Victimization and PTSD in Ugandan Youth


Background: Little is known about post-traumatic stress (PTSD) prevalence rates in community samples. This is especially true for the African continent where child-soldiers, HIV/AIDS affected and orphans have been the target for PTSD prevalence studies. Objectives: The aim of this study is to investigate the indirect and direct exposure to 20 potentially traumatic events and its relation with PTSD in a Ugandan sample of senior 3rd year students and to perform cross-cultural comparisons with previous studies examining this age group. Socio-economic status, coping styles, negative affect, and somatization are further examined. Method: A convenience sample of 408 senior secondary school students, from eight schools, across three major towns, Kampala, Mbarara, and Jinja, were selected. The Harvard Trauma Questionnaire (HTQ) was used to establish PTSD prevalence rates, The Coping Style Questionnaire (CSQ) was used to assess coping styles, and the Trauma Symptom Checklist (TSC) were used to measure negative affect and somatization. Results: The subjects had been exposed to a mean of 6.6 direct events and a mean of 7.2 indirect events. The estimated prevalence rate of PTSD was 37.7% and a further 28.2% reached a subclinical level, missing one symptom to have the full diagnosis. Variables related to a PTSD diagnosis were female gender, number of directly experienced events, emotional coping, negative affect, and somatization. Conclusions: Ugandan youth have been exposed to significantly more potentially traumatic events and negative life events than European youth, and subsequently PTSD prevalence rates are higher. In addition, fewer gender differences are found in the Ugandan sample compared to the European samples.

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Mandrup, L. and Elklit, A. (2014) Victimization and PTSD in Ugandan Youth. Open Journal of Epidemiology, 4, 141-156. doi: 10.4236/ojepi.2014.43020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Seides, R. (2010) Should the Current DSM-IV-TR Definition for PTSD Be Expanded to Include Serial and Multiple Microtraumas as Aetiologies? Journal of Psychiatric and Mental Health Nursing, 17, 725-731.
[2] Maschi, T., Baer, J., Morrissey, M.B. and Moreno, C. (2013) The Aftermath of Childhood Trauma on Late Life Mental and Physical Health: A Review of the Literature. Traumatology, 19, 49-64.
[3] Seedat, S., Nyamai, C., Njenga, F., Vythilingum, B. and Stein, D.J. (2004) Trauma Exposure and Post-Traumatic Stress Symptoms in Urban African schools. British Journal of Psychiatry, 184, 169-175.
[4] Mels, C., Derluyn, I., Broekaert, E. and Rosseel, Y. (2009) Screening for Traumatic Exposure and Posttraumatic Stress Symptoms in Adolescents in the War-Affected Eastern Democratic Republic of Congo. Archives of Pediatrics and Adolescent Medicine, 163, 525-530.
[5] Karsberg, S.H. and Elklit, A. (2012) Victimization and PTSD in a Rural Kenyan Youth Sample. Clinical Practice & Epidemiology in Mental Health, 8, 91-101.
[6] Harder, V.V., Mutiso, V.N., Khasakhala, L.I., Burke, H.H. and Ndetei, D.M. (2012) Multiple Traumas, Postelection Violence, and Posttraumatic Stress among Impoverished Kenyan Youth. Journal of Traumatic Stress, 25, 64-70.
[7] Domanskaite-Gota, V., Elklit, A. and Christiansen, D. (2009) Victimisation and PTSD in a Lithuanien National Youth Probability Sample. Nordic Psychology, 61, 66-81.
[8] Bodvarsdóttir, I. and Elklit, A. (2007) Victimisation and PTSD-like States in an Icelandic Youth Probability Sample. BMC Psychiatry, 7, 51.
[9] Petersen, T., Elklit, A. and Gytz Olesen, J. (2010) Victimisation and PTSD in a Faroese Youth Total-Population Sample. Scandinavian Journal of Psychology, 51, 56-62.
[10] Elklit, A. (2002) Victimisation and PTSD in a Danish National Youth Probability Sample. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 174-181.
[11] Bayer, C.P., Klasen, F. and Adam, H. (2007) Association of Trauma and PTSD Symptoms with Openness to Reconciliation and Feelings of Revenge among Former Ugandan and Congolese Child Soldiers. JAMA, 298, 555-559.
[12] Okello, J., Onen, T.S. and Musisi, S. (2007) Psychiatric Disorders among War-Abducted and Non-Abducted Adolescents in Gulu District, Uganda: A Comparative Study. African Journal of Psychiatry, 10, 225-231.
[13] Rasmussen, D.J., Karsberg, S., Karstoft, K.-I. and Elklit, A. (2013) Victimization and PTSD in an Indian Youth Sample from Pune City. Open Journal of Epidemiology, 3, 12-19.
[14] Sack, W.H., Seeley, J.R. and Clarke, G.N. (1997) Does PTSD Transcend Cultural Barriers? A Study from the Khmer Adolescent Refugee Project. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 49-54.
[15] Mehta, K., Vankar, G. and Patel, V. (2005) Validity of the Construct of Post-Traumatic Stress Disorder in a Low-Income Country. British Journal of Psychiatry, 187, 585-586.
