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PTSD and major depression in Children and Adolescents
Four Years After the communal violence
Abstract
Introduction: PTSD and major depression are common psychiatric sequelae
among children and adolescents after exposure to extreme stressors.
Methods: Children and adolescents who had lost one of their parents in
communal violence in 2002 were evaluated in 2006 i.e. four years after the event
for PTSD and major depression. UCLA Index for PTSD was used to screen for
PTSD, while Brief PHQ was used to screen for major depression.
Results: Out of 255 subjects studied, 25 had PTSD (9.8%), 19 had PTSD
co morbid with major depression (7.4%), and 8 had major depression (3.1%).
Thus, 52 subjects (20.4%) had psychiatric morbidity 4 years post-trauma.
Psychiatric morbidity was associated with female gender, age older than 12 and
residence in Ahmedabad (the worst affected city). PTSD was not associated with
religious affiliation, change of residence, income or education.
Implications: PTSD occurred in about 17.2% children and adolescents even
after 4 years of exposure to communal violence. Major depression was present in
10.5% children and adolescents. This emphasizes need for assessment and
treatment of these disorders in child and adolescent population exposed to
trauma.
(Key Words: PTSD, Children and Adolescents, communal violence)
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Introduction
PTSD is a common sequel after exposure to a traumatic event. Non referred
samples of adolescents exposed to various forms of trauma have documented
that 25% to more than 90% develop PTSD depending on the type of stressor, the
length of time since exposure (rates tend to rise over first several months to two
years with a gradual reduction over time) and the method used to assess
symptomatology. [1] Level of exposure and lack of social support tend to predict
higher risk of PTSD and other psychiatric disorders. Exposure to multiple
traumatic events and female gender increase PTSD risk.
Several studies indicate that majority of children with exposure to trauma develop
PTSD symptoms severe enough to interfere with functioning even in absence of
a PTSD diagnosis. Most studies have found girls to score higher than boys on
PTSD measures [2-5] while one study found girls to report greater subjective
appraisal of danger. [6] With regard to age, Green et aldid not find any significant
difference in the diagnosis of probable PTSD among three age groups (27, 8
11, and 1215 years) after the Buffalo Creek disaster. [7] However, there was a
significant difference in the average number of PTSD symptoms, with the
youngest age category showing fewer symptoms.
After Hurricane Hugo, Shannon et al reported that children younger than 13
years were more likely to test positive for posttraumatic stress syndrome than
older children. [4] After the earthquake in Armenia, there was no association found
between the severity of PTSD and age among students 816 years old. [8] In a
study among students exposed to the Chi-Chi earthquake in Taiwan, elementary
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school students experienced more severe PTSD symptoms compared to junior
high school students.[9]
With regard to post disaster adversities, La Greca et alreported that major life
events (e.g., death or hospitalization of a family member) had an additive effect
on childrens post disaster reactions. [10] Lonigan et alnoted that children whose
parents were unemployed experienced more PTSD symptoms. [11]
End of February, 2002 struck Ahmedabad and state of Gujarat with communal
violence that continued for three months and beyond. As per estimations, over
1200 people were killed, several thousands were injured, more than 30000
households were destroyed and about one lakh people were forced to take
shelter in relief camps. In the wake of communal violence, magazine stories
definitely talked about agony and distress of young children and adolescents who
had witnessed the violence.
Self Employed Womens Association (SEWA), one of the leading women
organizations, was working with violence-affected women and their children.
These children besides witnessing communal violence had lost either parent in
the violence. The grass root workers of SEWA were trained by the principal
author and his team to provide psychosocial care to these women and children
one year after the riots. The staff felt that there was need for working with
children and adolescents who had survived the riots. SEWA requested
Department of Psychiatry, Civil Hospital, Ahmedabad for evaluation of children
and adolescents four years post riots.
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Aims and Objectives:
To find out frequency of PTSD and major depression among children and
adolescents who were exposed to communal violence 4 years earlier
To find out demographic as well as phenomenological characteristics of
PTSD and major depression
To find out associations of PTSD and major depression with demographic
and trauma related factors
Material and Methods
The authors trained fifteen M.A. psychology postgraduates pursuing dcpp at
Kanoria Hospital, Ahmedabad to administer study instruments to children,
adolescents and their parents.
