The prevalence of posttraumatic stress disorder and associated mental health problems among institutionalized orphans in Dar es salaam, Tanzania

Abstract

Background: Orphanhood is becoming a more common experience for children in Tanzania, in part as a consequence of the AIDS pandemic, trauma and poverty. The number of orphans and risk of psychopathology has been steadily increasing even in regions where the AIDS epidemic has stabilized. Institutional care for orphaned children is uncommon in sub-Sahara Africa and seen as a last resort primarily as orphanages are often seen as a source of unhealthy psychological development and orphans’ ability to survive and thrive as adults is significantly threatened if raised in an orphanage. Research in this area is minimal in Tanzania. The magnitude of PTSD and associated mental health problems among orphans in Dar es Salaam is unknown, Objectives: The aims of the study was to determine the prevalence of post traumatic stress disorder (PTSD), child abuse, depressive symptoms and suicidal tendency among orphans in Dar es Salaam and the associations between PTSD and social demographic characteristics, child abuse, depression and suicidality among orphans in Dar es Salaam. Methodology: A cross-sectional study was conducted among orphans aged 7 to 17 years from 15 orphanages in Dar es Salaam. Ethical clearance was sought from MUHAS and convenient sampling applied to reach 350 eligible participants. A self administered structured questionnaire was used for data collection on socio-demographic characteristics and child abuse events. Three standardized scales were used to collect measures for PTSD, depression and suicidality. Data were cleaned and analyzed by SPSS version 15 windows. Univariate and multivariate statistical analysis with significant level set at p<0.005 were used. Results: Eighty four participants (24%) met DSM 1V criteria for PTSD, 65.7% reported child abuse events, 78% depressive symptoms and 25.7% suicidal tendency. Findings also showed a strong association between PTSD symptoms sexual abuse and suicidality. Analysis indicated that being out of school and being a single orphan was significantly associated with risk to develop PTSD (p < 0.002) (p<0.0009). Multinomial regression analysis revealed the predictors of PTSD among orphans to be sexual child abuse (AOR= 2.5, 95% CI 1.2 - 2.5, p <0.012) suicidal tendency (AOR= 3.7, 95% CI 1.6 - 5.0, p < 0.001) and marginally physical child abuse (AOR= 1.81, 95% CI 0.8 – 60.8, p < 0.07). Conclusion: Orphanhood brings a host of mental health vulnerabilities including PTSD. A cultural recognition of PTSD and its long term negative consequences needs to be developed and interventions to address the vulnerabilities and risks for mental health problems among institutionalized orphans. Recommendation: Caregivers should be trained to recognize PTSD symptoms, child abuse, depressive symptoms and suicidal tendencies among orphans and refer them for early intervention. School enrolment should be considered compulsory for all institutionalized orphans.