Prevalence of Posttraumatic Stress Disorder and Depression Among Internally Displaced Persons In Mogadishu


 Background

Nearly three decades of conflict and frequent droughts and environmental hardships, have left 2.6 million of Somalis in displacement camps. Even though psychological impact of war and natural disasters are well documented, little is known about the unseen scars of psychological trauma in Internally displaced persons in Somalia. The purpose of the study was to determine the prevalence of post-traumatic stress disorder (PTSD) and depression amongst internally displaced persons (IDPs), and examine association between displacement and these psychiatric conditions.
Methodology

A cross-sectional quantitative study was conducted among 406 IDPs in Mogadishu. Harvard Trauma Questionnaire was used to determine levels of trauma exposure and PTSD, and Hopkins Symptom Checklist-25 was used to estimate prevalence of depression. Multivariate and bivariate analysis was conducted to analyze the association of demographic and displacement variables on the outcomes of PTSD and depression.
Results

More than half (59%) of participants met the symptom criteria of depression, and nearly one third (32%) of respondents met the symptom criteria for PTSD. The most prevalent traumatic event was lack of food or water (80.2%). Important predictive factors in development of psychiatric morbidity were unemployment, cumulative traumatic exposure, frequency and duration of displacement.
Conclusion

The study revealed high levels of Depressive disorder and Post-Traumatic Stress Disorder among internally displaced persons in Mogadishu. Furthermore, this study provided evidence to IDPs’ susceptibility to trauma exposure and lack of essential services and goods. Study also highlighted the importance of provision of Mental Health and Psychosocial Support (MHPSS) service in IDP camps.


Methodology
The study was conducted in IDP camps in Mogadishu. Mogadishu is the capital and largest city of Somalia; it has population of 2.5 million residents within an area of 91 km 2 . It has been subdivided into 17 districts. In recent years Mogadishu hosted a huge number of internally displaced persons (600,000), who ed from neighboring regions. A cross-sectional survey was conducted between 1 st to 31 st January 2021. The minimum calculated sample size was used [N=406]. Internally displaced persons living in Mogadishu who were above 18 years and who consented to participate were included. Those who were severely ill were excluded from the study. Multistage random sampling method was used. In the rst stage four districts was randomly selected from 17 administrative districts in Mogadishu (Boondheere, Hodan, Wadajir, and Dharkeynley). There are about 76 IDP camps in the four districts (see the list of IDP camps in appendix XI), these camps were proportionately sampled based on estimated IDPs population from REACH Initiative 2016 joint IDP Pro ling report (see table   1). In the next stage due to restricted data and unsystemic layout of the camps, random and systemic sampling method were not feasible. According to (18), when there are limitations preventing using other methods of selecting households, a segmentation method can be used. This method involves obtaining roughly map of the camp from camp leaders or from other online data bases such as REACH. Camps were divided into smaller segment which approximately containing number of households desired to be sampled. A random segment of the camp was selected by numbering 4 pieces of paper (1 to 4) and picking one. Segment (n) was randomly chosen and all households within that segment were included until required number is reached. All eligible individual from selected household were included.
Ethical approval to conduct this study was obtained from Kenyatta National Hospital-University of Nairobi, Ethics and Research Committee (P120/03/2020).
Permission was also sought form local Benadir region administration. Camp leaders were consulted and their permission was obtained. Informed written consent was sought from respondents before the beginning of each interview and the process included an explanation on the purpose and nature of the study as well as an opportunity to ask any questions and seek clari cation.
Upon arrival to the camp, camp leaders were approached and the nature of the study explained.
Study respondents were recruited from households within the randomly selected section. Participants were in each household were invited to participate if they met the inclusion criteria and gave consent after being briefed about the nature of the study.

Frequency of Trauma exposure
All forms of traumatic experiences asked were reported by at least 26 participants. The most prevalent traumatic event was lack of food or water (80.2%) followed by Ill health without access to medical care (79.9%), Lack of shelter (77.9%) and combat situation (e.g., shelling and grenade attacks) at 55.5%. while the least prevalent was being forced to betray family member, or friend placing them at risk of death or injury (7.5%), being forced to betray someone who is not family or friend placing them at risk of death or injury (7.0%) and being forced to desecrate or destroy the bodies or graves of deceased persons (6.5%). The frequency of trauma exposure is shown in table 3. Prevalence of Traumatic events recorded Table 4 and Figure 1 presents the cumulative trauma events recorded. Majority of the participants (32.2%) indicated that they had experienced 5-9 traumatic events, followed by 22.4% who reported that they had experienced 10-14 traumatic events, 16.2% reported 15-19 traumatic events, 15.7% reported 0-4 traumatic events and 12.5% reported 20 and above traumatic experiences. Factors associated with PTSD (Bivariate Analysis) Table 5 presents the factors that are associated with PTSD at the bivariate level. Participants who were unemployed were at higher risk of PTSD as compared to those who were employed (p=0.016). Respondents who had family history of mental illness were signi cantly at higher risk of PTSD as compared to those without (p=0.010). the other factors which are associated with PTSD risk include, those who are displaced more than once (p<0.001), Respondents who were displaced when they were aged 19-35 years (p=0.003), participants who had been displaced for a duration of more than one year (p=0.006) and the number of cumulative traumatic events (p<0.001).  Table 6 presents the factors that are associated with depression at the bivariate level. Respondents who were aged more than 26 years and above were signi cantly more likely to be depressed compared to those who were aged between 18-25 years (p=0.029). A family history of psychiatric illness was signi cantly associated with depression (p=0.020). Other factors which are associated include; participants who are displaced more than once (p=0.012), Respondents who were displaced when they were older than 18 years (p=0.042), The more traumatic events exposed to the higher the chances of being at risk of depression (p=0.001)  Table 7 presents the independent predictors of PTSD. Participants who were unemployed were about 2 times more likely to be at risk of PTSD as compared to those who were employed (aOR 1.79; 95% C.I. 1.06-3.04; p=0.030). Respondents who had been displaced more than once were more likely to be at risk of PTSD as compared to those who had been displaced once. (aOR 3.21; 95% C.I.