Traumatic Stress Among Secondary School Students in Port Harcourt Metropolis

International Journal of Innovative Social & Science Education Research 8(3):1-10, July-Sept., 2020

Demographic Differences in the Epidemiology of Post- Traumatic Stress among Secondary School Students in Port Harcourt Metropolis

1Cookey, Patricia Uzoamaka; 2Dr. Margaret G. Kennedy & 3Dr. Maxwell D. Eremie

1Department of Educational Foundation, Faculty of Education, Rivers State University, Nkpolu, Oroworukwo, Port Harcourt, Nigeria [email protected]; 08064428229

2International Secondary School, Rivers State University, Port Harcourt, Nigeria [email protected]; 08138885391

3Department of Educational Foundation, Faculty of Education, Rivers State University, Nkpolu, Oroworukwo, Port Harcourt, Nigeria [email protected]; 08034827746

ABSTRACT The study investigated the Demographic Differences in the Epidemiology of Post-Traumatic Stress (PTS) among secondary school students in Port Harcourt Metropolis. Three research questions and three null hypotheses were raised and tested at 0.05 level of significance. The ex-post-facto research design was used. The population of the study comprised all the 4,600 students in the 5 selected schools in Port Harcourt Metropolis. The sample size of 270 students who experienced traumatic incidents was used. The PTSD was used for data collection. It is a standardized instrument with validation value of 0.96. The original Cronbach alpha reliability of the instrument is given as 0.90 while the test–retest for stability was .50. Means and standard deviations were used to answer the three research questions while the t-test statistics was used to test the three null hypotheses at P≤ .05 level of significance. Findings revealed that gender had no significant differences in posttraumatic stress among students. The age and geographical location of school showed significant differences in the experience of post-traumatic stress. It was recommended among others that there should be guidance and counselling units in schools irrespective of location where they don’t exist to enable counsellors to effectively manage psychological problems of students. Keywords: Demographic Difference, Epidemiology, Post-Traumatic Stress, Traumatic, Students

INTRODUCTION Post-Traumatic Stress (PTS) is a set of symptoms experienced by trauma survivors, which include hyper- vigilance, re-experiencing of the trauma and emotional numbing, among others. According to Sue, Sue and Sue in Cookey (2014) PTS lasts for more than thirty days, develops in response to a specific extreme stressor, and is characterized by intrusive memories of the traumatic event, emotional withdrawal, and heightened automatic arousal.

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When horrifying experiences occur as a result of trauma, they bring about general increases in anxiety and arousal, avoidance of emotionally charged situations, and the frequent reliving of the traumatic event. According to Oltmanns and Emery (1995), if symptoms become severe and persist for more than one month, what was simply known as “Post Traumatic Stress” (PTS) develops into a disorder (Post- Traumatic Stress disorder). Gallagher III (2002) further added that Post Traumatic Stress can occur at any age, including children. He indicates that symptoms usually begin within three months after the trauma, and for some people, there may be a delay for years. Whether the condition occurs or not depends on the severity, duration and proximity of an individual’s exposure to the traumatic event as well as to the quality of social supports available. In the same vein, Copeland, Keeler, Angold and Costello in Cookey (2014) have added that apart from PTSD, traumatic events in children are related to many forms of psychopathology, with the strongest links to anxiety and depressive disorders. Mohlen, Parzer, Resch and Brunner (2005) have also indicated that psychological and behavioral maladjustment is associated with traumatic events like war (whether it involves violent or non-violent acts). The Diagnostic and Statistical Manual (DSM-IV, Text Revision edition) (APA, 2000) identifies three categories of symptoms characterizing post traumatic stress disorder. They include the following: - (i) Re-experiencing the event: this could take the form of distressing memories of the events, distressing dreams about the event, reliving the event by acting or feeling as if the event were recurring, and intense psychological and physiological distress when exposed to situation reminiscent of the event. (ii) Emotional numbing and detachment:-This manifests in the form of avoiding thoughts, feelings, or conversations about the event; avoiding activities, places, or people associated with the event; having trouble recalling important aspects of the event; loss of interest in activities; feelings of detachment from others; inability to have loving feelings toward others and a general restriction of feelings; sense that the future is bleak. (iii) Hyper-vigilance and chronic arousal: this reaction includes symptoms such as difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hyper-vigilance, and exaggerated startle response. Nolen-Hoeksema (2001) has added that suffers of PTS may report “survivor guilt”, painful guilt feelings over the fact that they survived) or about things that they had to do to survive. For instance, she reports that many Holocaust survivors report guilt for having survived when their families did not or for not having taught more strongly against the Nazis. Post-Traumatic Stress, in the context of this work, is an anxiety disorder that occurs after one has gone through a traumatic event. Thus, all the different forms of stress usually diagnosed with traumatic events, which include acute stress disorder (ASD), panic disorder (PD) or even the more severe Post-Traumatic Stress (PTS) are included due to similarities between them and their association with trauma. An event becomes stressful or traumatic if the situation is such that involves someone’s life being threatened or severe injury has occurred like in the cases mentioned earlier. In the case of children, the risk of developing PTSD depends on a number of factors which include the seriousness of the traumatic events, whether the trauma is repeated, the child’s proximity to the trauma, and finally his/her relationship to the victim(s) (AACAP, in Cookey, 2014). The situation that had existed in the Niger Delta in recent times was such that has resulted directly or indirectly to traumatic experiences suffered by both children and adults alike. In the words of Saliu, Luqman and Abdullahi (2007), “no region of the country best exhibits the deplorable nature of Nigeria’s human security than the Niger Delta”. Reporting further on the same subject, Kinanee and Kpai (2008) have identified some of the security challenges in the area to include hostage taking/kidnapping, street violence, armed robbery, gangsterism and other violent crimes like school shooting. According to them, one psychological consequence of such events is Post Traumatic Stress. Post traumatic reactions have several educational implications. From all indications, PTS could affect school work tremendously. In an interview with a victim of trauma (a school child) by the Pandora’s 2

