Table 1 demonstrates the sociodemographic characteristics and mental disturbances of the participants at the time of the study. The mean age was 33.79 (SD = 12.74) years, and the range was 77 (18–95) years, but most of the participants were young (18–40 years). There were slightly more males than females (56.4% vs 43.6%). The largest group was from the Yezidi religion (n = 812, 98.8%), and most of them were married (77.6%). A total of 364 (44.3%) of the participants were illiterate, 33.1% had completed primary school, and a few had completed high school or held a higher academic degree. The majority were unemployed (n = 694, 86.2%). Most of the participants were from large families, and the mean number of siblings was 7.22 (SD = 3.26).
Table 1 Sociodemographic characteristics of participants and their PTSD prevalence rates. (N=822)
Sociodemographic characteristics
|
|
N
|
% of total
|
Ages
|
18-40 years old
|
618
|
75.2
|
|
41-64 years old
|
166
|
20.2
|
|
65 years old or more
|
38
|
4.6
|
Gender
|
Female
|
358
|
43.6
|
|
Male
|
464
|
56.4
|
Religion
|
Yezidi
|
812
|
98.8
|
|
Muslim
|
5
|
0.6
|
|
Christian
|
3
|
0.4
|
Marital status
|
Single
|
161
|
20.1
|
|
Married
|
622
|
77.6
|
|
Separated
|
3
|
0.4
|
|
Widow
|
16
|
2
|
Education level
|
Illiterate
|
364
|
44.3
|
|
Primary
|
272
|
33.1
|
|
Secondary
|
162
|
19.7
|
|
Academic
|
24
|
2.9
|
Work status
|
Employed
|
111
|
13.8
|
|
Not employed
|
694
|
86.2
|
Past psychiatric history
|
Positive
|
32
|
3.9
|
Past family psychiatric history
|
Positive
|
53
|
6.5
|
Number of siblings
|
Range, M (SD)
|
21, 7.22 (3.26)
|
PTSD symptoms
|
|
|
PTSD 16 items (Range = 1-4)
|
M (SD)
|
2.26 (0.510)
|
Intrusion (Range = 1-4)
|
M (SD)
|
2.63 (0.597)
|
Avoidance (Range = 1-4)
|
M (SD)
|
2.5 (0.639)
|
Numbing (Range = 1-4)
|
M (SD)
|
1.77 (0.650)
|
Hyperarousal (Range = 1-4)
|
M (SD)
|
2.11 (0.699)
|
PTSD, PTSD- first 16 questions of HTQ part IV
Only 3.9% had a positive past psychiatric history, and 6.5% had a family history of psychiatric disorders. The PTSD scores measured on the HTQ are also shown in Table 1. PTSD had a mean score of 2.26 (SD = 0.51, R = 1-4). Intrusion and avoidance symptoms had the highest means (M = 2.63, SD = 0.59, R = 1-4 and M = 2.5, SD = 0.63, R = 1-4, respectively) compared to numbing and hyperarousal symptoms.
Table 2 displays typing and subtyping of common traumatic events, item loading, and frequencies and percentages of experiencing or witnessing among the participants. Prior to the PCA step, the frequencies and percentages of exposure to traumatic events were studied. Traumatic events that were extremely rare (experienced by less than 5%) were deleted because they did not provide enough information to maintain a meaningful grouping of items. From a total of 48 items, 25 were deleted. Examples of uncommon traumatic events were sexual violence; brainwashing; forced labor; witnessing the torture, murder, arrest or execution of others; witnessing chemical attacks; being confined to home; being forced to pay for bullets used to kill family members; receiving the body of a family member and being prohibited from mourning and burial rites; and having someone inform against a participant. Another item (suffering ill health without access to medical care) was also canceled because its primary loading was less than 0.30 on the same factor. As a result, 22 variables remained that were suitable for PCA.
PCA yielded 6 trauma components, which altogether produced a cumulative variance of 50.1%. Every traumatic event subtype had a loading greater than 0.30 on one component and did not have a loading greater than 0.30 on the next component. The traumatic events were sorted as follows: 1. Trauma to or persecution of self, 2. Trauma to or abduction of family member or friend, 3. Forced immigration, 4. Lack of basic necessities, 5. Witnessed destruction, and 6. Coercion.
