Skip to main content

Screening for traumatic exposure and psychological distress among war-affected adolescents in post-conflict northern Uganda

Social Psychiatry and Psychiatric Epidemiology volume 47, pages 1489–1498 (2012)Cite this article

Abstract

Background

The war in northern Uganda has had a debilitating effect on the mental health of children and adolescents in the population. This study measures the prevalence and considers the aetiology of psychological distress in war-affected adolescents 4 years after the end of the conflict.

Methods

This is a cross-sectional study of 205 adolescents, aged 12–19, from a boarding primary school in Gulu, northern Uganda. A war experiences checklist was developed with the assistance of local professionals. The Impact of Event Scale-Revised (IES-R) measured post-traumatic stress symptoms. Finally, the Acholi Psychosocial Assessment Instrument (APAI) was used to measure locally described mental health constructs similar to the Western concepts of depression and anxiety.

Results

Four years after the end of the war, 57% of the students were still found to have clinically significant levels of post-traumatic stress symptoms using a similar cut-off score to previous studies among the same population. Both components of traumatic exposure: (i) the number of types of traumatic event experienced; and (ii) whether the adolescent was abducted were significantly associated with psychological distress. There was a strong correlation between post-traumatic stress symptoms and internalising symptoms.

Conclusion

War-affected adolescents may continue to suffer from significant psychological stress in the years following the cessation of conflict. Multiple exposure to a number of different types of traumatic event may directly increase the likelihood of psychological distress especially for those exposed to the most extreme violence. The feasibility of employing a locally developed and validated screening instrument is demonstrated. Implications for future research and intervention in post-conflict areas are considered.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Barenbaum J, Ruchkin V, Schwab-Stone M (2004) The psychosocial aspects of children exposed to war: practice and policy initiatives. J Child Psychol Psychiatry 45(1):41–62

    PubMed  Article  Google Scholar 

  2. Neuner F, Catani C, Ruf M, Schauer E, Schauer M, Elbert T (2008) Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): from neuro-cognitive theory to field intervention. Child Adolesc Psychiatry Clinics N. Am 17(3):641–664

    Article  Google Scholar 

  3. Dyregrov A, Yule W (2006) A review of PTSD in children. Child Adolesc Mental Health 11(4):176

    Article  Google Scholar 

  4. Schauer M, Schauer E (2010) Trauma-focused public mental health interventions: a paradigm shift in humanitarian assistance and aid work. In: Marz E (ed) Trauma rehabilitation after war and conflict: community and individual perspectives. Springer, New York

    Google Scholar 

  5. Coalition to Stop the Use of Child Soldiers (CSUCS) (2008) Child Soldiers Global Report 2008. Coalition to Stop the Use of Child Soldiers (CSUCS), London

    Google Scholar 

  6. Machel G (2001) The impact of war on children. Hurst & Company, London

    Google Scholar 

  7. Boothby NG, Knudsen CM (2000) Waging a new kind of war: children of the gun. Sci Am 282:60–65

    PubMed  Article  CAS  Google Scholar 

  8. Machel G (1996) Impact of armed conflict on children. Report of the Expert of the Secretary General of the United Nations. New York

  9. Amone-P’Olak K, Garnefski N, Kraaij V (2007) The impact of war experiences and physical abuse on formerly abducted boys in northern Uganda. S Afr Psychiatry Rev 10(2):76–82

    Google Scholar 

  10. Machel G (2009). Machel study 10-year strategic review: children and conflict in a changing world. Office of the special representative of the Secretary-General for children and armed conflict in collaboration with UNICEF UN children’s fund. www.unicef.org/publications/index_49985.html. Accessed 2 July 2010

  11. Annan J, Brier M, Aryemo F (2009) From ‘rebel’ to ‘returnee’: the reintegration of young soldiers in northern Uganda. J Adolesc Res 24:639–667

    Article  Google Scholar 

  12. Derluyn I, Broekaert E, Schuyten G, De Temmerman E (2004) Post-traumatic stress in former Ugandan child soldiers. Lancet 363(9412):861–863

