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Psychotic-like experiences in a conflict-affected population: a cross-sectional study in South Sudan

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Abstract

Purpose

This study investigates the prevalence of psychotic-like experiences (PLEs) and examines exposure to potentially traumatic events and other relevant risk factors for PLEs in the general population of a conflict-affected, low-income country.

Methods

We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire was applied to investigate exposure to potentially traumatic events. The Mini-International Neuropsychiatric Interview was used to detect PLEs.

Results

The estimated prevalence of lifetime PLEs was 23.3 % and the rate of PLEs which were evaluated as bizarre was 9.5 %. Exposure to higher number of potentially traumatic events, younger age, rural residency, being unemployed, not having a regular income and having traditional religion were significantly associated with having PLEs. PLEs were significantly associated with reporting of psychological distress when controlling for other covariates.

Conclusions

The finding of association between traumatic exposure and PLEs calls for greater attention to the diversity of negative mental health outcomes in conflict-affected populations.

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References

  1. Linscott RJ, Van Os J (2013) An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med 43(6):1133–1149

    Article  CAS  PubMed  Google Scholar 

  2. Van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness- persistence-impairment model of psychotic disorder. Psychol Med 39(2):179–195

    Article  PubMed  Google Scholar 

  3. Kelleher I, Cannon M (2011) Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis. Psychol Med 41:1–6

    Article  CAS  PubMed  Google Scholar 

  4. Hanssen MS, Bijl RV, Vollebergh, Van Os J (2003) Self-reported psychotic experiences in the general population: a valid screening tool for DSM-III-R psychotic disorders? Acta Psychiatr Scand 107(5):369–377

    Article  CAS  PubMed  Google Scholar 

  5. Armando M, Nelson B, Yung AR, Ross M, Birchwood M, Girardi P, Fiori Nastro P (2010) Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophr Res 119(1–3):258–265

    Article  PubMed  Google Scholar 

  6. Varghese D, Scott J, Welham J, Bor W, Najman J, O’Callaghan M, Williams G, McGrath J (2011) Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophr Bull 37(2):389–393

    Article  PubMed  Google Scholar 

  7. Armando M, Nelson B, Yung AR, Saba R, Monducci E, Dario C, Righetti V, Birchwood M, Fiori Nastro P, Girardi P (2012) Psychotic experience subtypes, poor mental health status and help-seeking behaviour in a community sample of young adults. Early Interv Psychiatry 6(3):300–308

    Article  PubMed  Google Scholar 

  8. Berry K, Ford S, Jellicoe-Jones L, Haddock G (2013) PTSD symptoms associated with the experiences of psychosis and hospitalisation: a review of the literature. Clin Psychol Rev 33(4):526–538

    Article  PubMed  Google Scholar 

  9. Alsawy S, Wood L, Taylor PJ, Morrison AP (2015) Psychotic experiences and PTSD: exploring associations in a population survey. Psychol Med 45(13):2849–2859

    Article  CAS  PubMed  Google Scholar 

  10. Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher FC, Vidaver R, Auciello P, Foy DW (1998) Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 66(3):493–499

    Article  CAS  PubMed  Google Scholar 

  11. Longden E, Madill A, Waterman MG (2012) Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing. Psychol Bull 138(1):28–76

    Article  PubMed  Google Scholar 

  12. Braakman MH, Kortman FAM, van den Brink W (2009) Validity of ‘posttraumatic stress disorder with secondary psychotic features’: a review of the evidence. Acta Psychiatr Scand 119(1):15–24

    Article  CAS  PubMed  Google Scholar 

  13. Shevlin M, Armour C, Murphy J, Houston JE, Adamson G (2011) Evidence for a psychotic posttraumatic stress disorder subtype based on the national comorbidity survey. Soc Psychiatry Psychiatr Epidemiol 46(11):1069–1078

    Article  PubMed  Google Scholar 

  14. Read J, Van Os J, Morrison AP, Ross CA (2005) Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand 112:330–350

    Article  CAS  PubMed  Google Scholar 

  15. Seedat S, Stein MB, Oosthuizen PP, Emsley RA, Stein DJ (2003) Linking posttraumatic stress disorder and psychosis: a look at epidemiology, phenomenology, and treatment. J Nerv Ment Dis 191:675–681

    Article  PubMed  Google Scholar 

  16. Larkin W, Morrison AP (eds) (2006) Trauma and psychosis: new directions for theory and therapy. Routledge, East Sussex

    Google Scholar 

  17. Morrison AP, Frame L, Larkin W (2003) Relationships between trauma and psychosis: a review and integration. Br J Clin Psychol 42:331–353

    Article  PubMed  Google Scholar 

  18. Shevlin M, Murphy J, Dorahy MJ, Adamson G (2007) The distribution of positive psychosis-like symptoms in the population: a latent class analysis of the National Comorbidity Survey. Schizophr Res 89(1–3):101–109

