Academic journal article South African Journal of Psychiatry

Traumatic Stress and Psychological Functioning in a South African Adolescent Community Sample

Academic journal article South African Journal of Psychiatry

Traumatic Stress and Psychological Functioning in a South African Adolescent Community Sample

Article excerpt

Introduction

Traumatic stress may arise from a variety of incidents, including artificial or natural disasters such as earthquakes and motor vehicle accidents or community violence such as gang violence, neighbourhood gun warfare, rape, school violence and victimisation. (1,2) Traumatic stress severely impacts personal functioning, interpersonal relationships and employment, and it is associated with a variety of other psychological conditions, including posttraumatic stress disorder (PTSD), anxiety, depression and somatisation. (1,2) However, many individuals exposed to trauma experience symptoms of PTSD that do not always meet diagnostic thresholds. (2) These people, who suffer debilitating symptoms at a sub-threshold level, are considered to have posttraumatic stress symptomatology (PTSS) for the purposes of this study. In this study, both PTSD and PTSS are considered.

The global lifetime prevalence of PTSD is estimated to be 1%-2% in Western Europe, 6%-9% in North America and just over 10% in countries exposed to long-term violence. This widespread difference in prevalence is attributable to the variation in the exposure to traumatic events according to these authors, (3) but it is well-known that trauma exposure is only one, albeit necessary, factor in the development of PTSD. In the USA, prevalence rates for the general population were 5.0% for males and 10.4% for females. In Europe, the general population prevalence rates range from 0.5% for males and 0.7% for females (4) in Iceland, to 0.56% in Spain, 0.76% in Belgium, 3% in the UK (0%) and 3.3% in the Netherlands. (5) The lifetime prevalence rates of PTSD in the general South African population have been found to be 2.3% for all ages and 1.8% for ages between 18 and 34 with the 12-month prevalence rate being 0.6% - 0.7%; sex, age and education were largely unrelated to PTSD risk. (6)

Interpersonal violence prevails in South Africa with mortality rates reaching seven times that of the global rate. (7) Interpersonal violence injuries are the second most dominant source of loss of healthy life, representing 14.3% of all disability-adjusted life years in South Africa in 2000. (7) Furthermore, South Africa has one of the highest motor vehicle accident rates in the world (8) and road traffic injuries are double that of the global rate. (7)

In a South African-based rural study (9) that linked violence exposure to health outcomes in children, 67.0% had directly or vicariously experienced a traumatic event with 8.4% having a PTSD diagnosis. A study (10) conducted in a Khayelitsha school and children's home found that all participants had reported exposure to indirect violence: 95.0% had witnessed violence and 56.0% had personally experienced violence, with 21.7% meeting the criteria for PTSD. In another study (11) which looked at 2041 boys and girls from various schools in Cape Town and Nairobi, 80% of the sample reported exposure to severe trauma. The South African cohort reported witnessing violence (58.0%), physical assault by family (14.0%) and sexual assault (14.0%)-22.2% met the criteria for PTSD and an additional 12.0% for sub-diagnostic PTSD. This study also noted no sex differences in PTSD symptom reporting.

PTSD is associated with psychiatric comorbidity, most notably substance use disorder, major depression, anxiety and somatic disorders. (12,13) Major depressive disorder as a comorbid condition with PTSD ranges from 30% to 50% (1,11,12) and is significantly correlated with exposure to violence. (14) Anxiety disorders are prevalent psychiatric disorders in childhood and adolescence, with 10%-15% meeting the diagnostic criteria for an anxiety disorder. (15)

PTSD and its associated sequelae are, therefore, a major public health concern in South Africa, (16) particularly for youth who are understood to be experiencing high levels of trauma stemming from discrimination, abuse, interpersonal violence and traumatic events, often against a backdrop of socioeconomic disproportion, reflecting the widening gap between the rich minority and the large proportion of poor in South Africa. …

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