Table 2 Typing and Subtypes of traumatic events, item loading, and frequencies and percentages of occurring among IDPs. (N = 822)
Traumatic event
|
1
|
2
|
3
|
4
|
5
|
6
|
N (%)
|
Tortured (physical or mental suffering)
|
0.78
|
|
|
|
|
|
91(11.1)
|
Searched
|
0.71
|
|
|
|
|
|
152(18.6)
|
Oppressed because of ethnicity, religion, or sect
|
0.67
|
|
|
|
|
|
519(63.3)
|
Exposed to combat situation
|
0.48
|
|
|
|
|
|
391(47.7)
|
Forced to change religion
|
0.45
|
|
|
|
|
|
338(41.4)
|
Disappearance, hostage or kidnapping of family member
|
|
0.68
|
|
|
|
|
110(13.4)
|
Murder or violent death of friend
|
|
0.65
|
|
|
|
|
219(26.8)
|
Murder or violent death of family member
|
|
0.59
|
|
|
|
|
114(13.9)
|
Disappearance, hostage, or kidnapping of friend
|
|
0.54
|
|
|
|
|
318(38.9)
|
Serious physical injury of family member or friend
|
|
0.43
|
|
|
|
|
64(7.8)
|
Witnessed video film on a known person or places, content is violence
|
|
0.32
|
|
|
|
|
50(6.1)
|
Forced to leave hometown
|
|
|
0.91
|
|
|
|
782(95.4)
|
Expelled from city based on ancestral origin, religion, or sect
|
|
|
0.89
|
|
|
|
771(94)
|
Lack of food or clean water
|
|
|
|
0.82
|
|
|
640(78)
|
Lacked shelter
|
|
|
|
0.81
|
|
|
747(91.1)
|
Witnessed desecration or destruction of religious shrines
|
|
|
|
|
0.76
|
|
124(15.3)
|
Witnessed shelling, burning, or razing of residential areas
|
|
|
|
|
0.76
|
|
103(12.7)
|
Witnessed rotting corpses
|
|
|
|
|
0.57
|
|
128(15.7)
|
Forced evacuation under dangerous conditions
|
|
|
|
|
|
0.71
|
771(93.8)
|
Forced to hide
|
|
|
|
|
|
0.61
|
700(85.4)
|
Confiscation, looting, or destruction of personal property
|
|
|
|
|
|
0.55
|
793(96.5)
|
Types of traumatic events: 1. Trauma or persecution to self, 2. Trauma or abduction of others, 3. Forced immigration, 4. Lack of basic necessities, 5. Witnessed destruction, and 6. Coercion.
Table 3 shows the cumulative trauma events and rates of PTSD among the participants. The prevalence of PTSD among them according to the cutoff scores was 33.8%. Among those who were mildly traumatized (1-10 traumatic events), only 163 (30.9%) screened positive for PTSD compared to 69.1% who screened negative. Only 109 (38.1%) of the IDPs who experienced 11-20 traumatic events screened positive for PTSD. Of those who were severely traumatized (>20 traumatic events), 6 (66.7%) had a diagnosis of PTSD compared to only 3 (33.3%) who did not. All these differences were statistically significant (X2 = 8.66, P < 0.05).
Table 3 Cumulative trauma events and rates of PTSD among IDPs. (N=822)
Traumas experienced by each IDP
N
|
PTSD diagnosis
|
Total
N (%)
|
Positive
N (%)
|
Negative
N (%)
|
1-10 traumas
|
163 (30.9)
|
364 (69.1)
|
527 (100)
|
11-20 traumas
|
109 (38.1)
|
177 (61.9)
|
286 (100)
|
>20 traumas
|
6 (66.7)
|
3 (33.3)
|
9 (100)
|
Total
|
278 (33.8)
|
544 (66.2)
|
822 (100)
|
PTSD, PTSD- first 16 questions of HTQ part IV > 2.5, X2 = 8.659, df = 2, P = 0.013
Multiple linear regression analysis of subtypes of experienced traumatic event components as predictors of PTSD is demonstrated in Table 4. The overall regression model was significant F (6,811) = 4.618, P< 0.001. Among the 6 types of traumatic components yielded by the PCA method, the types of individual trauma exposure that were significant predictors of the development of PTSD were unmet basic needs and having witnessed destruction (β = 0.096, P < 0.05 and β = 0.115, P = 0.001, respectively). Lower PTSD scores were associated with forced migration (β = -0.103, P < 0.05).
