Abstract
Research has shown that trauma exposure is associated with increased symptoms of posttraumatic stress disorder (PTSD). However, knowledge is sparse on whether there are differential predictions of specific clusters of PTSD symptoms by trauma exposure. We investigated the rate of trauma exposure and prevalence of PTSD as well as the contributions of trauma exposure to severity of four PTSD symptoms clusters among persons who were displaced due to terrorist attacks. Participants were Nigerian internally displaced persons (IDPs, N = 1059, 54.8% males; mean age = 34.30 years, SD = 13.69) who completed Hausa language versions of the Harvard Trauma Questionnaire – Part 1 for measuring trauma exposure and the Posttraumatic Stress Disorder Checklist for DSM-5 for assessing PTSD symptoms. The most frequently reported traumatic stressors were lack of basic needs, losses, maltreatment/torture, and violent deaths. Prevalence of PTSD was high (65.72%). Trauma exposure uniquely and strongly predicted increased PTSD symptoms severity across all the PTSD symptoms clusters by adding more variances above and beyond the demographic factors. Regular provision of relief materials is necessary in IDPs’ camps. Psychological interventions and mental healthcare services should be prioritized in comprehensive management of the displacement crisis resulting from terrorist attacks.
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Agyapong, V. I. O., Juhas, M., Omege, J., Denga, E., Nwaka, B., Akinjise, I., Corbett, S. E., Brown, M., Chue, P., Li, X.-M., & Greenshaw, A. (2019). Prevalence rates and correlates of likely post-traumatic stress disorder in residents of Fort McMurray 6 months after a wildfire. International Journal of Mental Health and Addiction. First online. https://doi.org/10.1007/s11469-019-00096-z.
Aluh, D. O., Okoro, R. N., & Zimboh, A. (2019). The prevalence of depression and post-traumatic stress disorder among internally displaced persons in Maiduguri, Nigeria. Journal of Public Mental Health, 19(2), 159–168. https://doi.org/10.1108/JPMH-07-2019-0071.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Armenta, R. F., Walter, K. H., Geronimo-Hara, T. R., Porter, B., Stander, V. A., LeardMann, C. A., & for the Millennium Cohort Study Team. (2019). Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry, 19, 396. https://doi.org/10.1186/s12888-019-2375-1.
Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J. D., & Pietrzak, R. H. (2015). Dimensional structure of DSM–5posttraumatic stress symptoms: Support for a hybrid anhedonia and externalizing behaviors model. Journal of Psychiatric Research, 61, 106–113. https://doi.org/10.1016/j.jpsychires.2014.10.012.
Augsburger, M., Meyer-Parlapanis, D., Bambonye, M., Elbert, T., & Crombach, A. (2015). Appetitive aggression and adverse childhood experiences shape violent behavior in females formerly associated with combat. Frontiers in Psychology, 6, 1756. https://doi.org/10.3389/fpsyg.2015.01756.
Biehn, T. L., Elhai, J. D., Seligman, L. D., Tamburrino, M., Armour, C., & Forbes, D. (2013). Underlying dimensions of DSM–5posttraumaticstress disorder and major depressive disorder symptoms. Psychological Injury and Law, 3, 290–298.
Bogic, M., Njoku, A., & Priebe, S. (2015). Long-term mental health of war-refugees: A systematic literature review. BMC International Health and Human Rights, 15, 29. https://doi.org/10.1186/s12914-015-0064-9.
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748–766.
Chukwuorji, J. C., Ifeagwazi, C. M., & Eze, J. E. (2017). Role of event centrality and emotion regulation in posttraumatic stress disorder symptoms among internally displaced persons. Anxiety, Stress, & Coping, 30(6), 702–715. https://doi.org/10.1080/10615806.2017.1361936.
Chukwuorji, J. C., Ifeagwazi, C. M., & Eze, J. E. (2019a). Event centrality influences post-traumatic stress disorder symptoms via core beliefs among older adults. Aging & Mental Health, 23(1), 113–121. https://doi.org/10.1080/13607863.2017.1396580.