The study team with data collectors visited Shantipath Centres (community
centres to the road to peace) located at various places in Ahmedabad, Mehsana,
Vadodara, Anand, Panchmahal and Sabarkantha. No particular sampling method
was used or applied. All such children and adolescents brought to our knowledge
were interviewed, so it was more of a convenient sample.
Study instruments
UCLA Child PTSD Index, UCLA Adolescent PTSD Index and UCLA PTSD
Index (current version) were used as appropriate (Rodriguez et al, 2001). [12]
The instruments are almost similar with minor changes in phrasing of questions
for the purpose.
Part 1 of the instrument asks about exposure to a traumatic event,
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Part 2 asks about what actually happened and what the child or adolescent felt at
the time of the trauma itself.
The next section contains statements about PTSD manifestations (21 statements
to reach the interviewee response on a score range of 0-4 (0=none, 1=little, 2=
some, 3=much, 4=most). The time frame for which the question is asked is last
one month. For diagnosis of PTSD, score of 3 or more on a question was
considered as manifestation being present. Those having a total score of 38 or
higher were diagnosed as having PTSD.
The Brief PHQ consists of nine items corresponding to the nine criteria for major
depression as per DSM-IV [13] for the time frame of last two weeks to be rated on
a 4-point scale (0= not at all, 1=frequently, 2= more than half of the days,
3=almost daily).
The PRIME-MD [14] was the first mental health diagnostic test that could be
entirely self-administered by the patient. The shortened version of the Prime MD
is called the "Patient Health Questionnaire". It is a self-administered
questionnaire that is 85% effective in suggesting the presence of a mental health
problem.
PHQ consists of 9 items for time frame of last two weeks to be rated on 4-point
scale (0 = Not At All, 1= Frequently, 2 = More than half of the days, 3 =Almost
Daily). Major depression is diagnosed when a person rates at least five
symptoms as 2 or more with sadness of mood or lack of pleasure as essential
criteria. Persons who have these essential criteria present plus 2 or 3 responses
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rated 2 or 3 were considered as having major depressive disorder. The ninth item
related to suicidal ideas was rated as present even if it were present for less than
half of the days.
In a study of 3,000 patients who used the Brief PHQ, about 30% had a mental
disorder according to the questionnaire. [15] It took the doctors about 3 minutes on
an average to review the questionnaire and most of the doctors agreed with the
PHQ result.
This instrument is extensively used in India and has been translated in all major
languages.
Demographic characteristics like name, age, religion, years in education, monthly
family income, occupation of mother or father and change in residence were
carefully noted.
Data analysis:
The subjects who had PTSD and major depression and those who didnt
(comparison group) were compared with regard to demographic characteristics,
associated factors. SPSS X version 2002 (SPSS Institute, 2002) was used to
analyze the data. [16]
Categorical data was assessed using Chi Square test and quantitative data was
assessed using t test. Correlation coefficient was calculated to find total number
of trauma related events and UCLA PTSD index scores. Principal component
analysis was done to delineate factor structure of PTSD.
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Results:
1. Demographic characteristics:
Total255 children and adolescents were interviewed whose ages ranged from 5-
21 years. There were 135 boys and 120 girls (52.9 vs. 47.1%). One hundred and
seventy three subjects (67.4%) had monthly income less than Rs. 1000 and a
vast majority, 198 (77.6%) were Muslims. Most had mother who was a
homemaker, unskilled worker or working part time as a tailor or small
shopkeeper. One hundred and seventy (66.7%) children and adolescents were
residents of Ahmedabad and the rest belonged to districts of Vadodara, Anand,
Mehsana and Sabarkantha.
2. Psychiatric morbidity:Out of the 255 subjects studied, 25 had PTSD (9.8%),
19 had PTSD co morbid with major depression (7.4%), and 8 had major
depression (3.1%). Thus 17.2% children and adolescents had PTSD, 4 years
after exposure to traumatic events.
For the subsequent discussion, the subjects with PTSD are referred as index
group and the rest as comparison group.
