Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia

  • Lauren C. NgEmail author
  • Girmay Medhin
  • Charlotte Hanlon
  • Abebaw Fekadu
Original Paper



To investigate exposure to traumatic and stressful events and their association with depression, suicidal ideation, and alcohol abuse in people with severe mental disorder (SMD) in Ethiopia.


As part of the Programme for Improving Mental health carE, 300 people with SMD (84% primary psychosis, 11% bipolar disorder, and 16% depression with psychotic features) in a rural district were identified by psychiatric nurses. A cross-sectional assessment included clinical characteristics, experience of being restrained, exposure to stressful events as measured by an adapted version of the List of Threatening Experiences scale, traumatic events as measured by endorsement of 13 locally relevant potentially traumatic events that occurred since the onset of the participant’s mental illness, depression symptoms measured by the Patient Health Questionnaire, the Suicidal Behavior Module of the Composite International Diagnostic Interview, and hazardous drinking which was calculated as a sum score of eight or higher on the Alcohol Use Disorders Identification Test.


Almost half of participants reported being restrained since becoming ill, which was associated with more suicidal ideation and less hazardous drinking. More than one-third experienced traumatic events since becoming ill, including being assaulted, beaten, or raped. Exposure to traumatic events was associated with hazardous drinking.


In this rural Ethiopian setting, people with SMD experienced high levels of traumatic and stressful events which were associated with co-morbid conditions. Greater attention needs to be given to trauma prevention and integration of treatment for trauma sequelae in efforts to expand integrated mental health care.


Alcoholism Depression Psychotic disorders Life change events Post-traumatic 



This study is a direct output of the PRogramme for Improving Mental health carE (PRIME). This work was supported by the UK Department for International Development (201446). The views expressed do not necessarily reflect the UK Government’s official policies. LN’s time was funded by the National Institute of Mental Health (NIMH) Grant numbers #T32MH093310 and #K23MH110601. The funders had no role in data collection, analysis, writing, or decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

The study was approved by the Institutional Review Board of the College of Health Sciences of Addis Ababa University. The secondary analyses presented here were reviewed by the Boston University Medical Campus Institutional Review Board and were determined to not be human subjects’ research.

Informed consent

All participants gave informed consent to participate.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryBoston University School of MedicineBostonUSA
  2. 2.Aklilu Lemma Institute of PathobiologyAddis Ababa UniversityAddis AbabaEthiopia
  3. 3.Centre for Global Mental Health, Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
  4. 4.Department of Psychiatry, School of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia

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