Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries

Stupar D., Stevanovic D., Vostanis P., Atilola O., Moreira P., Dodig-Curkovic K., Franic T., Doric A., Davidovic N., Avicenna M., Multazam I.N., Nussbaum L., Thabet A.A., Ubalde D., Petrov P., Deljkovic A., Monteiro A.L., Ribas A., Jovanovic M., Joana O., Knez R.

Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; School of Psychology, Leicester University, Leicester, United Kingdom; Department of Behavioural Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria; Lusíada University, Porto, Portugal; CIPD, Porto, Portugal; Medical Faculty Osijek, University Health Center Osijek, Osijek, Croatia; Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia; Department of Psychology, Faculty of Humanities and Social Sciences, Rijeka, Croatia; Faculty of Psychology, State Islamic University Syarif Hidayatullah, Jakarta, Indonesia; Dr Soeharto Heerdjan Mental Hospital Jakarta, Jakarta, Indonesia; Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; School of Public Health, Gaza Branch, Al Quds University, Jerusalem, Palestinian Territories, Israel; Department of Psychology, St. Dominic College of Asia, City of Bacoor, Bacoor, Philippines; Department of Child and Adolescent Psychiatry, University Hospital St. Marina, Varna, Bulgaria; Mental Health Center, Pljevlja, Montenegro; Universidade Estacio de Sá in Rio de Janeiro, Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Psychiatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia; Lusíada University, Porto, Portugal; Department of Pediatrics, Skaraborgs Hospital Skövde, Skövde, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden


Background: Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). Methods: Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. Results: The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. Conclusions: Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs. © 2021, The Author(s).

Culture; Prevalence; PTSD-RI-5; Traumatic events; UCLA PTSD index


Child and Adolescent Psychiatry and Mental Health

Publisher: BioMed Central Ltd

Volume 15, Issue 1, Art No 26, Page – , Page Count

Journal Link:

doi: 10.1186/s13034-021-00378-2

Issn: 17532000

Type: All Open Access, Gold, Green


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