The landmark Global Burden of Disease study xxix established for the first time the significant burden of mortality and disability associated with mental illnesses. Depression, the fourth leading cause of disease burden in 1990, is predicted to move to second place in 2020. Of the ten leading causes of disability worldwide, five were psychiatric conditions. Since this study did not focus on traumatized populations, it is estimated that the mental health effects of psychiatric disorders are much higher in CEs.
Despite methodological challenges in determining the prevalence of mental illness across cultures and in insecure environments, recent progress has been made in assessing the psychological and social impact of CEs. Indeed, the lack of accurate population estimates and culturally validated screening instruments had to be overcome to make culturally valid mental health assessments.xxx xxxi Validated measures for assessing economic and social productivity and social capital in CEs, however, are still needed. Numerous recent studies that underscore the severe mental health sequelae resulting from mass violence in various contexts are summarized in Table 1.
A longitudinal study of Bosnian refugees (1996) revealed for the first time, the serious disability associated with the mental health effects of mass violence. While 45% of those studied met DSM-IV criteria for depression, PTSD, or both, co-morbidity for these disorders was associated with high rates of physical disability (i.e. 25%).xxxii In 1999, this population revealed unremitting psychiatric disability and premature death in the elderly. xxxiii Other studies support these results, suggesting that suffering continues long after the crisis has ended.xxxivxxxv
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Table 1: Prevalence of Mental Health Disorders among Adult Populations Affected by CEs
STUDY PTSD Depression
Non-specific psychiatric
morbidity Screening Tool Source
CE Population Cambodian refugees in Thailand
Point 37.2% Point 67.9% N/A HTQ HSCL-25
Mollica et al. (1993)xxxvi Bosnian refugees in Croatia Point 26% Point 39% N/A HTQ
HSCL-25 Mollica et al. (1999)xxxvii
Kosovar Albanians in
Kosovo Point 17.1% N/A 43% (11 mean score) GHQ-28 HTQ Lopes Cardozo et al. (2000)xxxviii
Serbian minority in Kosovo (12.8 mean
score) GHQ-28 Salama (2000)et xxxixal.
Rwandan Refugees in Tanzania
N/A N/A 50% (14 mean score)
GHQ-28 De Jong et al.xl
Karenni (Burmese) refugees
in Thailand Point 4.6% Point 41.8% N/A HSCL-25 GHQ-28 HTQ SF-36
Lopes Cardozo et al. (2004)xli
(Repeat of Reference 13)
Cambodia Lifetime: 28.4% N/A N/A LESHQ
CIDI De Jong et al.
xlii
Algeria Lifetime: 37.4% N/A N/A LESHQ
CIDI
De Jong et al. 42
Ethiopia Lifetime: 15.8% N/A N/A LESHQ
CIDI De Jong et al.
42
Gaza Lifetime: 17.8% N/A N/A LESHQ
CIDI De Jong et al.
42
Baseline Population
US Population Lifetime: 1% 12-month 3.7% Lifetime 6.4 %
N/A DIS ECA Study
xliiiDepression:
Robins et al. (1991)
xliv PTSD: Helzer et
al. (1987) U.S. Population Lifetime: 7.8% 12 month: 6.6%
Lifetime: 16.2% CIDI (modified) NCS, Depression xlv(Kessler et al. (2003) NCS, PTSDxlvi (Kessler et al. (1995)) 15 Developing countries N/A N/A 2-6 (mean
score) GHQ-12 Goldberg et al. (1997)xlvii
(Repeat of Reference 31)
Harvard Trauma Questionnaire (HTQ); Hopkins Symptom Checklist – 25 (HSCL-25); General Health
Questionnaire (GHQ); Epidemiological Catchment Area (ECA); Diagnostic Interview Schedule (DIS); Life Events and Social History Questionnaire (adapted version) (LESHQ); WHO’s Composite International Diagnostic Interview (CIDI); National Comorbidity Study (NCS)
Table 2 highlights the prevalence of mental health disorders in children and adolescents affected by CEs. This research demonstrates the high prevalence of PTSD, depression and anxiety among affected children and adolescents xlviiixlixlliliiliiilivlvlvilviilviiilix lxlxi as compared to a baseline of non-traumatized children in the U.S.(References 76 and 77) In
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contrast to adult studies (Table 1), the generalizability of these results to CEs is limited since few of the studies sampled a general population of children involved in a CE53 or compared the subjects to a comparable non-traumatized control group.54
Table 2: Prevalence of Mental Health Disorders in Children and Adolescents Affected by CEs
Study PTSD Depression Total Problem Score % in
Clinical Range Screening Tool Source CE Populations
6 Year follow up of 30
Young Khmer refugees 50% 1984 38% 1990 41% 1987 6% 1990 N/A K-SADS-E Sack WH et al (1993)lxii
170 Cambodian adolescent
refugees 26.5% 12.9% N/A K-SADS-E Sack WH et al (1996)lxiii
480 Croatian refugee
children N/A 11.28% N/A CDI Zivcic I et al. (1993)lxiv
59 Young Cambodian-
Americans Point 24% Lifetime 59%
19% N/A SCID-NP Hubbard J et al (1995)lxv
182 Cambodian refugee camp adolescents and their
parents N/A N/A CBCL 53.8% YSR 26.4% CBCL YSR
Mollica RF et al. (1997)lxvi
209 Khmer Adolescents 12.9-41.2% N/A N/A SSADS
SCID Sack WH et al. (1995)lxvii
99 Cambodian refugees Point 31.3% Lifetime 37.3% Point 68.4% Lifetime 86% N/A SSADS Interview Savin D et al (1996)lxviii
Cambodian refugees in US Point 28.6%
Lifetime 37.1% Point 17.1% Lifetime
37.1% N/A SSADS Interview Reference 68 12 Bosnian adolescents in US 25% 17% N/A CTEI Weine S et al (1995)lxix 147 Bosnian children
refugees N/A 25.90% N/A Self Report Stein B (1999)lxx
492 Israeli children during
Scud missile attacks 24.9% N/A N/A SRQ Schwarzwald J et al. (1993)lxxi
150 Palestinian mothers and
their children N/A N/A 58.8% CBCL et al. (1996)Garbarino J lxxii
234 Children in the Gaza Strip
Point 40.6%
1 Year 10% N/A N/A CPTS-RI Thabet AA et al. (2000)lxxiii
Baseline Populations
Children (US) N/A Point 2% N/A DSM-III-R
Interview AACAP (1998)
lxxiv
9-17 year-olds (US) 6 month 2% 6 month 6% N/A DISC-2.3 Shaffer D (1996)lxxv
Kiddie Schedule For Affective Disorders And Schizophrenia (KSADS); School Children Version Schedule For Affective Disorders And Schizophrenia (SSADS); Child Depression Inventory (CDI); Child Behavioral Checklist (CBCL); Youth Self Report (YSR); Communal Traumatic Experiences Inventory (CTEI); Child Posttraumatic Stress Reaction Index (CPTS-RI); Stress Reaction Questionnaire (SRQ); American Academy of Child and Adolescent Psychiatry (AACAP).
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