PTSD and Major Depression in Children and Adolescents Four Years After the Communal Violence

8/6/2019 PTSD and Major Depression in Children and Adolescents Four Years After the Communal Violence

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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.



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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.


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.



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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


27/27

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.

PTSD and Major Depression in Children and Adolescents Four Years After the Communal Violence

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Transcript of PTSD and Major Depression in Children and Adolescents Four Years After the Communal Violence