Prevalence of Violence Exposure and Post Traumatic Stress Disorder (PTSD) Among Adolescents in Udugama, Sri Lanka

Abstract

Background: Violence exposure in children can lead to psychological problems and poor health outcomes that can be associated with post-traumatic stress disorders (PTSD). This study aimed to estimate the prevalence of full or partial PTSD associated with exposure to community and domestic violence in school-aged children in Sri Lanka. The study aimed to (1a) estimate the prevalence of community violence and domestic violence among school-aged adolescents in Sri Lanka, (1b) estimate the prevalence of community violence and domestic violence overall and by sex among school-aged adolescents in Udugama, Sri Lanka, (2) estimate the prevalence of partial PTSD and full PTSD among those who experience community and/or domestic violence, (3) and does it vary by age, sex, socioeconomic status, and length of exposure to do violence with exposure to domestic and community violence.Methods: This study was a secondary data analysis that utilized a cross-sectional design, using two questionnaires: (1) Child Exposure to Domestic Violence (CEDV) Scale to measure violence exposure, and (2) The UCLA PTSD Reaction Index for DSM IV, a self-report questionnaire to screen for exposure to traumatic events and assess PTSD symptoms in school-age children and adolescents. 346 school children were selected for the study. Children in grades 10 and 11 were selected with a mean age of 14.9 years (SD = 0.02), with a range of 14 to 16 years old were randomly selected from two secondary schools in Udugama MOH area. The two largest schools were non-randomly selected. Within the two schools, four classes were selected randomly. All children present on the day of data collection were selected for the study. As more than 90% of the children are schooling in Sri Lanka, we believe a school-based screening will obtain a representative sample of adolescents in the community. Logistic regression models were used to explore the relationship between sex, age, socioeconomic status, and length of exposure with domestic and community violence. Log-risk regression models were used to explore the prevalence of community and domestic violence and the relationship between violence exposure and full or partial PTSD symptoms. Univariable logistic models were used to estimate associations between individual characteristics (such as age, sex, socioeconomic status, and length of exposure to violence) and partial or full PTSD. Results: Among the 346 participants, 304 (88%) adolescents reported experiencing some type of violence, whether it was community violence or domestic violence on the CEDV questionnaire. Only those who reported experiencing violence were then asked to take the UCLA PTSD Index. Of these, a total of 203 (68%) met criteria A on the UCLA PTSD index and therefore had experienced at least one traumatic event. Of these a total of 52(26%) did not have PTSD, 53 (26%) had partial PTSD, and 98 (48%) had full PTSD. The results showed that age and sex were not associated with PTSD severity. Sex was not associated with the outcome of partial PTSD (p > 0.682; CI: -0.136, 0.089) and full PTSD (p > 0.682; CI: -0.089, 0.136). Age was not statistically significantly associated with the outcome of partial PTSD (p > 0.924; CI: -0.147, 0.162) and full PTSD (p >0.924; CI: -0.162, 0.147). However, the age range was limited to 14 to 16 years, and further research needs to be done for more definitive conclusions. Duration of violence was the only individual characteristic that was statistically significant in the analysis for two responses 1) two to three years back (OR 5.07 (CI:1.11; 23.21) p = 0.037) and 2) as long as I can remember (OR 11.03 (CI: 1.22; 99.51) p = 0.032). Conclusions: The most significant finding of this study is that of those who experience domestic or community violence, 61.9% will develop PTSD. Additionally, domestic violence 189 (90.8%) was reported more often by adolescents than community violence 20 (9.57%). This study was limited due to the small study size and the narrow range of age, which limits its generalizability to the wider population of Sri Lanka or adolescents in general. Therefore, conclusions about the significance of individual characteristics such as age, sex, socioeconomic status, and duration of violence exposure resulting in partial or full PTSD could not be determined. More studies are necessary to test the hypothesis of whether individual characteristics of adolescents in Sri Lanka is associated with partial or full PTSD.