Table 1 Approximately here
3. Psychiatric morbidity and demographic characteristics:
Table 2 compares index and comparison group regarding their demographic
characteristics.
Table 2 Approximately here
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Out of 120 girls, 31(25.8%) had psychiatric morbidity, while out of 135 boys,
21(15.6%) had psychiatric morbidity. There was statistically significant gender
difference in the occurrence of psychiatric morbidity. Subjects living in
Ahmedabad as compared to those living in other parts of Gujarat had higher
morbidity. Adolescents older than 12 years of age compared to younger children
also had higher morbidity. No other demographic characteristics like religion,
education, family income or relocation were associated with higher psychiatric
morbidity.
4. Exposure to trauma related events:
The index group was exposed to 1-8 events with mean of 4.25(SD1.86) events
whereas the comparison group was exposed to 0-8 events with mean of
4.0(SD1.82).
Table 3 compares both the groups regarding the events. Seeing a dead body
and getting to know about a loved ones (apart from parents) death or serious
injury were objective trauma related events associated with higher PTSD and
major depression. None of the other trauma related events were associated with
higher psychiatric morbidity.
Table 3 approximately here
5. Subjective experience and psychiatric morbidity
Table 4 approximately here
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Apart from being seriously injured, all the subjective experiences of the trauma
as mentioned in Table 4 had a strong association with psychiatric morbidity.
6. Number of trauma related events and PTSD score:
The number of trauma related events the subjects were exposed to was
proportionately related to severity of post traumatic reaction as measured by total
UCLA PTSD Index scores. This confirmed dose-response relationship (Pearson
correlation: 0.227, significant at 0.01 level, 2 tailed).
7. Manifestations of PTSD:
25 subjects had PTSD while 19 had PTSD co morbid with major depression.
Their score on PTSD Index ranged from 38 to 80 with a mean score of
48.1 (SD 10.1).
Table 5 shows manifestations of PTSD in these subjects.
The manifestations which were present in more than 50% PTSD subjects
included the following: irritability, reminder of traumatic event causing anxiety,
sadness, fear; hyper arousal, sleep disturbance, difficulty concentrating and
physical symptoms. Survivor guilt, emotional blunting and feeling estranged were
absent.
Table 5 Approximately here
Factor Structure of PTSD:
Table 6 shows factor structure of PTSD on Principal Component Analysis.
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Principal component analysis revealed 4 factors with Eigen value more than 1.
Factor 1 explained greatest variance i.e. 37.4% and the items Hyper vigilance,
Reminder of traumatic event causing anxiety, sadness, fear, Flashback-thoughts,
images, voices, Irritability, Nightmares, Re experience of traumatic event,
Remaining lonely, Emotional blunting, Avoiding talk, thoughts related to traumatic
event, Hyperarousal, Sleep disturbance, Difficulty concentrating, Avoiding
people, places, things related to the event, Physical symptoms, Impending doom,
Frequent quarrels, Gloomy future outlook and Fear that the event would happen
again had high loading.
Factor 2 explains 6.5% of variance. Reduction in emotional reactivity had high
loading on this.
Factor 3 explains 5.6% of variance and consists of high loading on items
Emotional blunting and Feeling of happiness and love reduced,
Factor 4 explains 5.1% of variance and has high loading on item Loss of
memory about the event
Thus this study reveals that in child and adolescent population- re experiencing,
avoidance and hyper arousal are inter related and contribute most to clinical
manifestations. Reduction in emotional feeling and dissociative amnesia due to
trauma emerge as distinct but less powerful manifestations contributing to overall
clinical picture of PTSD.
Table 6 Approximately here
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Discussion:
Prevalence of PTSD: Although PTSD is a controversial diagnosis according to
some; qualitative study of women exposed to communal violence has concluded
that PTSD may be a relevant clinical construct even in Indian context. [17]This
study furthers our knowledge that PTSD can occur even in children and
adolescents who are exposed to traumatic events in India and possibly in some
may run a chronic course. Earlier in earthquake affected and riots affected
adolescent population PTSD prevalence 6-8 month post-trauma was found to be
20-22.5%. Most PTSD onset occurs soon after exposure to trauma, themanifestations gradually reduce over 2-year period and in some, they become
chronic. [1]Studies have indicated that children and adolescents exposed to thecatastrophic1988 Spitak earthquake in Armenia were suffering from chronic
severe posttraumatic stress disorder (PTSD) symptoms years after the
earthquake. [3,18] This emphasizes screening of trauma exposed children and
adolescents for PTSD and adequate early intervention.