Chukwuorji, J. C., Abiama, E. E., Ifeagwazi, C. M., Iorfa, S. K., & Nwonyi, S. (2019b). Psychometric properties of the meaning in life questionnaire – Hausa version (MLQ-H) among internally displaced persons in Nigeria. Transcultural Psychiatry, 56(1), 103–122. https://doi.org/10.1177/1363461518794218.
Creamer, M. (1995). A cognitive processing formulation of posttrauma reactions. In R. J. K. C. R. Figley & B. P. R. Gersons (Eds.), Beyond trauma. The Plenum Series on Stress and Coping. Springer.
Dai, W., Wang, J., Kaminga, A. C., Chen, L., Tan, H., Lai, Z., Deng, J., & Liu, A. (2016). Predictors of recovery from post-traumatic stress disorder after the dongting lake flood in China: A 13–14 year follow-up study. BMC Psychiatry, 16, 382. https://doi.org/10.1186/s12888-016-1097-x.
Desai, B. (2018). “It’s a time bomb” - protracted displacement and urban planning in Abuja. Retrieved on June 12 2020 from https://www.internal-displacement.org/expert-opinion/its-a-time-bomb-protracted-displacement-and-urban-planning-in-abuja.
Ebulum, G. C. (2014). Role of intensity of event, distress disclosure and resilience in posttraumatic stress disorder among flood victims in Anambra state. MSc. thesis. Department of Psychology, University of Nigeria, Nsukka.
Feingold, D., Zerach, G., & Levi-Belz, Y. (2019). The association between moral injury and substance use among Israeli combat veterans: The mediating role of distress and perceived social support. International Journal of Mental Health and Addiction, 17, 217–233. https://doi.org/10.1007/s11469-018-0012-8.
Felbab-Brown, V. (2018). In Nigeria, we don’t want them back’: Amnesty, defectors’ programs, leniency measures, informal reconciliation, and punitive responses to Boko Haram. In The limits of punishment: Transitional justice and violent extremism. United Nations University.
Flory, J. D., & Yehuda, R. (2015). Comorbidity between post-traumatic stress disorder and major depressive disorder: Alternative explanations and treatment considerations. Dialogues in Clinical Neuroscience, 17(2), 141–150.
Halasa, S., Hamdan-Mansour, A. M., Salami, I., & Alenezi, A. (2020). Post-traumatic stress and social anxiety among children of Syrian refugees in Jordan. International Journal of Mental Health and Addiction. First online., 18, 1611–1619. https://doi.org/10.1007/s11469-020-00250-y.
Hamid A. A. R. M., & Musa, S. A. (2010). Mental health problems among internally displaced persons in Darfur. International Journal of Psychology, 45(4), 278–285.
Hoge, C. W., Riviere, L. A., Wilk, J. E., Herrell, R. K., & Weathers, F. W. (2014). The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: A head-to-head comparison of DSM–5 versus DSM–IV–TR symptom criteria with the PTSD checklist. Lancet Psychiatry, 1, 269–277. https://doi.org/10.1016/S2215-0366(14)70235-4.
Idemudia, E. S., Olawa, B. D., Wyatt, G. E., & Milburn, N. (2020). Pre-displacement stressors, psychological morbidity, and PTSD symptoms among displaced women by Boko-haram in north-East Nigeria: The buffering roles of psychological capital. Journal of Psychology in Africa, 30(4), 307–314. https://doi.org/10.1080/14330237.2020.1796032.
Institute for Economics and Peace. (2015). Global terrorism index 2014: Measuring and understanding the impact of terrorism. Institute for Economics & Peace.
Institute for Economics and Peace. (2020). Global terrorism index 2019: Measuring and understanding the impact of terrorism. Institute for Economics & Peace.
