected hospitals in southern Ethiopia.MethodsInstitution based cross-sectional study design was employed from April 1/2018-Sep 30/2019. Data were collected from a sample of consecutively selected 423 RTA survivors through an interviewer-administered technique. A pre-tested post-traumatic stress disorder Checklist-Specific version (PCL-S) tool was used to screen PTSD. Data were entered and analysed using SPSS 22 software. A logistic regression model was fitted to identify determinants of PTSD. An adjusted odds ratio (AOR) with a 95% confidence interval was computed to determine the level of significance with a p-value of less than 0.05.ResultA total of 416 participants were included in the study and the response rate was 98.6%. The prevalence of probable PTSD among RTA survivors was 15.4% (64). After adjusting for the effects of potential confounding variables; time since accident (30–90 days) (AOR = 0.33; 95%CI (0.15, 0.73), history of previous road traffic accident (AOR = 2.67; 95%CI (1.23, 5.77), depressive symptoms (AOR = 2.5, 95% CI (1.10, 6.10)) and common mental disorder (AOR = 12.78, 95% CI (5.56, 29.36)) were significant determinants of PTSD.ConclusionThe prevalence of probable PTSD in the current study was high (15.4%). Time since accident, history of a previous road traffic accident, having depressive symptoms and common mental disorder were significant determinants of PTSD. RTA survivors attending adult Emergency and orthopedic clinics need to be screened for PTSD and get appropriate management.

Prevalence and Determinants of PTSD 3 Years After an Earthquake in Iran.

Post-Traumatic Stress Disorder (PTSD) is one of the most debilitating and costly mental health problems that can develop following exposure to natural disasters. Nevertheless, much remains unknown about how to best address PTSD and other mental health needs in disaster-stricken areas, particularly in rural and under-resourced areas. The present study is a population-based cross-sectional study conducted in rural areas that were affected by a destructive earthquake in Iran. The aim of the research is to explore the prevalence and determinants of PTSD among survivors 3years after the earthquake. A multi-stage cluster random sampling technique was used to obtain a sample of 600 respondents between the ages of 18- and 87-years-old in affected areas. In the present sample, 224 individuals (37.3%) reported some PTSD symptoms. Factors associated with an increased likelihood of developing PTSD included being in a severely-stricken (as opposed to moderately-stricken) village and being female. However, there were no significant associations between PTSD and age groups, marital status, profession, and educational status. These results underscore the need for improved psychosocial interventions following disasters.

A Meta-Analysis of Risk Factors for Post-Traumatic Stress Disorder (PTSD) in Adults and Children after Earthquakes.

PTSD is considered the most common negative psychological reactions among survivors following an earthquake. The present study sought to find out the determinants of PTSD in earthquake survivors using a systematic meta-analysis. Four electronic databases (PubMed, Embase, Web of Science, and PsycInfo) were used to search for observational studies about PTSD following earthquakes. The literature search, study selection, and data extraction were conducted independently by two authors. 52 articles were included in the study. Summary estimates, subgroup analysis, and publication bias tests were performed on the data. The prevalence of PTSD after earthquakes ranged from 4.10% to 67.07% in adults and from 2.50% to 60.00% in children. For adults, the significant predictors were being female, low education level or socio-economic status, prior trauma; being trapped, experiencing fear, injury, or bereavement during the disaster. For children, the significant predictors were being older age, high education level; being trapped, experiencing fear, injury, or bereavement, witnessing injury/death during the earthquakes. Our study provides implications for the understanding of risk factors for PTSD among earthquake survivors. Post-disaster mental health recovery programs that include early identification, on-going monitoring, and sustained psychosocial support are needed for earthquake survivors.

Prevalence and determinants of post-traumatic stress disorder, anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti, four years after

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD=2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.

Coexistence and different determinants of posttraumatic stress disorder and posttraumatic growth among Chinese survivors after earthquake: role of resilience and rumination.

Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are two different outcomes that may occur after experiencing traumatic events. Resilience and rumination are two important factors that determine the development of these outcomes after trauma. We investigated the association between these two factors, PTSD and PTG, among Chinese survivors in an earthquake. With a convenience sample of 318 survivors from earthquake, we measured trauma exposure, PTSD, PTG, resilience, and rumination (Impact of Event Scale-Revised, Posttraumatic Growth Inventory, 10 item Connor–Davidson Resilience Scale, Ruminative Response Scale). Then we used bivariate correlation and structural equation modeling to examine the structure of relations among these factors. Results showed that resilience and reflective rumination have a positive effect on PTG (β = 0.32, p < 0.001; β = 0.17, p = 0.049). Earthquake exposure, brooding rumination and depressed-related rumination are related with higher level of PTSD (β = 0.10, p = 0.021; β = 0.33, p < 0.001; β = 0.36, p < 0.001). The findings suggest distinct determinants of the negative and positive outcomes, and this may provide better understanding about the risk and protective factors for traumatic reactions.