Risk Factors for PTSD:
In this work, there was significant gender difference in the rate of PTSD and
major depression. This is in agreement with most other studies on gender and
PTSD. [2-5]
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Adolescents older than 12 years of age had higher psychiatric morbidity in this
study; this is in contrast to other studies that found younger children having
higher PTSD. [4,9]
Relocation did not have a negative impact on posttraumatic symptoms in this
study; this is as per Armenia study after the Spitak earthquake [19] or the Chi-Chi
earthquake in Taiwan. [20] However, among relocated students in Taiwan, those
who lived with their parents had fewer acute PTSD symptoms.
Trauma related events and psychiatric morbidity:
A few objective trauma events were associated with psychiatric morbidity. This
study also confirms a dose response relationship, i.e. greater the number of
trauma related events, higher the PTSD score. This is also in harmony with our
own work in earthquake and communal violence in adolescent population. [21,22]
Manifestations of PTSD:
The manifestations of PTSD were similar to those described in literature. [1]
Irritability was the commonest manifestation reported. It has been mentioned that
manmade traumatic events compared to natural disasters more often provoke
anger and irritability as the manmade events are considered as eminently
controllable or willful. Flashbacks were present in 70% subjects; in children
intrusive memories are more common than flashbacks. Avoidance symptoms
were present in about three-fourth of the subjects.
Survivor guilt was absent in children and adolescents in this study, perhaps
because the traumatic events were manmade on which they did not have control.
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Factor structure of PTSD revealed the largest one factor indicating that the
manifestations like re-experiencing, avoidance and hyperarousal are closely
linked, dissociative feature might be considered a separate though less powerful
factor contributing to clinical picture.
PTSD and grief: The more sudden, unexpected and unnatural the death, the
more likely the bereavement process is to overlap with traumatic stress
reactions. Indeed, in the most traumatic situations, both grief and PTSD are likely
to co-occur. A study conducted two years after the communal violence in Gujarat
on 110 widows who lost their husbands in the riots found 12.7% of the women
had PTSD co morbid with complicated grief.[23]
Delayed onset PTSD: Ten case studies and 19 group studieshave consistently
showed that delayed-onset PTSD in the absence of any prior symptoms was
rare, whereas delayed onsets that represented exacerbations or reactivations of
prior symptoms accounted on average for 38.2% and 15.3%, respectively, of
military and civilian casesof PTSD.[24]Little is known about whatdistinguishes the
delayed-onset and immediate-onset forms of the disorder. Continuing scientific
study of delayed-onset PTSD would benefit if future editions of DSM were to
adopt a definition that explicitly accepts the likelihood of at least some prior
symptoms.
Limitations of this study: We did not have PTSD data at baseline, sooner after
exposure to trauma to compare. Such data would throw more light on the natural
history of the disorder, suggesting whether the PTSD was chronic or delayed
onset in nature.
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The traumatic event was 4 years prior to the study; this may lead to recall bias on
part of children and adolescents.
This study has not explored sub threshold PTSD (which though do not meet
DSM IV criteria of PTSD but cause comparable distress and disability) and
psychiatric morbidities like substance use after exposure to trauma.
Implications of the study:
In India, child and adolescent population exposed to traumatic events like
communal violence may suffer from PTSD and major depression, even
four years after such events
Risk factors for PTSD included female gender, being adolescent rather
than child, and living in violence- torn area
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7. Green BL, Korol M, Grace MC, et al. Children and disaster: age, gender, and
parental effects on PTSD symptoms. Journal of American Academy of Child and
Adolescent Psychiatry 1991; 30:94551.
8.Pynoos R, Goenjian A, Tashjian M, et al. Post-traumatic stress reactions in
children after the 1988 Armenian earthquake. British Journal of Psychiatry 1993;
163:23947.