Internal Displacement Monitoring Centre and the Norwegian Refugee Council. (2020). Global Report on Internal Displacement 2019. Retrieved on June 10 2020 from https://www.internal-displacement.org/global-report/grid2019/
International Organisation for Migration. (2015). Nigeria: Displacement tracking matrix (DTM) – site assessment. Retrieved on March 10, 2016 from https://reliefweb.int/report/nigeria/displacement-tracking-matrix-dtm-round-vii-report-december-2015
Kaiser, B. N., Ticao, C., Boglosa, J., Minto, J., CChikwiramadara, C., Tucker, M., & Kohrt, B. A. (2020). Mental health and psychosocialsupport needs among people displaced by Boko Haram in Nigeria. Global Public Health, 15(3), 358–371. https://doi.org/10.1080/17441692.2019.1665082.
Kim, G., Torbay, R., & Lawry, L. (2007). Basic health, women’s health, and mental health among internally displaced persons in Nyala province, South Darfur, Sudan. American Journal of Public Health, 97, 353–361.
Kubiak, S. P. (2005). Trauma and cumulative adversity in women of a disadvantaged social location. American Journal of Orthopsychiatry, 75, 451–465.
Lagos-Gallego, M., Gutierrez-Segura, J. C., Lagos-Grisales, G. J., & Rodriguez-Morales, A. J. (2017). Post-traumatic stress disorder in internally displaced people of Colombia: An ecological study. Travel Medicine and Infectious Diseases, 16, 41–45. https://doi.org/10.1016/j.tmaid.2017.02.008.
Mahmood, H. N., Ibrahim, H., Goessmann, K., Ismail, A. A., & Neuner, F. (2019). Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq. Conflict and Health, 13, 51. https://doi.org/10.1186/s13031-019-0238-5.
Marshall, G. N., Schell, T. L., Elliott, M. N., Rayburn, N. R., & Jaycox, L. H. (2007). Psychiatric disorders among adults seeking emergency disaster assistance after a wildland-urban interface fire. Psychiatric Services, 58(4), 509–514. https://doi.org/10.1176/ps.2007.58.4.509.
McGowan, I. W. (2019). The economic burden of PTSD. A brief review of salient literature. Journal of Psychiatry and Mental Health, 1, 20–26.
Miliband, D., & Tessema, M. T. (2018). The unmet needs of refugees and internally displaced people. The Lancet, 392(10164), 2530–2532. https://doi.org/10.1016/S0140-6736(18)32780-6.
Mohamed, H. (2018). Thousands displaced by Boko Haram languish in Abuja IDP camps. Retrieved on July 12, 2019 from https://www.aljazeera.com/indepth/features/thousands-displaced-boko-haram-languish-abuja-idp-camps-180325070133915.html.
Mollica, R. F., 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. Journal of Nervous and Mental Disease, 180, 111–116. https://doi.org/10.1992/02000/8.pdf.
Morina, N., Akhtar, A., Barth, J., & Schnyder, U. (2018). Psychiatric disorders in refugees and internally displaced persons after forced displacement: A systematic review. Frontiers in Psychiatry, 9, 433. https://doi.org/10.3389/fpsyt.2018.00433.
Mugisha, J., Muyinda, H., Wandiembe, P., & Kinyanda, E. (2015). Prevalence and factors associated with posttraumatic stress disorder seven years after the conflict in three districts in northern Uganda (the Wayo-Nero study). BMC Psychiatry, 15, 170–181. https://doi.org/10.1186/s12888-015-0551-5.
Musa, N. (2020). ‘Refugee crises in Nigeria, Cameroon, eight others, world’s most neglected’. Retrieved on June 10, 2020 from https://guardian.ng/news/refugee-crises-in-nigeria-cameroon-eight-others-worlds-most-neglected/.
Nandi, C., Crombach, A., Elbert, T., Bambonye, M., Pryss, R., Schobel, J., & Weierstall-Pust, R. (2020). The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers. Aggressive Behaviour. First online., 46, 391–399. https://doi.org/10.1002/ab.21895.
Olanrewaju, F. O., Olanrewaju, A., Omotoso, F., Alabi, J. O., Amoo, E., Loromeke, E., & Ajayi, L. A. (2019). Insurgency and the invisible displaced population in Nigeria: A situational analysis. SAGE Open. First online. https://doi.org/10.1177/2158244019846207.