[16] UNFPA: Population Secretariat (POPSEC) Uganda (2012) State of the Uganda Population Report 2012.
[17] Lazarus, R.S. and Folkman, S. (1984) Stress, Appraisal, and Coping. Springer, New York.
[18] Patterson, J.M. and McCubbin, H.I. (1987) Adolescent Coping Style and Behaviors: Conceptualization and Measurement. Journal of Adolescence, 10, 163-186.
[19] Carver, C.S. and Connor-Smith, J.K. (2010) Personality and Coping. Annual Review of Psychology, 61, 679-704.
[20] Plancherel, B., Bolognini, M. and Halfon, O. (1998) Coping Strategies in Early and Mid-Adolescence: Differences According to Age and Gender in a Community Sample. European Psychologist, 3, 192-201.
[21] Bodvarsdóttir, I. and Elklit, A. (2004) Psychological Reactions in Icelandic Earthquake Survivors. Scandinavian Journal of Psychology, 45, 3-13.
[22] Watson, D. and Clark, L.A. (1984) Negative Affectivity: The Disposition to Experience Aversive Emotional States. Psychological Bulletin, 96, 465-490.
[23] Petersen, T., Armour, C. and Elklit, A. (2013) Modelling Patterns of Negative Life Experiences and Mental Health in Faroese Adolescents. Scandinavian Journal of Child and Adolescent Psychiatry, 1, 63-71.
[24] Escalona, R., Achilles, G., Waitzkin, H. and Yager, J. (2004) PTSD and Somatization in Women Treated at a VA Primary Care Clinic. Psychosomatics, 45, 291-296.
[25] North, C.S., Kawasaki, A., Spitznagel, E.L. and Hong, B. (2004) The Course of PTSD, Major Depression, Substance Abuse, and Somatization after a Natural Disaster. Journal of Nervous & Mental Disease, 192, 823-829.
[26] Katon, W., Sullivan, M. and Walker, E. (2001) Medical Symptoms without Identified Pathology: Relationship to Psychiatric Disorders, Childhood and Adult Trauma, and Personality Traits. Annals of Internal Medicine, 134, 917-925.
[27] Balvig, F. (1999) RisikoUngdom. Ungdomsundersogelse. DetkriminalpraventiveRad, Copenhagen.
[28] Rogers, D., Jarvis, G. and Najarian, B. (1993) Detachment and Coping: The Construction and Validation of a New Scale for Measuring Coping Strategies. Personality and Individual Differences, 15, 619-626.
[29] Elklit, A. (1996) Coping Styles Questionnaire: A Contribution to the Validation of a Scale for Measuring Coping Strategies. Personality and Individual Differences, 21, 809-812.
[30] Mollica, R.F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S. and Lavelle, J. (1992) The Harvard Trauma Questionnaire: Validating a Cross-Cultural Instrument for Measuring Torture, Trauma and Posttraumatic Stress Disorder in Indochinese Refugees. Journal of Nervous & Mental Disease, 180, 111-116.
[31] American Psychiatric Association (2000) DSM-IV-TR. Author, Washington DC.
[32] Briere, J. and Runtz, M. (1989) The Trauma Symptom Checklist (TSC-33): Early Data on a New Scale. Journal of Interpersonal Violence, 4, 151-163.
[33] Krog, T. and Duel, M. (2003) Trauma Symptom Checklist (TSC). Psykologisk Studieskriftserie, 6, 1-162.
[34] Hanson, R.F., Borntrager, C., Self-Brown, S., Kilpatrick, D.G., Saunders, B.E., et al. (2008) Relations among Gender, Violence Exposure, and Mental Health: The National Survey of Adolescents. American Journal of Orthopsychiatry, 78, 313-321.
[35] Buka, S.L., Stichick, T.L., Birdthistle, I. and Earls, F.J. (2001) Youth Exposure to Violence Prevalence Risks and Consequences. American Journal of Orthopsychiatry, 71, 298-310.
[36] Foster, F.D., Kuperminc, G.B. and Price, A.V. (2004) Gender Differences in Posttraumatic Stress and Related Symptoms in among Inner-City Minority Youth Exposed to Community Violence. Journal of Youth and Adolescence, 33, 59-69.
[37] O’Donnell, D.A., Roberts, W.C. and Schwab-Stone, M.E. (2011) Community Violence Exposure and Posttraumatic Stress Reactions among Gambian Youth: The Moderating Role of Positive School Climate. Social Psychiatry and Psychiatric Epidemiology, 46, 59-67.
[38] Broderick, P.C. (1998) Early Adolescent Gender Differences in the Use of Ruminative and Distracting Coping Styles. The Journal of Early Adolescence, 18, 173-191.
[39] Matud, M.P. (2004) Gender Differences in Stress and Coping Styles. Personality and Individual Differences, 37, 1401- 1415.
[40] Kaiseler, M., Polman, R.C.J. and Nicholls, A.R. (2012) Gender Differences in Appraisal and Coping: An Examination of the Situational and Dispositional Hypothesis. International Journal of Sport Psychology, 43, 1-14.
