Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon

  • Laila F. Farhood
  • Hani Dimassi
Original Paper



To determine the prevalence and predictors of psychiatric disorders in a general population from South Lebanon, an area that was under military occupation for more than 20 years.


This study assessed post-traumatic stress disorder (PTSD) and depression thresholds along with general health (GHQ) among 625 citizens in six villages in South Lebanon using a cross-sectional design through random sampling.


The prevalence ranged from 17.6 to 33.3% for PTSD and from 9.2 to 19.7% for depression. GHQ total score was found to be 6.7 significantly greater than the internationally established mean score of 5.0. Social support, financial resources, gender, and war exposure were significantly related to PTSD and depression thresholds.


The results strongly suggest that the general population in South Lebanon suffer from mental health disorders calling for appropriate psychiatric interventions and development planning.


Psychiatric disorder PTSD Depression General health South Lebanon 



The authors thank Ms Rana Bachir for her valuable input in preparing this document and Ms Nicole Strauss for her help in the reviewing and editing process.


  1. 1.
    Adwan C (2005) Corruption in reconstruction: the cost of ‘National Consensus’ in Post-War Lebanon.
  2. 2.
    Ahern J, Galea S, Fernandez WG, Koci B, Waldman R, Vlahov D (2004) Gender, social support and posttraumatic stress in postwar Kosovo. J Nerv Ment Dis 192:762–770PubMedCrossRefGoogle Scholar
  3. 3.
    Alqahtani MM, Salmon PD (2008) Prevalence of somatisation and minor psychiatric morbidity in primary healthcare in Saudi Arabia: a preliminary study in Asia region. J Fam Commun Med 15(1):27–33Google Scholar
  4. 4.
    Amnesty International (2006) Out of all proportion- civilians bear the brunt of the war.
  5. 5.
    Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck, Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100CrossRefGoogle Scholar
  6. 6.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiat 4:561–571PubMedCrossRefGoogle Scholar
  7. 7.
    Bhui K, Craig T, Mohummud S et al (2006) Mental disorders among Somali refugees: developing culturally appropriate measures and assessing socio-cultural risk factors. Soc Psychiatry Psychiatr Epidemiol 41:400–408PubMedCrossRefGoogle Scholar
  8. 8.
    Boscarino JA, Adams RE, Figley CR (2004) Mental health service use 1-year after the World Trade Center disaster: implications for mental health care. Gen Hosp Psychiat 26:346–358CrossRefGoogle Scholar
  9. 9.
    Breslau N, Chilcoat HD, Kessler RC, Davis GC (1999) Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit area survey of trauma. Am J Psychiat 156:902–907PubMedGoogle Scholar
  10. 10.
    Breslau N, Davis GC, Schultz LR (2003) Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Arch Gen Psychiat 60:289–294PubMedCrossRefGoogle Scholar
  11. 11.
    Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68(4):748–766PubMedGoogle Scholar
  12. 12.
    Bromet E, Sonnega A, Kessler RC (1998) Risk factors for DSM-II-R Posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147:353–361PubMedGoogle Scholar
  13. 13.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Academic Press, New YorkGoogle Scholar
  14. 14.
    Creamer M, Burgess P, McFarlane AC (2004) Post-traumatic stress disorder: findings from the Australian National survey of Mental Health and Well-being. Psychol Med 31:1237–1247Google Scholar
  15. 15.
    De Jong JM, Komproe IH, 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. J Am Psychiatr Assoc 286:555–562Google Scholar
  16. 16.
    Eytan A, Gex-Fabry M, Toscani L, Deroo L, Loutan L, Bovier PA (2004) Determinants of postconflict symptoms in Albanian Kosovars. J Nerv Ment Dis 192:664–671PubMedCrossRefGoogle Scholar
  17. 17.
    Farhood L, Zurayk H, Chaya M, Saadeh F, Meshefedjian G, Sidani T (1993) The impact of the war on the physical and mental health of the family: the Lebanese experience. Soc Sci Med 36(12):1555–1567PubMedCrossRefGoogle Scholar
  18. 18.
    Farhood L (1999) Testing a model of family stress and coping based on war and non-war stressors, family resources and coping among Lebanese families. Arch of Psychiatr Nurs XIII(4):192–203Google Scholar
  19. 19.
    Farhood L, Noureddine S (2003) PTSD, depression, and health status in Lebanese civilians exposed to a church explosion. Int J Psychiat Med 33:39–53CrossRefGoogle Scholar
  20. 20.
    Farhood L, Dimassi H, Lehtinen T (2006) Exposure to war-related traumatic events, prevalence of PTSD, and general psychiatric morbidity in a civilian population from southern Lebanon. J Transcult Nurs 17(4):333–340PubMedCrossRefGoogle Scholar
  21. 21.
    Frans Ö (2003) Posttraumatic stress disorder (PTSD) in the general population. Unpublished doctoral dissertation. Uppsala University, UppsalaGoogle Scholar
  22. 22.
    Frans Ö, Rimmö P-A, Åberg L, Fredrikson M (2005) Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiat Scand 111:291–299PubMedCrossRefGoogle Scholar
  23. 23.
    Freddy JR, Hobfoll SE, Ribbe D (1994) Life events, war, and adjustment: lessons for the Middle East. Anxiety Stress Copin 7:191–203CrossRefGoogle Scholar
  24. 24.
    Goldberg DP, Hillier VF (1979) A scaled version of the General Health Questionnaire. Psychol Med 9:139–145PubMedCrossRefGoogle Scholar
  25. 25.
    Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197PubMedCrossRefGoogle Scholar
  26. 26.