The stone that mourns its victims: Haiti still recovering from its injuries and traumas 5 years after the 2010 earthquake.

On Jan. 12, 2010, at 4:53 p.m. local time, Haiti was struck by the largest earthquake in its modern history. The quake killed over 222,000 people, about 2.5% of the national population, and left more than 300,000 injured, between 4,000 and 7,000 amputees, and roughly 1.5 million homeless. Following the earthquake, studies were carried out to evaluate its impact on mental health. Depending on the age group and the time of assessment, prevalences ranged from 24.6% to 47.7% for posttraumatic stress disorder (PTSD) and from 26.0% to 46.2% for major depressive disorder (1–4). Studies also revealeddifficulties inmourning the deaths of those who went missing (5). The inhumation of corpses in mass graves without identification and without respect for any cultural ritual has greatly prevented survivors from mourning their relatives who perished in this disaster, as is described by participants in various studies carried out since July 2010 (2) and reported in other studies (6). In fact, as Kluger(7) suggested,whenthere isnograve,mourningbecomes endless. Indeed, according to figures from the Haitian government and international institutions, at least 180,000 corpses were put in mass graves without being formally identified (8). Moreover, to date, no list of victims has been established. In theabsenceof this list, forwhichnoofficial initiativehas been takenyet, thememorial of theearthquakehasbecomean important place of pilgrimage. Consisting of the stone shown here and its plate, on which is written in Creole “12 January 2010/We will never forget,” the memorial represents, symbolically, the solid remains of the disaster. Erected on the largest mass grave at the north entrance of Port-au-Prince, where between 70,000 and 90,000 corpses are buried, according to the authorities, it is a place of contemplation for relatives who pay tribute to victims at special occasions: birthdays,November1 (All Saints’Day), January12, etc. In the absence of tangible signs that can facilitate the grieving Memorial for the Haiti earthquake of Jan. 12, 2010 (photograph by Darwin Clormeus; used by permission)

Assessment of prevalence and determinants of posttraumatic stress disorder and depression symptoms in adults survivors of earthquake in Haiti after 30 months

BackgroundOn January 12, 2010, a powerful 7.0 magnitude earthquake struck the Republic of Haiti and destroyed Port-au-Prince, the capital and others cities across the country. While some studies have examined the long-term traumatic effects of the seismic event on children and adolescents victims, so far no study has examined the consequences on adults generally. As such, this study aims to investigate the traumatic consequences of the earthquake among adults related to degree of exposure, peritraumatic distress, depressive symptoms and sociodemographic factors two and a half years after. In addition, predictive factors of PTSD and depressive symptoms were also identified. MethodsFrom June to July 2012, a total of 1355 adults (660 women) was assessed by means the traumatic exposure questionnaire, the Life Events Checklist subscale, the Peritraumatic Distress Inventory (PDI), the Impact of Event Scale – Revised (IES-R) and the Beck Depression Inventory (BDI), in addition to social demographic characteristics. ResultsThe prevalence rates of PTSD and depressive symptoms were 36.75% (498 cases) and 25.98% (352 cases) respectively. The risk factors for PTSD and depressive symptoms were young and old age, female gender, unemployed status and low level of education. The bests predictives variables were peritraumatic distress for PTSD (β=.57, p<.0001) and for depressive symptoms (β=.21, p<.0001). The commorbidity between PTSD and depression was 13.36%. ConclusionsThis study found that psychological symptoms are frequent event 30 months after the earthquake. The different mental health care providers, the public health ministry, NGOs working on the ground in Haiti should design programmes in order to aid the psychological wellbeing of the population focussing on youth, older and retired adults, females, people with low levels of education and those who do not work.