[41] Schumm, J.A., Briggs-Phillips, M. and Hobfoll, S.E. (2006) Cumulative Interpersonal Traumas and Social Support as Risk and Resiliency Factors in Predicting PTSD and Depression among Inner-City Women. Journal of Traumatic Stress, 19, 825-836.
[42] Holeva, V., Tarrier, N. and Wells, A. (2001) Prevalence and Predictors of Acute Stress Disorder and PTSD Following Road Traffic Accidents: Thought Control Strategies and Social Support. Behavior Therapy, 32, 65-83.
[43] Ullman, S.E., Townsend, S.M., Filipas, H. and Starzynski, L. (2007) Structural Models of the Relations of Assault Severity, Social Support, Avoidance Coping, Self-Blame and PTSD among Sexual Assault Survivors. Psychology of Women Quarterly, 31, 23-37.
[44] Siedlecki, K.L., Salthouse, T.A., Oishi, S. and Jeswani, S. (2014) The Relationship between Social Support and Subjective Wellbeing across Age. Social Indicators Research, 117, 561-576.
[45] Brannan, D., Biswas-Diener, R., Mohr, C.D., Mortazavi, S. and Stein, N. (2013) Friends and Family: A Cross-Cultural Investigation of Social Support and Subjective Well-Being among College Students. The Journal of Positive Psychology, 8, 65-75.
[46] Lakey, B. and Tanner, S.M. (2013) Social Influences in Negative Thinking and Affect. Cognitive Therapy and Research, 37, 160-172.
[47] ANPPCAN: African Network for the Prevention and Protection against Child Abuse and Neglect (2011) Baseline Survey on Violence against Children in Uganda.
[48] Naker, D. (2005) Violence against Children—The Voices of Ugandan Children and Adults.
[49] UNFPA Uganda Country Office Annual Report 2012.
[50] UBOS: Uganda Bureau of Statistics (2007) Uganda Demographic and Health Survey 2006.
[51] Idsoe, T., Dyregrov, A. and Cosmovici, E. (2012) Bullying and PTSD Symptoms. Journal of Abnormal Child Psychology, 40, 901-911.
[52] Cluver, L., Bowes, L. and Gardner, F. (2010) Risk and Protective Factors for Bullying Victimization among AIDS-Affected and Vulnerable Children in South Africa. Child Abuse & Neglect, 34, 793-803.
[53] Frans, O., Rimmo, P.A., Aberg, L. and Fredrikson, M. (2005) Trauma Exposure and Post-Traumatic Stress Disorder in the General Population. Acta Psychiatrica Scandinavica, 111, 291-299.
[54] Saul, A.L., Grant, K.E. and Carter, J.C. (2008) Post-Traumatic Reactions in Adolescents: How Well Do the DSM-IV PTSD Criteria Fit the Real Life Experience of Trauma Exposed Youth? Journal of Abnormal Child Psychology, 36, 915-925.
[55] Kaysen, D., Morris, M.K., Rizvi, S.L. and Resick, P.A. (2005) Peritraumatic Responses and Their Relationship to Perceptions of Threat in Female Crime Victims. Violence against Women, 11, 1515-1535.
[56] Costa, P.T., Somerfeld, M.R. and McCrae, R.R. (1996) Personality and Coping: A Reconceptualization. In: Zeidner, M. and Endler, N.S., Eds., Handbook of Coping: Theory, Research, Applications, Wiley, Oxford, 44-61.
[57] Kardum, I. and Krapic, N. (2001) Personality Traits, Stressful Life Events, and Coping Styles in Early Adolescence. Personality and Individual Differences, 30, 503-515.
[58] Christiansen, D.M., Hansen, M. and Elklit, A. (2014) Correlates of Coping Styles in an Adolescent Trauma Sample. Journal of Child & Adolescent Trauma, 7, 75-85.
[59] Watson, D. and Hubbard, B. (1996) Adaptational Style and Dispositional Structure: Coping in the Context of the Five-Factor Model. Journal of Personality, 64, 737-774.
[60] Kolk, V.D., Pelcovitz, D., Roth, S., Mandel, F.S., McFarlane, A. and Herman, J.L. (1996) Dissociation, Somatization, and Affect Dysregulation: The Complexity of Adaptation to Trauma. American Journal of Psychiatry, 153, 83-93.
[61] Jobson, L. and O’Kearney, R.T. (2009) Impact of Cultural Differences in Self on Cognitive Appraisals in Posttraumatic Stress Disorder. Behavioral and Cognitive Psychotherapy, 37, 249-266.
[62] Sato, T. (2001) Autonomy and Relatedness in Psychopathology and Treatment: A Cross-Cultural Formulation. Genetic Social and General Psychology Monographs, 127, 89-127.
[63] Markus, H.R. and Kitayama, S. (1991) Culture and the Self: Implications for Cognition, Emotion, and Motivation. Psychological Review, 98, 224-253.
[64] Willis, G.B. and Gonzales, A. (1998) Methodological Issues in the Use of Survey Questionnaires to Assess the Health Effects of Torture. Journal of Nervous & Mental Disease, 186, 283-289.

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