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Project (2009), it was reported that PTSD created a wave-effect on the school life of the child. The student experienced periods of depression and poor concentration. In addition, her motivation significantly decreased to study and to go to class. There were also attacks of constant flashbacks and panic attacks, which distanced her more from the school. Other effects on class work included procrastination and constant struggle with homework and examinations. Generally speaking, in addition to the above, PTS is associated with decreased motivation to study. The regular flashbacks and panic attacks they experience make school children find it difficult to attend school the way they are supposed to. Other studies (Ovuga, Oyok & Moro, 2008) have shown that school children that are victims of PTS are also predisposed to regular outbursts of anger and irritability which keep them away from other students hence reducing the chances of socialization which education enhances. No wonder, Koester (2010) reported that such children attempt to avoid thoughts, conversations, and feelings associated with the trauma, feeling detached from others (including fellow students and teachers), attempt to avoid people, activities, and places that remind the individual of the event, a restricted range of affects, and a decreased interest or participation in important activities, including those of the school. With sleeping difficulties, hyper-vigilance, and concentration difficulties, children suffering from PTS are unable to display mental strength needed to process information in class. It is on account of the foregoing that this study has been designed, so that appropriate strategies can be sought for managing victims in the school system by mental health practitioners. In terms of the epidemiology of PTS, a study by Oltmanns and Emery (1995), conducted in the Detroit area of the U.S found that trauma was more likely to be experienced by men; by those with less education, and by people who were more neurotic or extroverted, had a history of conduct problems during childhood, or had a family history of mental disorder. In terms of management of Post-Traumatic Stress, the initial reactions of most parents had been to resort to traditional (and sometimes primitive) methods of dealing with behavioral problems as is common in African societies. Only very few, especially the enlightened ones would consider hospital management of the symptoms of PTS.. Pandora (2009) has recommended the use of counseling and psychotherapy sessions for victims of Post-Traumatic Stress in the school setting in addition to any other relevant interventions. There seems to be very few studies that have been carried out by mental health practitioners (counselors, psychologists, psychiatrists and social workers) with regard to Post-Traumatic Stress among students in the school system in the Niger Delta region of Nigeria. Considering the traumatic events that have occurred in the region in recent times, and the apparent dearth of materials on the subject, the researchers deemed it necessary to investigate the demographic differences in the epidemiology of post-traumatic stress among secondary school students in Rivers State. The study will, among other things, investigate whether the experience of PTS among students is related to the gender, age and geographical location of school. Statement of problem Post-Traumatic Stress is a more serious condition that results from situations where people are exposed to traumatic events like kidnapping, war, earthquake, social or physical violence and the like. While natural disasters such as tornados or earthquakes have little potential for being personalized, victims of rape, torture or kidnapping usually face their assailants. Other situations like technological disasters such as car or airplane crashes and dam bursts may occur as a result of human error on a grand scale. Each of these events so mentioned is capable of precipitating Post Traumatic Stress. From all indications, it appears that the more personal the trauma is to an individual, the more likely the long-term psychological problems that would arise from it. Such traumas are also more likely to include elements of anger and hostility, flashbacks or reliving the traumatic event for minutes or even days, upsetting dreams about the incident, memory problems, trouble concentrating, avoiding activities one once enjoyed, to mention a few. Such experiences have health, social, educational and vocational implications.