What are the determinants of post-traumatic stress disorder: age, gender, ethnicity or other? Evidence from 2008 Wenchuan earthquake

ObjectiveTo estimate the prevalence of post-traumatic stress disorder (PTSD) and assess determinants related to PTSD symptoms among adult earthquake survivors after the 2008 Wenchuan earthquake in China. Study designCross-sectional multicluster sample surveys with data collected from four counties. MethodsSurveys were conducted separately in four counties in Sichuan Province, with a total of 2004 respondents. Beichuan County and Dujiangyan City were damaged more severely than Yaan County and Langzhong County during the earthquake. In total, 1890 households were represented, with a mean of 2.2 respondents per household. Data were collected using structured interviews, and the Harvard Trauma Questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were used to diagnose PTSD. ResultsThe prevalence rates of suspected PTSD were 47.3% (n = 436) in heavily damaged areas and 10.4% (n = 93) in moderately damaged areas. The prevalence rates of PTSD symptoms among elderly, middle aged and young adults were 55.8%, 50.2% and 28.6% (P = 0.001), respectively, in heavily damaged areas. Older age, female gender, unmarried/divorced/widowed, ethnic minority, death of family member, no household income and damaged household were independent risk factors for PTSD symptoms in heavily damaged areas. ConclusionInterventions designed to reduce PTSD among populations affected by the 2008 earthquake should focus on people without household incomes, those with damaged households and those who experienced the death of a family member. Effective, sustainable and culturally sensitive psychosocial interventions and mental health services are required, and attention should be directed to survivors who experienced the death of a family member, women and older adults following the devastating natural disaster. Governments should support income-generating activities and improve living conditions. Trained field personnel can assist with PTSD assessments and referrals, and existing rural healthcare services can be used to provide treatment for common psychiatric disorders.

Le syndrome de la guerre du Golfe vingt ans après

Resume Le syndrome de la Guerre du Golfe (S2G) semblait etre un nouveau trouble qui associait une kyrielle de symptomes fonctionnels integrant les systemes locomoteurs, digestifs, tegumentaires et neurosensoriels. Mais malgre des investigations scientifiques tres poussees, vingt ans apres la fin de la guerre, aucun marqueur de souffrance physique objectif n’est retenu pour rendre compte des troubles presentes qui seront finalement attribues au stress. Les facteurs de stress ne manquaient pas pour les troupes deployees : alertes repetees d’attaques chimiques, hostilite du milieu avec ses vents de sable et ses animaux venimeux, conditions climatiques rendant difficiles de longues heures de soutien et d’observation statique, ramassage des corps et incertitude sur la duree du conflit. La tenue militaire de protection antinucleaire–bacteriologique–chimique permettait un confinement certes protecteur grâce a la fermeture au monde hostile duquel viendrait la menace, mais dans le meme temps, cet isolement majore la peur d’un risque hypothetique alors que les perceptions internes sont majorees et peuvent ouvrir la voie a des somatisations. Dans un tel contexte, les manifestations somatiques de l’anxiete (palpitations, sueurs, paresthesies, cephalees…) s’associent volontiers a des troubles fonctionnels somatises auxquels peuvent encore s’adjoindre des surinterpretations de sensations corporelles selon un mecanisme d’analyse hypochondriaque. Le S2G existe bel et bien : il ne s’agit pas d’une « maladie imaginaire » mais d’un trouble psychogene impliquant un serieux probleme de sante publique qui a occasionne des dizaines de milliers de plaintes et englouti des millions de dollars. Si une souffrance psychique et psychosomatique survenant chez les veterans est immuable au cours de l’histoire, l’expression de ces difficultes possede des specificites en fonction du contexte culturel, politique et scientifique d’alors. Pour repondre aux souffrances humaines, une « nouvelle » entite nosographique peut se repandre dans la societe en prenant l’expression epidemique d’un trouble somatise via des mecanismes d’identification, d’imitation et de suggestion.

Prevalence and Significant Determinants of Post-traumatic Stress Disorder in a Large Sample of Patients with Multiple Sclerosis

Chronic and life-threatening neurodegenerative diseases may be associated with post-traumatic stress disorder (PTSD). Therefore, the current study was an investigation of the prevalence of PTSD in multiple sclerosis (MS) patients, and identification of significant determinants of PTSD. Two hundred thirty-two MS patients were consecutively recruited and screened for the presence of PTSD with the Impact of Event Scale-Revised, corroborated by the Structured Clinical Interview for DSM-IV. Furthermore, participants were administered the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. Twelve patients (12/232, i.e. 5.17%) were diagnosed as suffering from PTSD. Levels of education, anxiety and depression were significant determinants of the presence of PTSD. The role played by the levels of education, anxiety and depression in determining the presence of PTSD has been discussed. Further research on the psychological features of neurodegenerative diseases is urgently needed in order to plan appropriate treatments and improve patients' quality of life.