Table 4 Types of the experienced traumatic events (by HTQ) as predictors of PTSD among Iraqi IDPs. (N=822)
Variables
|
Untenderized B
|
Standardized β
|
T
|
P
|
R2
|
F
|
P
|
|
|
|
|
|
0.033
|
4.618
|
<0.001
|
Trauma or persecution to self
|
-0.159
|
-0.055
|
-1.438
|
0.151
|
|
|
|
Trauma or abduction to others
|
0.014
|
0.006
|
0.155
|
0.877
|
|
|
|
Forced immigration
|
-0.258
|
-0.103
|
-2.923
|
0.004
|
|
|
|
Lack of basic needs
|
0.161
|
0.096
|
2.721
|
0.007
|
|
|
|
Witnessed destruction
|
0.227
|
0.115
|
3.194
|
0.001
|
|
|
|
Coercion
|
-0.056
|
-0.02
|
-0.548
|
0.584
|
|
|
|
HTQ, Harvard trauma questionnaire, PTSD, PTSD- first 16 questions of HTQ part IV
To study the sociodemographic correlates (age, gender, marital status, religion, education level, occupation, and number of siblings) for PTSD, a binary logistic regression model was used (Table 5). Religion was not entered into logistic regression because the majority were Yezidis, and the number of individuals belonging to other religions, such as Muslims or Christians, was ≤5. The table shows that sociodemographic variables were not risk factors for developing PTSD among the Iraqi IDPs except that being a widow was a strongly significant predictor (OR = 14.559, P = 0.001, 95% CI for OR = 2.933-72.274).
Table 5 Sociodemographic variables as predictors of PTSD among Iraqi IDPs. (N=822)
Demographic variables (reference)
|
P-value
|
OR
|
95%CI for OR
|
Age
|
|
0.357
|
1.007
|
0.993-1.021
|
Gender
|
Male (ref)
|
|
1.00
|
|
|
Female
|
0.089
|
0.738
|
0.52-1.047
|
Marital status
|
Single (ref)
|
|
1.00
|
|
|
Married
|
0.542
|
1.167
|
0.71-1.921
|
|
Separated
|
0.195
|
5.11
|
0.433-60.369
|
|
Widow
|
0.001*
|
14.559
|
2.933-72.274
|
Education
|
Illiterate (ref)
|
|
1.00
|
|
|
Primary
|
0.08
|
0.72
|
0.498-1.04
|
|
Secondary
|
0.354
|
0.794
|
0.488-1.293
|
|
Academic
|
0.494
|
0.715
|
0.273-1.871
|
Work status
|
Employed (ref)
|
|
1.00
|
|
|
Unemployed
|
0.996
|
1.001
|
0.629-1.594
|
Number of siblings
|
|
0.058
|
1.047
|
0.998-1.099
|
Psychiatric history
|
Negative (ref)
|
|
1.00
|
|
|
Positive
|
0.815
|
0.905
|
0.393-2.084
|
Family history
|
Negative (ref)
|
|
1.00
|
|
|
Positive
|
0.309
|
0.711
|
0.368-1.371
|
OR, Odd ratio, CI, Confidence interval, *P-value <0.05
Table 6 demonstrates the comparison of the means and SDs of the GHQ-28 and its components among Iraqi IDPs with or without the diagnosis of PTSD. The scores of the total GHQ-28 and all its components were significantly higher in those diagnosed with PTSD than in those without the diagnosis (P <0.001 in all domains). The total GHQ-28 score was near the average cutoff mean (M = 13.32, SD = 4.71, R = 0-28) among the IDPs with a diagnosis of PTSD. The mean scores of anxiety/insomnia and somatic symptoms were above the average cutoff means (M = 3.74, SD = 1.98, R = 0-7 and M = 3.69, SD = 2.14, R = 0-7, respectively) among the IDPs with PTSD.
Table 6 Psychiatric symptoms by general health questionnaire (GHQ-28) among Iraqi IDPs with or without the diagnoses of PTSD.
|
Range
|
PTSD
M (SD)
|
No PTSD
M (SD)
|
t
|
df
|
P
|
Total GHQ-28
|
0-28
|
13.32 (4.709)
|
8.75 (4.706)
|
13.171
|
820
|
< 0.001
|
Somatic symptoms
|
0-7
|
3.69 (2.140)
|
2.37 (2.172)
|
8.326
|
820
|
< 0.001
|
Anxiety/ insomnia
|
0-7
|
3.74 (1.978)
|
2.63 (1.887)
|
7.866
|
820
|
< 0.001
|
Social dysfunction
|
0-7
|
2.73 (1.831)
|
1.49 (1.714)
|
9.652
|
820
|
< 0.001
|
Severe depression
|
0-7
|
3.15 (1.338)
|
2.27 (1.349)
|
8.899
|
820
|
< 0.001
|
IDPs, internally displaced persons, PTSD, post-traumatic stress disorder mean score ≥ 2.5, t, independent sample t test, df, degree of freedom, P, P value.