Traumatic stress may arise from various incidents often leading to posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD is estimated at 1% – 2% in Western Europe, 6% – 9% in North America and at just over 10% in countries exposed to long-term violence. In South Africa, the lifetime prevalence for PTSD in the general population is estimated at 2.3%.
To examine the prevalence of posttraumatic stress symptomatology and related psychological functioning in a community sample of adolescents.
Low-socioeconomic communities in KwaZulu-Natal.
Home interviews with adolescents and their maternal caregivers were used to collect the data using standardised instruments. Adolescents completed the Trauma Symptom Checklist for Children; Children’s Depression Inventory; Children’s Somatization Inventory; and Revised Children’s Manifest Anxiety Scale. The Child Behaviour Checklist was completed by the caregivers. The sample comprised Grade 7 (
Almost 6% of the sample endorsed PTSD and an additional 4% of the participants had clinically significant traumatic stress symptomatology. There was a significant, large, positive correlation between posttraumatic stress and anxiety, and medium positive correlations between posttraumatic stress and depression and somatic symptoms.
Posttraumatic stress symptomatology can be debilitating, often co-occurring with symptoms of depression, anxiety and somatic complications. This may lead to long-term academic, social and emotional consequences in this vulnerable group.
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.
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,
Interpersonal violence prevails in South Africa with mortality rates reaching seven times that of the global rate.
In a South African-based rural study
PTSD is associated with psychiatric comorbidity, most notably substance use disorder, major depression, anxiety and somatic disorders.
PTSD and its associated sequelae are, therefore, a major public health concern in South Africa,
Many of the studies reviewed have employed clinical samples, with little work focusing on local community samples. Furthermore, most community-based studies in KwaZulu-Natal focused on single conditions and did not investigate co-occurrences of psychiatric symptoms. The aim of this study was to examine the prevalence of traumatic stress symptomatology and related psychological functioning in a community sample of adolescents in low-socioeconomic areas of KwaZulu-Natal.
Ethical approval was obtained from the Biomedical Research Ethics Committee of UKZN. The KwaZulu-Natal Department of Education approved the study and consent was obtained from the relevant school principals. Participation in the study was voluntary and participants could withdraw at any stage. In order to compensate and show appreciation for their time, shopping vouchers to a value approved by the ethics committee were provided to the participants.
A cross-sectional study design was used. The sample was dichotomised into participants with posttraumatic symptomatology (PTS+) and those without (PTS-) in order to examine the prevalence of traumatic stress symptomatology and related psychological functioning in this sample.
The study was conducted within low-socioeconomic communities in Durban, KwaZulu-Natal. Government census statistics were used to identify low-socioeconomic communities based on levels of crime, education and income.
Participants were maternal caregivers (
Principals of identified schools were approached to participate in the study and learners were addressed in their classrooms based on a standardised script. Information packs, comprising a formal letter addressed to their maternal caregiver that described the study, assent forms and consent forms, were distributed to the learners. Caregivers and adolescents who agreed to participate provided written consent and assent, respectively, and were contacted to arrange for the home-based interviews. Each adolescent and their maternal caregiver were interviewed separately. At any given time four research assistants were trained to conduct the interviews.
Several scales were used to collect the data. The Child Behaviour Checklist (CBCL) was completed by the maternal caregivers and all other scales were completed by the adolescents.
The Trauma Symptom Checklist for Children (TSCC)
The Children’s Depression Inventory (CDI)
The Children’s Somatization Inventory (CSI)
The Revised Children’s Manifest Anxiety Scale (RCMAS) is a 37-item self-report instrument designed to measure emotions and physical symptoms of anxiety in children and adolescents aged between 6 and 19 years.
The CBCL
The Statistical Package for Social Sciences version 22 (SPSS 22) was employed for the analyses of data. The sample was dichotomised into participants with PTS+ and those without (PTS-) based on a
Descriptive statistics (
Descriptive statistics for demographical variables for the PTS+ group and PTS- group.