    PubMed  Article  Google Scholar 

  13. Amone-P’Olak K (2005) Psychological impact of war and sexual abuse on adolescent girls in northern uganda. Intervention 3(1):33–45

    Google Scholar 

  14. Karunakara UK, Neuner F, Schauer M, Singh K, Hill K, Elbert T et al (2004) Traumatic events and symptoms of post-traumatic stress disorder amongst Sudanese nationals, refugees and Ugandans in the West Nile. Afr Health Sci 4(2):83–93

    PubMed  Google Scholar 

  15. Bayer C, Klasen F, Adam H (2007) Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese Child Soldiers. J Am Med Assoc 298(5):555–559

    Article  CAS  Google Scholar 

  16. Schauer E (2008) Trauma treatment for children in war. Build-up of an evidence-based large-scale mental health intervention in North Eastern Sri Lanka. Dissertation (PhD) thesis, University of Konstanz, Konstanz, Germany, Department of Clinical Psychology and Neuropsychology. http://www.ub.unikonstanz.de/kops/volltexte/2008/5424/

  17. Ehntholt KA, Yule W (2006) Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma. J Child Psychol Psychiatry 47(12):1197–1210

    PubMed  Article  Google Scholar 

  18. Mels C, Derluyn I, Broekaert E, Rosseel Y (2009) Screening for traumatic exposure and posttraumatic stress symptoms in adolescents in the war-affected eastern democratic republic of congo. Arch Pediatr Adolesc Med 163(6):525

    PubMed  Article  Google Scholar 

  19. Smith P, Perrin S, Yule W, Hacam B, Stuvland R (2002) War exposure among children from Bosnia–Hercegovina: psychological adjustment in a community sample. J Trauma Stress 15:147–156

    PubMed  Article  Google Scholar 

  20. Thabet AA, Abed Y, Vostanis P (2002) Emotional problems in Palestinian children living in a war zone:a cross-sectional study. Lancet 359(9320):1801–1804

    PubMed  Article  Google Scholar 

  21. Goenjian AK, Molina L, Steinberg AM, Fairbanks LA, Alvarez ML (2001) Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch. Am J Psychiatry 158(5):788–794

    PubMed  Article  CAS  Google Scholar 

  22. Pham PN, Vinck P, Kinkodi DK, Weinstein H (2010) Sense of cohesion and its association with exposure to traumatic events, post-traumatic stress disorder, and depression in eastern Democratic Republic of the Congo. J Trauma Stress 23/3:313–321

    Google Scholar 

  23. Heptinstall E, Sethna V, Taylor E (2004) PTSD and depression in refugee children: association with premigration trauma and post-migration stress. Eur Child Adolesc Psychiatry 13:373–380

    PubMed  Article  Google Scholar 

  24. Mels C, Derluyn I, Broekaert E, Rosseel Y (2010) Community-based cross-cultural adaptation of mental health measures in emergency settings: validating the IES-R and HSCL-37A in eastern Democratic Republic of Congo. Soc Psychiatry Psychiatr Epidemiol 45(9):899–910

    PubMed  Article  Google Scholar 

  25. Taylor S, Thordarson D, Maxfiled L, Fedoroff I, Lovell K, Ogrodniczuk J (2003) Comparative efficacy, speed, and adverse effects of three PTSD treatments. J Consult Clin Psychol 71(2):330–338

    PubMed  Article  Google Scholar 

  26. Saigh PA, Mroueh M, Bremner JD (1997) Scholastic impairments among traumatized adolescents. Behav Res Ther 35(5):429–436

    PubMed  Article  CAS  Google Scholar 

  27. Laor N, Wolmer L (2002) Children exposed to disaster: the role of the mental health professional. In: Lewis M (ed) Child and adolescent psychiatry: a comprehensive textbook. Lippincott Williams & Wilkins, Philadelphia, pp 925–937

    Google Scholar 

  28. Joshi PT, O’Donnell DA (2003) Consequences of child exposure to war and terrorism. Clin Child Fam Psychol Rev 2003 6(4):275–292

    Article  Google Scholar 

  29. Famularo R, Fenton T, Kinscherff R, Augustyn M (1996) Psychiatric comorbidity in childhood post traumatic stress disorder. Child Abuse Negl 20:953–961