Mental and physical health in Rwanda 14 years after the genocide

To examine the socio-demographic determinants of post-traumatic stress disorder (PTSD) and its association with major depressive episode and self-perceived physical and mental health in a large random sample of the Rwandan population 14 years after the 1994 genocide. Using the Mini International Neuropsychiatric Interview and Medical Outcomes Study 36-Item Short-Form (SF-36) translated in Kinyarwanda, we interviewed 1,000 adult residents from the five provinces of Rwanda. Socio-demographic data and specific somatic symptoms were also recorded. Data analysis included 962 questionnaires. Participants were predominantly female (58.9%), aged between 16 and 34 years (53.2%), with a low level of education (79.7% below secondary school). Prevalence of PTSD was estimated to be 26.1%. In multivariable analysis, factors associated with PTSD were being aged between 25 and 34 years, living in extreme poverty, having endured the murder of a close relative in 1994, being widowed or remarried, having lost both parents and living in the South Province. Participants who fulfilled diagnostic criteria for PTSD were significantly more often affected with major depression (68.4 vs. 6.6%, P < 0.001) and substance dependence (7.6 vs. 3.5%, P = 0.013) than respondents without PTSD. They scored significantly lower on all SF-36 subscales. Somatic symptoms such as hiccups, fainting and loss of speech or hearing delineated a specific pattern of post-traumatic stress syndrome. PTSD remains a significant public health problem in Rwanda 14 years after the genocide. Facilitating access to appropriate care for all those who need it should be a national priority.

Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson Trauma Scale

Pakistan's 2005 earthquake claimed almost 87,000 lives and displaced millions. The present study sought to assess PTSD prevalence among earthquake survivors, to evaluate its determinants, and to identify protective factors that suggest future interventions in the aftermath of disasters. In a cross-sectional survey, three districts were selected based on their proximity to the epicenter and the presence, accessibility, and security of refugees, 300 earthquake survivors were enrolled. Analysis revealed that after 30months, PTSD prevalence was high. Being female, older, unmarried, head of the family, and currently unemployed and having low income and living in temporary housing confer higher risks of PTSD. Having a high social capital and religious inclination seem to have protective, buffer effect and increase resilience against PTSD. This is the first post-quake study in Pakistan that has utilized, adapted and validated Davidson Trauma Scale in the local context. Results imply the significance of continued psychological support, of drawing on resilience factors in PTSD management. Implications and directions for future research are discussed.

Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event

Hurricane Ike struck the Galveston Bay area of Texas on September 13, 2008, leaving substantial destruction and a number of deaths in its wake. We assessed differences in the determinants of posttraumatic stress disorder (PTSD) and depression after this event, including the particular hurricane experiences, including postevent nontraumatic stressors, that were associated with these pathologies. 658 adults who had been living in Galveston and Chambers counties, TX in the month before Hurricane Ike were interviewed 2-5 months after the hurricane. We collected information on experiences during and after Hurricane Ike, PTSD and depressive symptoms in the month before the interview, and socio-demographic characteristics. The prevalence of past month hurricane-related PTSD and depression was 6.1 and 4.9%, respectively. Hurricane experiences, but not socio-demographic characteristics, were associated with Ike-related PTSD. By contrast, lower education and household income, and more lifetime stressors were associated with depression, as were hurricane exposures and hurricane-related stressors. When looking at specific hurricane-related stressors, loss or damage of sentimental possessions was associated with both PTSD and depression; however, health problems related to Ike were associated only with PTSD, whereas financial loss as a result of the hurricane was associated only with depression. PTSD is indeed a disorder of event exposure, whereas risk of depression is more clearly driven by personal vulnerability and exposure to stressors. The role of nontraumatic stressors in shaping risk of both pathologies suggests that alleviating stressors after disasters has clear potential to mitigate the psychological sequelae of these events.

Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first two years after Hurricane Katrina

Hurricane Katrina was the most devastating natural disaster to hit the United States in the past 75 years. The authors conducted interviews of 810 persons who were representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina. The prevalence of posttraumatic stress disorder (PTSD) since Hurricane Katrina was 22.5%. The determinants of PTSD were female gender, experience of hurricane-related financial loss, postdisaster stressors, low social support, and postdisaster traumatic events. Kaplan-Meier survival curves suggest that exposure to both hurricane-related traumatic events and to financial and social stressors influenced the duration of PTSD symptoms. Postdisaster interventions that aim to improve manipulable stressors after these events may influence the onset and course of PTSD.