Variable | % | PTS+ | PTS- | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
% | s.d. | % | s.d. | |||||||||
Black African | 176 | 55.00 | 17 | 53.13 | 19.20 | 3.90 | 159 | 55.21 | 4.32 | 3.84 | 0.44 | 0.72 |
Mixed race | 47 | 14.69 | 4 | 12.5 | 18.00 | 2.94 | 43 | 14.93 | 4.03 | 3.99 | ||
Indian | 75 | 23.44 | 6 | 18.75 | 17.28 | 1.06 | 69 | 23.96 | 4.33 | 3.75 | ||
White people | 22 | 6.88 | 5 | 15.63 | 18.00 | 2.35 | 17 | 5.9 | 4.30 | 3.70 | ||
Total | 320 | 100. | 32 | 100 | 18.50 | 3.19 | 288 | 100 | 4.28 | 3.81 | ||
Grade 7 | 252 | 78.75 | 21 | 65.63 | 18.19 | 3.27 | 231 | 80.21 | 4.14 | 3.76 | 1.13 | 0.29 |
Grade 10 | 68 | 21.25 | 11 | 34.37 | 19.09 | 3.12 | 57 | 19.79 | 4.84 | 4.02 | ||
Total | 320 | 100 | 32 | 100 | 18.50 | 3.19 | 288 | 100 | 4.28 | 3.81 | ||
Male | 112 | 35 | 11 | 34.34 | 17.18 | 3.71 | 101 | 35.07 | 4.26 | 3.46 | 1.90 | 0.17 |
Female | 208 | 65 | 21 | 65.63 | 19.19 | 2.73 | 187 | 64.93 | 4.29 | 4.00 | ||
Total | 320 | 100 | 32 | 100 | 18.50 | 3.19 | 288 | 100 | 4.28 | 3.81 |
s.d., standard deviation.
On the TSCC, 19 participants (5.94%) had
Comparison of means and standard deviation scores for PTS+ and PTS- groups for PTS, anxiety, depression and somatisation.
Variable | PTS+ | PTS- | |||
---|---|---|---|---|---|
s.d. | s.d. | ||||
1. PTS | 18.50 | 3.19 | 4.28 | 3.81 | −23.41 |
2. Anxiety (TSCC) | 12.15 | 5.26 | 3.29 | 3.34 | −13.32 |
3. CDI | 15.47 | 7.92 | 7.69 | 6.16 | −5.38 |
4. CSI | 22.44 | 14.31 | 10.35 | 10.15 | −6.1 |
5. Physiological anxiety (RCMAS) | 4.13 | 2.38 | 1.83 | 1.78 | −6.68 |
6. Total anxiety (RCMAS) | 16.01 | 6.21 | 8.07 | 5.82 | −6.9 |
7. CBCL Anxiety-depression | 5.53 | 5.28 | 4.76 | 4.57 | −0.87 |
8. CBCL Somatic complaints | 3.75 | 4.13 | 3.49 | 3.36 | −0.41 |
s.d., standard deviation.
PTS+, with posttraumatic symptomatology; PTS-, without posttraumatic symptomatology; TSCC, Trauma Symptom Checklist for Children; CDI, Children’s Depression Inventory; CSI, Children’s Somatization Inventory; RCMAS, Revised Children’s Manifest Anxiety Scale; CBCL, Child Behaviour Checklist.
The relationship between PTSS and the other study variables of anxiety, depression and somatic symptoms is represented in
Correlations between posttraumatic stress, anxiety, depression, and somatisation.
Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
---|---|---|---|---|---|---|---|---|
1. PTS | - | 0.83 |
0.49 |
0.41 |
0.52 |
0.57 |
0.10 | 0.01 |
2. Anxiety (TSCC) | - | 0.47 |
0.44 |
0.53 |
0.60 |
0.11 |
0.04 | |
3. CDI | - | 0.52 |
0.65 |
0.69 |
0.17 |
0.06 | ||
4. CSI | - | 0.62 |
0.60 |
0.07 | 0.02 | |||
5. Physiological anxiety (RCMAS) | - | 0.84 |
0.08 | 0.03 | ||||
6. Total anxiety (RCMAS) | - | 0.09 | 0.01 | |||||
7. Anxiety-depression (CBCL) | - | 0.48 |
||||||
8. Somatic complaints (CBCL) | - | |||||||
M | 5.70 | 4.18 | 8.46 | 11.53 | 2.04 | 8.83 | 4.83 | 3.56 |
s.d. | 5.69 | 4.45 | 6.73 | 11.17 | 1.97 | 6.31 | 4.62 | 3.48 |
Sample size ranged from 318 to 324 because of missing data.
s.d., standard deviation.