    PubMed  Article  CAS  Google Scholar 

  30. Saltzman WR, Layne CM, Steinberg AM, Arslanagic B, Pynoos RS (2003) Developing a culturally-ecologically sound intervention program for youth exposed to war and terrorism. Child Adoles Psychiatr Clin N. Am 12:319–342

    Article  Google Scholar 

  31. Weiss DS, Marmar CR (1997) The impact of events scale-revised. In: Wilson JP, Keane TM (eds) Assessing Psychological Trauma and PTSD. Guilford Press, New York

    Google Scholar 

  32. Betancourt T, Bass J, Borisova I, Neugebauer R, Speelman L, Onyango G, Bolton P (2009) Assessing local instrument reliability and validity: a field-based example from northern Uganda. Soc Psychiatry Psychiatr Epidemiol 44(8):685–692

    PubMed  Article  Google Scholar 

  33. Schauer M, Neuner F, Elbert T (2005) Narrative exposure therapy: a short-term intervention for traumatic stress disorders after war, terror, or torture. Hogrefe & Huber, Göttingen

    Google Scholar 

  34. Smith P, Dyregrov A, Yule W, Perrin S, Gjestad R, Gupta L (2002) Children and war: teaching recovery techniques. Foundation for Children and War, Bergen. Retrieved 15 May 2010 http://www.childrenandwar.org

  35. Broidy L, Agnew R (1997) A general strain theory perspective. J Res Crime Delinq 34:275–306

    Article  Google Scholar 

  36. Klasen F, Oettingen G, Daniels J, Post M, Hoyer C, Adam H (2010) Posttraumatic resilience in former Ugandan child soldiers. Child Dev 81(4):1096–1113

    PubMed  Article  Google Scholar 

  37. Derluyn I, Broekaert E, Schuyten G (2008) Emotional and behavioural problems in migrant adolescents in Belgium. Eur Child Adolesc Psychiatry 17(1):54–62

    PubMed  Article  Google Scholar 

  38. Betancourt T, Agnew-Blais J, Gilman S, Williams D, Ellis B (2010) Past horrors, present struggles: the role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Soc Sci Med (1982) 70(1):17–26

    Article  Google Scholar 

  39. Ovuga E, Boardman J, Wasserman D (2007) Integrating mental health into primary health care: local initiatives from Uganda. World Psychiatry 6:60–61

    PubMed  Google Scholar 

  40. Summerfield D (1999) A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Soc Sci Med 48(10):1449–1462

    PubMed  Article  CAS  Google Scholar 

  41. Smith P, Perrin S, Dyregrov A, Yule W (2003) Principal components analysis of the impact of event scale with children in war. Pers Individ Differ 34:315–322

    Article  Google Scholar 

  42. Crumlish N, O’Rourke K (2010) A systematic review of treatments for post-traumatic stress disorder among refugees and asylum-seekers. J Nerv Ment Dis 198(4):237

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

With sincere appreciation and thanks to all the young people who participated in this study, to their teachers and caregivers and to our friends in Gulu without whom this study would not have been possible. The authors declare that they have no financial, personal, or professional interests that could be construed to have influenced their article.

Author information

Authors and Affiliations

  1. School of Psychology, Queens University Belfast, David Kier Building, Belfast, BT9 5BP, UK

    John D. McMullen, Paul S. O’Callaghan, John G. Eakin & Harry Rafferty

  2. Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK

    Justin A. Richards

Authors
  1. John D. McMullen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul S. O’Callaghan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin A. Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John G. Eakin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harry Rafferty
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John D. McMullen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

McMullen, J.D., O’Callaghan, P.S., Richards, J.A. et al. Screening for traumatic exposure and psychological distress among war-affected adolescents in post-conflict northern Uganda. Soc Psychiatry Psychiatr Epidemiol 47, 1489–1498 (2012). https://doi.org/10.1007/s00127-011-0454-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-011-0454-9

Keywords

  • Trauma
  • Depression
  • Adolescent
  • War
  • Exposure