9. Chen S-H, Lin Y-H, Tseng H-M, et al. Posttraumatic stress reactions in
children and adolescents one year after the 1999 Taiwan Chi-Chi earthquake. J
Chinese Institute of Engineers 2002; 25:597608.
10.La Greca AM, Silverman WK, Vernberg EM, et al. Symptoms of posttraumatic
stress in children after Hurricane Andrew: a prospective study. Journal of
Consulting and Clinical Psychology. 1996; 64:712 23.
11. Lonigan CJ, Shannon MP, Taylor CM, et al. Children
exposed to disaster, II: risk factors for the development of post traumatic
symptomatology. J.Am.Acad.Child Adolesc.Psychiatry 1994: 33:94-105.
12.Rodriguez N, Steinberg AM, Saltzman W et al. UCLA PTSD Reaction Index:
psychometric analysis, in Proceedings of the International Society for Traumatic
Stress Studies. Northbrook, Ill, ISTSS, 2001.
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13.American Psychiatric Association (1994). Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition. Washington, DC: American Psychiatric
Association.
14.Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report
version of PRIME-MD: the PHQ Primary Care Study. JAMA 1999; 282:1737-
1744.
15.Spitzer R.l. Williams JBW,Kroenke et al. Validity and utility of the PRIME MD
Patient Health Questionnaire in assessment of 3000 obstetric gynecological
patients: the PRIME MD Patient Health Questionnaire obstetric gynecology
study. JAMA, 183:759-69.
16.Statistical Package for Social Sciences Institute: SPSS X, 2002.
17. Mehta K, Vankar G., Patel V (2005) Validity of the construct of posttraumatic
stress disorder in a low-income country. British Journal of Psychiatry. 187:585-6.
18. Goenjian AK, Karayan I, Pynoos RS, et al: Outcome of psychotherapy among
early adolescents after trauma. American Journal of Psychiatry 1997; 154:536
42.
19. Najarian LM, Goenjian AK, Pelcovitz D, et al.: Relocation after a disaster:
posttraumatic stress disorder in Armenia after the earthquake. Journal of
American Academy of Child and Adolescent Psychiatry 1996; 35:37483.
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20. Soong T-W, Lee Y-C, Huang R-R, et al. A comparative study of post-
traumatic symptoms between students living at Yu-Chih and relocating to
Kaohisung after the Chi-Chi earthquake, in Proceedings of the International
Workshop on Annual Commemoration of Chi-Chi Earthquake. Taipei, Taiwan,
National Center for Research on Earthquake Engineering, 2000, pp 30817.
21. Mehta K, Vankar GK, Panchal B, et al. Posttraumatic stress among
adolescents in by earthquake-affected Kutch. 2002. (Unpublished work)
22. Mehta K and Vankar GK. Post traumatic stress disorder among adolescent
girls exposed to communal riots. 2003. (Unpublished work)
23.Saiyad MS, KumarA, Patel C, ShidhayeR, GargS, BhaiyaN, et al.
Traumatic widowhood and major depression: A study of widows affected by
communal violence. 2004. (Unpublished work)
24.Andrews B, Brewin CR, Philpott R, Stewart L. Delayed-onset posttraumatic
stress disorder: A systematic review of the evidence.Am J Psychiatry 2007;
164:1319-26.