PTS, Posttraumatic Stress Sub-Scale of TSCC; TSCC, Trauma Symptom Checklist for Children; CDI, Children’s Depression Inventory; CSI, Children’s Somatization Inventory – Short Form; RCMAS, Revised Children’s Manifest Anxiety Scale.
ANOVAs for race, grade and sex on PTS, anxiety, depression, and somatisation.
Variable | Race | Grade | Sex | |||
---|---|---|---|---|---|---|
1. PTS | 0.44 | 0.72 | 1.13 | 0.29 | 1.90 | 0.17 |
2. Anxiety (TSCC) | 1.47 | 0.22 | 0.11 | 0.74 | 10.92 | 0.00 |
3. CDI | 1.17 | 0.32 | 1.20 | 0.27 | 2.53 | 0.11 |
4. CSI | 0.64 | 0.59 | 0.32 | 0.57 | 3.62 | 0.06 |
5. Physiological anxiety (RCMAS) | 2.10 | 0.10 | 5.01 | 0.03 |
1.62 | 0.20 |
6. Total anxiety (RCMAS) | 2.34 | 0.07 | 8.11 | 0.01 |
2.74 | 0.10 |
7. CBCL anxiety-depression | 1.53 | 0.21 | 0.20 | 0.66 | 0.69 | 0.41 |
8. CBCL somatic complaints | 0.58 | 0.63 | 4.99 | 0.03 |
2.14 | 0.15 |
Df: Race = 3; Grade = 1; Sex = 1.
PTS, posttraumatic symptomatology; TSCC, Trauma Symptom Checklist for Children; CDI, Children’s Depression Inventory; CSI, Children’s Somatization Inventory; RCMAS, Revised Children’s Manifest Anxiety Scale; CBCL, Child Behaviour Checklist.
Multiple two-way ANOVAs were conducted considering the impact of race, grade and sex on the other study variables of anxiety, depression and somatic symptoms (see
This study investigated the relationship between traumatic stress and anxiety, depression and somatisation in a multi-racial community sample. Ten percent of the adolescents in this study endorsed responses on the TSCC that indicated clinically significant PTSS. Almost 6.0% of the youth had PTSD (
It was hypothesised that traumatic stress levels would be positively correlated with levels of anxiety, depression and somatic symptoms. This study demonstrated a large positive correlation between traumatic stress and anxiety, and medium positive correlations between posttraumatic stress and depression and somatic symptoms, which is similar to other research findings.
No statistically significant main effect for sex on PTS scores was found suggesting that sex was found to be unrelated to PTSD risk which is supported by other studies.
PTSD can be a debilitating disorder and may often have long-term academic, social and emotional consequences for an individual.
It is paramount that youth mental health status needs be addressed, as PTSS often has delayed comorbidity and is associated with several problems outlined above. As noted in other work,
A major limitation of this study is the cross-sectional design, which did not allow for the analysis of changes in symptomatology over time and their associated comorbidities. A further limitation is the exclusive reliance on self-reported psychometric inventories, the reliability of which may be affected by inattention, flawed recall or deliberate distortion.
This community-sample study concluded that 10% of adolescents endorsed clinically significant PTSS, with almost 6% having PTSD. The results showed a correlation between traumatic stress and anxiety as well as between posttraumatic stress and depression and somatic symptoms. Females reported higher anxiety and somatic symptoms (
This study was funded by a Global Education Grant from Virginia Commonwealth University, United States, and from the Department of Behavioural Medicine at the University of KwaZulu-Natal. The entire Project CARE team at the University of KwaZulu-Natal and Virginia Commonwealth University is acknowledged with sincere thanks.
The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.
K.S. made a substantial contribution to the concept and design of the article; assisted with the acquisition of data in the form of training interviewer assistants; analysed the data; drafted the article; and approved the final version to be published. B.J.P. made a substantial contribution to the concept and design of the article; assisted with data analysis; revised the article; and approved the final version to be published. W.K. made a substantial contribution to the concept and design of the article; provided substantial assistance with data analysis; revised the article and approved the version to be published.