Omenma, J. T., Onyishi, I. E., & Okolie, A.-M. (2020). A decade of Boko Haram activities: The attacks, responses and challenges ahead. Security Journal., 33, 337–356. https://doi.org/10.1057/s41284-020-00231-9.
Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacemment factors associated with mental health of refugees and internally displaced persons. Journal of the American Medical Association, 294, 602–612.
Rasmussen, A., Nguyen, L., Wilkinson, J., Raghavan, S., Vundla, S., Miller, K. E., & Keller, A. S. (2010). Rates and impact of trauma and current stressors among Darfuri refugees in eastern Chad. American Journal of Orthopsychiatry, 80(2), 227–236.
Roberts, B., Ocaka, K. F., Browne, J., Oyok, T., & Sondorp, E. (2008). Factors associated with posttraumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC Psychiatry, 8, 38.
Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis. Clinical Psychology Review, 38, 25–38. https://doi.org/10.1016/j.cpr.2015.02.007.
Shalev, A. Y., Gevonden, M., Ratanatharathorn, A., Laska, E., van der Mei, W. F., Qi, W., Lowe, S., Lai, B. S., Bryant, R. A., Delahanty, D., Matsuoka, Y. J., Olff, M., Schnyder, U., Seedat, S., deRoon-Cassini, T. A., Kessler, R. C., Koenen, K. C., & International Consortium to Predict PTSD. (2019). Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP). World Psychiatry, 18(1), 77–87. https://doi.org/10.1002/wps.20608.
Sheikh, T. L., Mohammed, A., Agunbiade, S., Ike, J., Ebiti, W. N., & Adekeye, O. (2014). Psycho-trauma, psychosocial adjustment, and symptomatic post-traumatic stress disorder among internally displaced persons in Kaduna, northwestern Nigeria. Frontiers in Psychiatry, 5, 127–133. https://doi.org/10.3389/fpsyt.2014.00127.
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & 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, 537–549. https://doi.org/10.1001/jama.2009.1132.
Strauss, S., & Wieviorka, M. (2020). Introducing a new journal: Violence. Violence: An International Journal. https://doi.org/10.1177/2633002420904265.
Taru, M. Y., Bamidele, L. I., Makput, D. M., Audu, M. D., Philip, T. E., John, D. F., Yusha'u, A. A., & Annah, G. B. (2018). Posttraumatic stress disorder among internally displaced victims of Boko Haram terrorism in north-eastern Nigeria. Jos Journal of Medicine, 12(1), 8–15.
Warner, J., & Matfess, H. (2017). Exploding stereotypes: The unexpected operational and demographic characteristics of Boko Haram's suicide bombers. Retrieved on June 10 2020 from https://ctc.usma.edu/app/uploads/2017/08/Exploding-Stereotypes-1.pdf
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD.
World Health Organization. (2013). Guidelines for the management of conditions specifically related to stress. World Health Organization.
Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., Foa, E. B., Young-McCaughan, S., Yarvis, J. S., Hembree, E. A., Mintz, J., Peterson, A. L., & Litz, B. T. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28(11), 1392–1403. https://doi.org/10.1037/pas0000260.
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Ethical clearance for the study was granted by the relevant institutional review committee, and permission to conduct the study was granted by the National Emergency Management Agency (NEMA) office in Abuja, Nigeria.
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Emmanuel Ekpedoho Abiama, Chuka Mike Ifeagwazi, and JohnBosco Chika Chukwuorji declare that they have no conflict of interest.
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Abiama, E.E., Ifeagwazi, C.M. & Chukwuorji, J.C. Rates of Occurrence and Influence of Trauma Exposure on Posttraumatic Stress Disorder Symptoms Among Survivors of Terrorist Attacks in Northeast Nigeria. Int J Ment Health Addiction 20, 2478–2492 (2022). https://doi.org/10.1007/s11469-021-00527-w
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DOI: https://doi.org/10.1007/s11469-021-00527-w