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Table 1: Psychiatric Morbidity
Diagnosis N=255
N (%)Post Traumatic Stress Disorder (PTSD) 25 (9.8)
MDD + PTSD 19 (7.4)
Major Depressive Disorder (MDD) 8 (3.1)
Total psychiatric morbidity 52 (20.4)
Table 2: Demographic Characteristics and Psychiatric morbidity
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Table 3:
Psychiatric morbidity and trauma related events
PsychiatricMorbidityN=52N (%)
No PsychiatricMorbidityN=203N (%)
Age years Range
Mean
SD
6-19
12.8
3.4
5-21
11.4
3.5
T=2.59, df=253,p=0.01
Upto 12
>12
25 (48.1)
27 (51.9)
147 (72.4)
56 (29.6)
2=11.2, df=1,p=0.0008
OR= 0.35(0.18-0.69)
Gender Boys
Girls
21 (40.4)
31 (59.6)
114 (56.2)
89 (43.8)
2=4.13, df=1, p=0.04
OR= 0.53(0.27-1.03)
Education Range
Mean
SD
0-10
5.3
2.8
0-15
5.3
3.1
T=0.00, df=253,p=1.00
Religion Hindu
Muslim
9 (17.3)
43 (82.7)
38 (18.7)
165 (81.3)
2=0.05, df=1, p=0.81
OR= 0.91(0.38-2.14)
Income
(Rs/month)
1001
40 (76.9)
12 (23.1)
133 (65.5)
70 (34.5)
2=2.47, df=1, p=0.12
OR= 1.75(0.82-2.79)
Change ofresidence
Yes
No
21 (40.4)
31 (59.6)
102 (50.2)
101 (49.8)
2=1.61, df=1, p=0.20
OR= 0.67(0.35-1.30)
Residence Ahmedabad
Other
42 (80.8)
10 (19.2)
128 (63.1)
75 (36.9)
2=5.85, df=1,
p=0.015
OR= 2.46(1.11-5.58)
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Event PsychiatricMorbidityN=52N (%)
No PsychiatricMorbidityN=203N (%)
Significance
Violence, residence in
violence affected area
48 (92.3) 167 (82.3) 2=2.44, df=1, p=0.12
OR= 2.59(0.82-9.03)Beaten, fired at or
threatened
26 (50.0) 80 (39.4) 2=1.91, df=1, p=0.17
OR= 1.54(0.80-2.96)
Family member being
beaten, fired at, threat of
serious injury
49 (94.2) 175 (86.2) 2=1.80, df=1, p=0.18
OR= 2.61(0.76-
13.95)
Witnesses someone being
beaten, fired at or killed
23 (44.2) 76 (37.4) 2=0.80, df=1, p=0.37
OR= 1.33(0.68-2.57)
Seeing Dead body 24 (46.2) 61(30.1) 2=4.83,df=1, p=0.02
OR= 2.00(1.02-3.89)
Came to know about loved
ones (apart from parents)
death or serious injury
50 (96.2) 174 (86.7) 2=6.15,df=1,
p=0.013
OR= 5.95(1.44-52.3)
Forced to live in camp 23 (44.2) 85 (41.9) 2=0.09,df=1, p=0.76
OR= 1.10(0.57-2.12)
Damage to house 19 (36.5) 89 (43.8) 2=0.90,df=1, p=0.34
OR= 0.74(0.37-1.44)
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Table 4:
Subjective experience of trauma and psychiatric morbidity
Psychiatric
MorbidityN=52N (%)
No
PsychiatricMorbidityN=203N (%)
Significance
Scared that he or she willbe killed
44 (84.6) 118 (58.1) 2=12.53, df=1,
p=0.004
OR= 3.96(1.69-6.94)
Scared that he or she willbe seriously injured
44 (84.6) 97 (47.8) 2=22.72, df=1,
p=0.000002
OR= 6.01(2.56-14.60)
Sustained serious injury 6 (11.5) 19 (09.4) 2=0.22, df=1, p=0.64
OR= 1.26(0.39-3.53)
Scared that someone elsewill be killed
42 (80.8) 86 (42.4) 2=24.42, df=1,
p=0.0000008
OR= 5.71(2.59-12.92)
Scared that someone elsewill be seriously injured
46 (88.5) 127 (62.6) 2
=12.73, df=1,
p=0.0036
OR= 1.83(4.59-13.71)
Scared that someone elsewas seriously injured
33 (63.5) 96 (47.3) 2=4.33, df=1, p=0.04
OR= 1.94(0.99-3.81)
Someone died 47 (90.4) 96 (47.3) 2=29.49, df=1,