    Hapke U, Schumann A, Rumpf H-J, John U, Konerding U, Meyer C (2005) Association of smoking and nicotine dependence with trauma and posttraumatic stress disorder in a general population sample. J Nerv Ment Dis 193:843–846PubMedCrossRefGoogle Scholar
  27. 27.
    Hill PC, Pargament KI (2003) Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. Am Psychol 58:64–74PubMedCrossRefGoogle Scholar
  28. 28.
    Hobfoll SE (1988) The ecology of stress. Hemisphere, WashingtonGoogle Scholar
  29. 29.
    Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL (2004) Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New Engl J Med 351:13–22PubMedCrossRefGoogle Scholar
  30. 30.
    Johnson H, Thompson A (2008) The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev 28:36–47PubMedCrossRefGoogle Scholar
  31. 31.
    Karam EG (1992) PTSD and the Lebanon Wars: criteria & prevalence stress, psychiatry and War. Ed. C. Douthau World Psychiatric Association, Paris, Val-de-GraceGoogle Scholar
  32. 32.
    Karam EG, Howard DB, Karam AN, Ashkar A, Shaaya M, Melhem N, El-Khoury N (1998) Major depression and external stressors: the Lebanon wars. Eur Arch Psychiatry Clin Neurosci 248:225–230PubMedCrossRefGoogle Scholar
  33. 33.
    Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC, Chatterji S, Kessler RC (2006) Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. Lancet 367:1000–1006PubMedCrossRefGoogle Scholar
  34. 34.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nilson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiat 52:1048–1060PubMedCrossRefGoogle Scholar
  35. 35.
    Koenen KC, Harley R, Lyons MJ, Wolfe J, Simpson JC, Goldberg J, Eisen SA, Tsuang M (2002) A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder. J Nerv Ment Dis 190:190–218CrossRefGoogle Scholar
  36. 36.
    Kotler M, Iancu I, Efroni R, Amir M (2001) Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder. J Nerv Ment Dis 189(3):162–167PubMedCrossRefGoogle Scholar
  37. 37.
    Lang AJ, Rodgers CS, Laffaye C, Satz LE, Dresselhaus TR, Stein MB (2003) Sexual trauma, posttraumatic stress disorder, and health behavior. Behav Med 28(4):150–158PubMedCrossRefGoogle Scholar
  38. 38.
    Lopes Cardozo B, Vergara A, Agani F, Goway CA (2000) Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo. JAMA 284(5):569–577PubMedCrossRefGoogle Scholar
  39. 39.
    Lopez Cardozo B, Bilukha OO, Gotway Crawford CA, Shaikh I, Wolfe MI, Gerber ML, Anderson M (2004) Mental health, social functioning, and disability in postwar Afghanistan. J Am Psychiatr Assoc 292:575–584Google Scholar
  40. 40.
    Miller KE, Weine SM, Ramic A, Brkic N, Djuric Bjedi Z, Smajkic A, Boskailo E, Worthungtron G (2002) The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. J Traum Stress 15:377–387CrossRefGoogle Scholar
  41. 41.
    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 180:111–116PubMedCrossRefGoogle Scholar
  42. 42.
    Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T (2004) Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiat 4(34).
  43. 43.
    Nolen-Hoeksema S, Davis CG (1999) Thanks for sharing that: ruminators and their social support networks. J Pers Soc Psychol 77:801–814PubMedCrossRefGoogle Scholar
  44. 44.
    Norris FH, Kaniasty K (1996) Received and perceived social support in times of stress: a test of the social support deterioration deterrence model. J Pers Soc Psychol 71(3):498–511PubMedCrossRefGoogle Scholar
  45. 45.
    Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002) 60,000 Disaster Victims Speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65 (3):207–239Google Scholar
  46. 46.
    Scholte WF, Olff M, Ventevogel P, de Vries GJ, Jansveld E, Lopez Cardozo BL, Gotway Crawford CA (2004) Mental health symptoms following war and repression in eastern Afghanistan. J Am Psychiatr Assoc 292:585–593Google Scholar
  47. 47.
    Silove et al (2007) Screening for depression and PTSD in a Cambodian population unaffected by war: comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire with the Structured Clinical Interview. J Nerv Ment Dis 195: 152–157Google Scholar
  48. 48.
    Thabet AA, Vostanis P (2005) The validity and reliability of Arabic Version of General Health Questionnaire in the Gaza Strip. Palestinian Med J 1(1):33–36Google Scholar
  49. 49.
    Thapa SB, Hauff E (2005) Psychological distress among displaced persons during an armed conflict in Nepal. Soc Psychiatry Psychiatr Epidemiol 40:672–679PubMedCrossRefGoogle Scholar
  50. 50.
    Werneke U, Goldberg P, Yalcin I, Ustun BT (2000) The stability of the factor structure of the General Health Questionnaire. Psychol Med 30:823–829PubMedCrossRefGoogle Scholar
  51. 51.
    Wolff AC, Ratner PA (1999) Stress, social support, and sense of coherence. Western J Nurs Res 21:182–197CrossRefGoogle Scholar
  52. 52.
    World Health Organization. World Mental Health surveys.
  53. 53.
    World Health Organization (2006) Project report on: mental health and psychosocial care—Postwar Lebanon, 2006: Phase I—Training of Primary Health Care Providers. Prepared by Dr. Laila FarhoodGoogle Scholar
  54. 54.
    Yahov R, Cohen M (2007) Symptoms of acute stress in Jewish and Arab Israeli citizens during the Second Lebanon War. Soc Psychiatry Psychiatr Epidemiol 42:830–836CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Psychiatry-Mental Health Nursing, Hariri School of NursingAmerican University of BeirutBeirutLebanon
  2. 2.Psychiatry DepartmentAmerican University of BeirutBeirutLebanon
  3. 3.School of PharmacyLebanese American UniversityJbeilLebanon

Personalised recommendations