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In the light of the numerous traumatic events reported in Rivers State in particular and Niger Delta in general recently, it has become necessary to give a thought to the phenomenon of post-traumatic stress among secondary school students. A recent study of UNICEF 2010 in Cookey (2014) indicated how in some communities in Rivers and other Niger Delta states, schools were closed down due to militant activities, while teachers and students alike were exposed to gun shots which led to the maiming and death of some of them. Furthermore, it was reported that some school compounds became training grounds for militant groups or camping grounds for the Joint Task Force (a security outfit set up by the government of Nigeria). Recent literatures on the subject (Medicine Net, 2008, Giardino, Harris & Giardino, 2009) have shown the grave nature of that kind of situation on school children. For instance, such children exposed to psychological trauma would definitely have problems with school work. Apart from obvious poor performance as a result of poor concentration and impaired thinking ability as well as emotional problems, some gradually find it difficult even going to school. The implication of this situation on the future of the economic, political and educational development of the area can better be imagined than discussed. Sometimes, parents may not understand why such children act the way they do, in and out of the classroom situation. The need to understand this phenomenon and its management strategies especially among school children therefore becomes a welcome development, considering the research area. Considering the horrible effect all those events could have on the school system, the researchers are motivated to investigate the Demographic Differences in the Epidemiology of Post-Traumatic Stress among Secondary School Students in Rivers State. Therefore, the Statement of Problem is: What is the extent of Demographic Differences of gender, age, geographical location of schools in the Post-Traumatic Stress among Secondary School Students in Port Harcourt Metropolis? Purpose of the Study The purpose of this study was to examine Demographic Differences in the Epidemiology of Post- Traumatic Stress (PTS) among secondary school students in Port Harcourt Metropolis with special regard to gender, geographical location and age of students. Research Questions The following research questions have been raised to guide this study: 1. To what extent does the experience of post-traumatic stress differ based on gender among students in Port Harcourt metropolis? 2. To what extent does the experience of post-traumatic stress differ based on geographical location among students in Port Harcourt metropolis? 3. To what extent does the experience of post-traumatic stress differ on the basis of age among secondary school students in Port Harcourt Metropolis? Hypotheses The following null hypotheses were formulated to guide the study. (1) There is no significant gender difference in Post-traumatic stress experience among students in Port Harcourt metropolis. (2) There is no significant difference between urban and rural students in their experience of post- traumatic stress in the secondary schools in Port Harcourt Metropolis. (3) There is no significant difference between 10-14 years and above 15 years students in their experience of post-traumatic stress in the secondary schools in Port Harcourt Metropolis.

METHODOLOGY This study is an ex-post-facto design. It investigated the Demographic Differences of Post- Traumatic Stress (PTS) among secondary school students in Port Harcourt Metropolis. This design is used to cover investigations that are done retrospectively to identify possible cause-and-effect relations between variables under study. The population for this study comprised five (5) selected schools from the areas of Port Harcourt Metropolis that were regarded as hotbeds of militancy in the area. They include the following: 4