    Article  PubMed  Google Scholar 

  19. Sareen J, Cox BJ, Goodwin RD, JG Asmundson G (2005) Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample. J Trauma Stress 18:313–322

    Article  PubMed  Google Scholar 

  20. Scott J, Chant D, Andrews G, Martin G, McGrath J (2007) Association between trauma exposure and delusional experiences in a large community-based sample. Br J Psychiatry 190:339–343

    Article  PubMed  Google Scholar 

  21. Conghaile A, DeLisi LE (2015) Distinguishing schizophrenia from posttraumatic stress disorder with psychosis. Curr Opin Psychiatry 28(3):249–255

    Article  Google Scholar 

  22. Lindley SE, Carlson EB, Hill KR (2014) Psychotic-like experiences, symptom expression, and cognitive performance in combat veterans with posttraumatic stress disorder. J Nerv Ment Dis 202(2):91–96

    Article  PubMed  Google Scholar 

  23. Brewin CR, Patel T (2010) Auditory pseudohallucinations in United Kingdom war veterans and civilians with posttraumatic stress disorder. J Clin Psychiatry 71:419–425

    Article  PubMed  Google Scholar 

  24. Soosay I, Silove D, Bateman-Steel C, Steel Z, Bebbington P, Jones PB, Chey T, Ivancic L, Marnane C (2012) Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey. BMC Psychiatry 18(12):229

    Article  Google Scholar 

  25. World Bank: Key Indicators for Southern Sudan. Southern Sudan Centre for Census, Statistics and Evaluation; 2008 http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/SOUTHSUDANEXT/0,,contentMDK:22950607~pagePK:141137~piPK:141127~theSitePK:8019852,00.html. Accessed 10 Feb 2016

  26. Ayazi T, Lien L, Eide AH, Ruom MM, Hauff E (2012) What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? A cross-sectional community study in South Sudan. BMC Psychiatry 12:175

    Article  PubMed  PubMed Central  Google Scholar 

  27. Roberts B, Damundu EY, Lomoro O, Sondorp E (2009) Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba. Southern Sudan. BMC Psychiatry 4:7

    Article  Google Scholar 

  28. Roberts B, Damundu EY, Lomoro O, Sondorp E (2010) The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern Sudan. BMC Public Health 10:518

    Article  PubMed  PubMed Central  Google Scholar 

  29. South Sudan National Bureau of Statistics: Sudan Census. Priority result; 2008. http://ssnbs.org/census-2008-priority-results/. Accessed 10 Feb 2016

  30. World Health Organization Department of Immunization Vaccines and Biologicals: immunization coverage cluster survey—reference manual. Geneva: World Health Organization. Report No.: WHO/IVB/04.23; 2005

  31. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33 (quiz 34–57)

    PubMed  Google Scholar 

  32. Eytan A, Durieux-Paillard S, Whitaker-Clinch B, Loutan L, Bovier PA (2007) Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees. J Nerv Ment Dis 195(9):723–728

    Article  PubMed  Google Scholar 

  33. Goldberg P, Williams P (1998) A user’s guide to the general health questionnaire. NFER-NELSON, Windsor

    Google Scholar 

  34. McDowell I, Newell C (1996) Psychological well-being: The General Health Questionnaire. In measuring health: a guide to rating scales and questionnaires, 2nd edn. Oxford University Press, New York, pp 225–236

    Google Scholar 

  35. Osman AM, Elkordufani Y, Abdullah MA (2009) The psychological impact of vitiligo in adult Sudanese patients. Afr J Psychiatry Johannesb 12(4):284–286

    CAS  Google Scholar 

  36. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J (1992) The harvard trauma questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis 180:111–116

    Article  CAS  PubMed  Google Scholar 

  37. George D, Mallery P (2003) SPSS for windows step by step: a simple guide and reference. 11.0 update, 4th edn. Allyn & Bacon, Boston

    Google Scholar 

  38. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549

    Article  CAS  PubMed  Google Scholar 

  39. de Jong JT, Komproe IH, Van Ommeren M, El Masri M, Araya M, Khaled N, van De Put W, Somasundaram D (2001) Lifetime events and posttraumatic stress disorder in 4 postconflict settings. JAMA 286(5):555–562

    Article  PubMed  Google Scholar 

  40. Shevlin M, Houston JE, Dorahy MJ, Adamson G (2008) Cumulative traumas and psychosis: an analysis of the national comorbidity survey and the British Psychiatric Morbidity Survey. Schizophr Bull 34(1):193–199

    Article  PubMed  Google Scholar 

  41. Ndetei DM, Muriungi SK, Owoso A, Mutiso VN, Mbwayo AW, Khasakhala LI, Barch DM, Mamah D (2012) Prevalence and characteristics of psychotic-like experiences in Kenyan youth. Psychiatry Res 196(2–3):235–242

