Prevalence of War-Related Mental Health Conditions and Association With Displacement Status in Postwar Jaffna District, Sri Lanka

• Published in: JAMA : the journal of the American Medical Association 2011-08, Vol.306 (5), p.522-531
• Main Authors: Husain, Farah, Anderson, Mark, Lopes Cardozo, Barbara, Becknell, Kristin, Blanton, Curtis, Araki, Diane, Kottegoda Vithana, Eeshara
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anxiety - epidemiology; Anxiety - etiology; Biological and medical sciences; conflicts; Cross-Sectional Studies; depression; Depression - etiology; Epidemiology; Female; General aspects; households; Humans; Male; Medical sciences; mental disorders; Mental health; Middle Aged; Military medicine; Miscellaneous; Post traumatic stress disorder; posttraumatic stress disorder; Prevalence; Psychology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Refugees - psychology; Severity of Illness Index; Sri Lanka; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; War; Warfare; Wounds and Injuries - psychology; Young Adult
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2011.1052

CONTEXT: Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons. OBJECTIVES: To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka. DESIGN, SETTING, AND PARTICIPANTS: Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health. MAIN OUTCOME MEASURES: Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist–25. RESULTS: The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure. CONCLUSION: Among residents of Jaffna District in Sri Lanka, prevalence of symptoms of war-related mental health conditions was substantial and significantly associated with displacement status and underlying trauma exposure.