Prevalence of Posttraumatic Stress Disorders among Sample of Internally Displaced Persons in Iraq, A Preliminary Study

Background: The displacement due to wars and disasters is public problems as the people with displacement exposed to different kinds of traumas, violence, injuries, making them more vulnerable for large scale of psychological disorders such as depression, anxiety, suicidal ideation with attempts and among of these disorders is Posttraumatic Stress Disorder (PTSD). Iraqi have long bad experiences of wars, sanction and community violence that produced large scale of physical and mental disorders. Objective: Measuring the effect of displacement on mental health of internally displaced people (IDP) by estimating the prevalence of PTSD. Methods: Cross-sectional study was done during the January 2016 at major camp for internal displaced people in west of Baghdad-Abu-Graib camp. A convenient sample was obtained and each participant filled a questionnaire that consisted of socio-demographic, in addition to questions of Iraqi version of Harvard Trauma Questionnaire (HTQ) for assessing the PTSD. Results: 20.8% of the participants had symptoms of PTSD. There was statistically insignificant between gender, marital status education and income with posttraumatic stress disorder symptoms. Conclusion: High prevalence of PTSD symptoms among Internally Displaced People (IDP).


Introduction
The displacement due to wars and disasters is public health problems as the people with displacement exposed to different kinds of trauma, violence, injuries, making them more vulnerable for large scale of psychological disorders such as depression, anxiety, suicidal ideation with attempts and among of these disorders is posttraumatic disorders (PTSD) that occurred due to witness and or self-exposed to horrible conditions such as murders, threating, kidnapping, loss of relativesfriends, loss of house, starvations [1,2]. The process of migration leads to loss of social role, stress of acculturation, in addition to social isolation [3].
Posttraumatic Stress Disorder (PTSD) is the psychiatric disorder that can result from the experience or witnessing of traumatic or lifethreatening events such as terrorist attack, violent crime and abuse, military combat, natural disasters, serious accidents or violent personal assaults [4].
In Iraq the situation is more complex as the population faced different types of traumas as wars, displacements for decades since Iraqi-Iranian war at 1980, Gulf war 1991 with sanction then US war on Iraq 2003 [1,5]. The condition became more deteriorated after June 2014 when Islamic States of Iraq and Sham (ISIS) occupied many Iraqi governorates including Mosul, Anbar, Salah-al Din and parts of Diyala [6], leaving hundreds of thousands of internally displaced persons without shelter, medical care or education as more than 1.3 million Iraqis have been confirmed displaced in 2014, in three distinct displacement waves 1) those displaced from the Anbar conflict starting in early January, 2) the Mosul conflict, which began in early June and 3) the Sinjar crisis in which began on 4 August [7].
The reports that discussed the psychological adverse effects on Internally Displaced Persons (IDP) in Iraq are scarce, so the aim of this study is to estimate the prevalence of PTSD among a sample of IDP in Iraq.

Subjects and Methods
A cross-sectional study was done during the January 2016 at one of major camp for IDP in west of Baghdad-Abu-Graib camp that especially for people who displaced form Anbar.
A convenient sample was obtained which was feasible to the worker and to the general conditions of the displaced persons. Each participant filled a questionnaire that consisted of socio-demographic variables including age, gender, education, marital status, family history of chronic disease, in addition to questions of Iraqi version of Harvard Trauma Questionnaire (HTQ) for assessing the PTSD and Score>2.5 indicates PTSD that meet the criteria of the Diagnostic and Statistical Manual, 4 th edition. It has a good internal consistency [8].
The questionnaire was used in Iraq during many previous studies with good reliability and validity [9].
Verbal consent was obtained from each participant after explanation the aims and concept of the study, the information of those who was illiterate was collected by interview with them. The subjects were given the choice to participate without any reward or penalty.
Data entry followed by descriptive and analytic statistics were performed using the Statistical Package for Social Science (SPSSversion 21) program.
Chi square was used to measure the association between PTSD symptoms and socio-demographical variables and P value<0.05 was considered as a significant association.

Results
Out of total, 67 (87%) was male and 10 (13%) of them was females, married individuals consisted 71.4% of the sample, with mean age of 33.4 ± 9.2 years. 68.5% of the sample had university education.
More than 75% of them lived with income less than 500000 ID (about 350$) per month, Table 1 gives more descriptive data for the sample.

Variables
Frequency Percentage (%)  The results show that 20.8% of the participants had PTSD ( Table 2). Prevalence of PTSD among female was 66% while in male was 22%, and there was statistically insignificant association between gender, marital status education level and monthly income with PTSD (Table  3).

Discussion
The literature reveals the rate of PTSD differs among population according to several factors such as age of individuals, type, duration and severity of trauma [3], in communities that affected by war and forced migration, the prevalence of PTSD ranges between 14 and 37% [10].
The research showing that the prevalence of PTSD in our region is high as civilians in the Middle East have been subjected to frequent episodes of violence, intra-and inter-group conflicts, and natural disasters [5], in the Gaza Strip, researchers reported that the lifetime prevalence of PTSD among adults was 17.8% [11][12][13]. A study that conducted in southern Lebanon reported that (29.3%) of an adult sample met criteria for PTSD [14], other studies demonstrated a range PTSD from 15.4% to 35.0% among population in Lebanon after the 2006 July War [15].
The rate of 20.8% among IDP in the current study is lower than prevalence of PTSD among sample of internally displaced youth in Erbil (26.5%) [11] and lower than what reported in a sample of adolescents in Baghdad (24.7%) [12], this finding could be attributed to several factors as the differences in regions, age of participants, methods of studies including questionnaires of data collection.
The finding of statistically insignificant association between gender, and PTSD is inconsistent with what reported in the literature as female is more vulnerable for PTSD than male [3,16], this could be due fact that Iraqis was exposed to wide spread violence for long period of time that had bad effect on whole population, as the effects of war include long-term of physical and psychological harm to children and adults [1,17].