    Article  PubMed  Google Scholar 

  42. Temmingh H, Stein DJ, Seedat S, Williams DR (2011) The prevalence and correlates of hallucinations in a general population sample: findings from the South African Stress and Health Study. Afr J Psychiatry Johannesbg 14(3):211–217

    CAS  PubMed  Google Scholar 

  43. Gureje O, Olowosegun O, Adebayo K, Stein DJ (2010) The prevalence and profile of non-affective psychosis in the Nigerian Survey of Mental Health and Wellbeing. World Psychiatry 9:50–55

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kessler RC, Birnbaum H, Demler O et al (2005) The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry 58(8):668–676

    Article  PubMed  PubMed Central  Google Scholar 

  45. Scott J, Chant D, Andrews G, McGrath J (2006) Psychotic-like experiences in the general community: the correlates of CIDI psychosis screen items in an Australian sample. Psychol Med 36(2):231–238

    Article  PubMed  Google Scholar 

  46. Johns LC, Cannon M, Singleton N et al (2004) Prevalence and correlates of self-reported psychotic symptoms in the British population. Br J Psychiatry 185:298–305

    Article  PubMed  Google Scholar 

  47. Miller KE, Omidian P, Rasmussen A, Yaqubi A, Daudzai H (2008) Daily stressors, war experiences, and mental health in Afghanistan. Trans Psychiatry 45(4):611–638

    Article  Google Scholar 

  48. Stevens G, Eagle G, Kaminer Higson-Smith C (2013) Continuous traumatic stress: conceptual conversations in contexts of global conflict, violence and trauma. Peace Conflict J Peace Psychol 19(2):75–84

    Article  Google Scholar 

  49. Lien YJ, Kao YC, Liu YP, Chang HA, Tzeng NS, Lu CW, Lin SJ, Loh CH (2015) Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample. Soc Psychiatry Psychiatr Epidemiol 50(2):289–298

    Article  PubMed  Google Scholar 

  50. Yung AR, Buckby JA, Cotton SM et al (2006) Psychotic-like experiences in non-psychotic help-seekers: associations with distress, depression and disability. Schizophr Bull 32:352–359

    Article  PubMed  Google Scholar 

  51. Yung AR, Nelson B, Baker K, Buckby JA, Baksheev G, Cosgrave EM (2009) Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia. Aust N Z J Psychiatry 43:118–128

    Article  PubMed  Google Scholar 

  52. Allen JG, Coyne L (1995) Dissociation and vulnerability to psychotic experiences: the Dissociative Experiences Scale and the MMPI-2. J Nerv Ment Dis 183:615–622

    Article  CAS  PubMed  Google Scholar 

  53. Moskowitz A (2011) Schizophrenia, trauma, dissociation, and scientific revolutions. J Trauma Dissociation 12(4):347–357

    Article  PubMed  Google Scholar 

  54. Patel V (1995) Explanatory models of mental illness in sub-Saharan Africa. Soc Sci Med 40(9):1291–1298

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The study is a part of the NUCOOP project (Capacity Building in the Field of Mental Health in South Sudan), which is funded by NORAD (Norwegian Agency for Development Cooperation). The study is also funded by LEVE (Livelihoods in Developing Countries), University of Oslo.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O box 1171, Blindern, 0318, Oslo, Norway

    Touraj Ayazi & Edvard Hauff

  2. Department of Psychology, Alan J. Flisher Centre for Public Mental Health, Stellenbosch University Private, Bag X1, Matieland, 7602, South Africa

    Leslie Swartz

  3. SINTEF Technology and Society, P.O. Box 124, Blindern, 0314, Oslo, Norway

    Arne H. Eide

  4. National Center for Dual Diagnosis, Innlandet Hospital Trust, Furnesvegen 26, 2380, Brumunddal, Norway

    Lars Lien

  5. Faculty of public health, Hedmark University College, P.O.Box 400, 2418, Elverum, Norway

    Lars Lien

  6. Division of Mental Health and Addiction, Department of Research and Development, Oslo University Hospital, Ulleval Kirkeveien 166, Building 20, 0407, Oslo, Norway

    Edvard Hauff

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  1. Touraj Ayazi
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  2. Leslie Swartz
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  3. Arne H. Eide
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  4. Lars Lien
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Correspondence to Touraj Ayazi.

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Ayazi, T., Swartz, L., Eide, A.H. et al. Psychotic-like experiences in a conflict-affected population: a cross-sectional study in South Sudan. Soc Psychiatry Psychiatr Epidemiol 51, 971–979 (2016). https://doi.org/10.1007/s00127-016-1243-2

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  • DOI: https://doi.org/10.1007/s00127-016-1243-2

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