p=0.0000001
OR= 10.48(3.93-34.8)
Worst fear of lifetime 48 (92.3) 61 (30.1) 2=63.04, df=1,
p=0.0000000
OR= 27.93(9.4-109.8)
Helplessness, wished 47 (90.4) 123 (63.5) 2=16.54, df=1,
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someone should help p=0.0005
OR= 6.11(2.29-20.43)
Watching gruesome scenes 34 (65.4) 99 (48.8) 2=4.58, df=1, p=0.032
OR= 1.98(1.01-3.93)Restless 40 (76.9) 119 (58.6) 2=5.91, df=1, p=0.015
OR= 2.35(1.11-5.06)
Confused, didnt know whatto do
43 (82.7) 117 (57.6) 2=11.12, df=1,
p=0.0008
OR= 3.51(1.55-8.20)
Feeling of unreality 37 (71.2) 64 (31.5) 2=27.18, df=1,
p=0.0000002
OR= 5.36(2.62-11.07)
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Table 5: Manifestations of PTSD
Item Manifestation N=44
N (%)
4 Irritability 38 (86.4)
18 Physical symptoms 37 (84.1)2 Reminders of trauma upset, frighten, make sad 36 (81.8)
17 Avoiding people, places, things related to the event 32 (72.7)
3 Flashback-thoughts, images, voices 31 (70.5)
12 Hyper arousal 31 (70.5)
16 Difficulty concentrating 30 (68.2)
22 Fear that the event would happen again 30 (68.2)
9 Avoiding talk, thoughts related to traumatic event 29 (65.9)
13 Sleep disturbance 29 (65.9)
21 Gloomy future outlook 29 (65.9)
5 Nightmares 25 (56.8)19 Impending doom 25 (56.8)
20 Frequent quarrels 24 (54.5)
1 Hyper vigilance 22 (50.0)
10 Trouble feeling of happiness and love 22 (50.0)
8 Emotional blunting 21 (47.7)
6 Re experience of traumatic event 17 (38.6)
7 Prefers being alone than in company 14 (31.8)
15 Loss of memory about the event 11 (25.0)
14 Feelings of guilt 9 (20.5)
11 Trouble feeling sad or angry 5 (11.4)
Table 6: Factor Structure of PTSD
Principal Component Analysis of UCLA PTSD Index:
Total Variance Explained
InitialEigen-values
ExtractionSums ofSquared
Loadings
Component
Total % of Varian
Cumulative
Total % of Varia
Cumulative
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ce % nce %1 8.094 36.79
336.793 8.094 36.79
336.793
2 1.405 6.385 43.178 1.405 6.385 43.1783 1.267 5.761 48.939 1.267 5.761 48.939
4 1.125 5.111 54.050 1.125 5.111 54.0505 1.023 4.650 58.700 1.023 4.650 58.700
Component MatrixComponen
t
1 2 3 4 5VAR0000
1.59 .25 1.930E-02 -.12 .38
VAR00002
.71 .16 5.973E-03 -.29 6.558E-02
VAR00003 .67 .21 -.24= -.11 2.427E-02
VAR00004
.60 -.36-4.620E-02-8.750E-02 7.136E-02
VAR00005
.56 .20 -.28 -.19 -.16
VAR00006
.64 2.184E-02 .12 -.24 -.20
VAR00007
.41-2.239E-02 .13 .19 .42
VAR0000
8
.62 -.15 .56 -.19 -.21
VAR00009
.58 1.893E-02 .18 .12 .36
VAR00010
.58 -.30 .56 -.16 -.15
VAR00011
.27 .56 .25 3.434E-02 .14
VAR00012
.67 .15 -.21-8.957E-02 .14
VAR00013
.63 -.14 -.22 .13 -.11
VAR00014 .41 .38 .10 .21 -.45
VAR00015
.25 .27 .23 .70 -.10
VAR00016
.64 -.28-9.699E-02 .32 .14
VAR00017
.65 .19 .12 -.12 .16
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VAR00018
.735-2.684E-02-7.950E-02-3.311E-02-6.012E-02
VAR00019
.69 -.17 -.16 .25 -.13
VAR0002
0
.63 -.43 -.18 7.934E-02 5.406E-02
VAR00021
.77 -.13-4.902E-03 .16-7.831E-02
VAR00022
.63 .19 -.31-3.736E-02 -.26
Extraction Method: Principal Component Analysis.5 components extracted.