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1. Baptist High School, Borikiri Port Harcourt (Boys School) with a population of about 600 students. 2. Federal Government College, Rumuokoro- Port Harcourt (mixed school) with a population of about 1,400 students. 3. Holy Rosary Secondary School (Girls School) with a population of 800 students. 4. Community Secondary School Rumuekini with a population of 600 students 5. Community Secondary School Ogbogoro with a population of 1,200 students The total population for the study is 4,600 students (source: information from principals of various schools). The sample size for this study is 270. The sample was purposive because only students having traumatic experiences were used for the study. They were spotted with the PTSD Checklist civilian version for the study. The instrument used for data gathering was the “PTSD Checklist Civilian version” (PCL). The instrument (PCL) is a 17-item self-report measure of PTSD symptomatology. Respondents are usually asked to indicate the ex contains a list of problems and complaints that people sometimes have in response to stressful experiences. Respondents are to tick which of the options applies to them and the responses are scored according to the impact, thus: 1 for “Not at all”, 2 for “A little bit”, 3 for “Moderately”, 4 for “Quite a bit”, and 5 for “Extremely”. A minimum score on the scale is 17. The higher the score the greater the post traumatic experience. The score range between 17-33 are considered low, 34-50 moderate while the scores between 51-85 are considered high. The PSTD is a standardized instrument with a validation value of 0.96. The Cronbach coefficient alpha reliability of the instrument is given as 0.90 while the test-re-test for stability was .050. The instrument was administered to the respondents through the direct delivery method with the assistance of the class teachers. The strata were formed based on the location being the Rural and Urban. Three schools were selected in the Urban while two schools were selected in the Rural. The researcher also obtained permission from the school heads to gain access to the staff and students. . In each of the school visited, the researchers explained the purpose of the research and how to fill the instrument to the respondents before administering the questionnaires. The instruments were retrieved on the same day no dearth of instrument was recorded. The researchers used the descriptive statistics of Means and Standard Deviations to answer all the three research questions. The independent t-test statistic was used to test the three null hypotheses involving dichotomous variables of gender, age and geographical location.

RESULTS Research Question 1: To what extent does the experience of post traumatic stress differ based on gender among students in Port Harcourt metropolis? Hypothesis 1: The hypothesis states that there is no significant gender difference in Post -traumatic stress experience among students in Port Harcourt metropolis. In order to answer this research question 1 and test its corresponding null hypothesis 1, the mean, standard deviation and independent t-test statistics were computed. The results obtained from the analysis are presented on table 1

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Table 1: T-test analysis of the gender differences in the experience of Post traumatic stress among secondary school students

Gender N Mean SD df t-cal Sig MD 95% C I Lower Bound Upper Bound Decision

Male 89 36.685 12.536 268 .179 .437 .277 -2.766 3.400 Female 181 36.409 11.635 P≥.05

N = 270, MD = Mean difference, ≥>.05 level of significance, CI = Confidence interval.

As shown in table 1, the descriptive outputs of post-traumatic stress based on gender variable include: Male, n = 89, Mean = 36.685, SD = 12. 536 and female, n = 181, Mean = 36.409, SD = 11.635, the mean difference, MD = .277. This provides answer to the research question 1 and shows that there is a difference between male and female students in their experience of Post- traumatic stress in Port Harcourt Metropolis. The mean difference is .277 in favour of male students and shows that female students have higher post-traumatic stress more than their male counterpart. In order to test the hypothesis 1, the descriptive statistical outputs of means of the two independent groups and their standard deviations as shown in table 1 were subjected to t-test analysis. The computed t-test value, .437, df = 268, P≥.05 level of significance. Therefore, the hypothesis which states that there is no significant difference between male and female students in their experience of post-traumatic stress in the secondary schools in Port Harcourt Metropolis was retained.The mean difference MD = .277 in favour of male students, was not significant at the 95% confidence interval. The conclusion was drawn that the male and female students involved in this study experienced similar post-traumatic stress in Port Harcourt Metropolis. Research Question 2: To what extent does the experience of post-traumatic stress differ based on geographical location among students in Port Harcourt metropolis? Hypothesis 2: The hypothesis states that there is no significant geographical location difference in Post- traumatic stress experience among students in Port Harcourt metropolis. In order to answer this research question 2 and test its corresponding null hypothesis 2, the Means, Standard deviations and Independent t-test statistics were computed. The results obtained from the analysis are presented in table 2 Table 2: T-test analysis of the geographical location differences in the experience of Post -traumatic stress among secondary school students

Location N Mean SD df t-cal Sig MD 95% C I Lower Bound Upper Bound Decision

Urban 134 34.082 12.107 268 .001 -4.800 -7.603 -1.998 Rural 136 38.882 11.271 P≤.05 N = 270, MD = Mean difference, P≤.05 level of significance, CI= confidence interval. As shown in table 2, the descriptive output of post-traumatic stress based on geographical variable include: Urban, n = 134, Mean = 34.082, SD = 12. 107 and Rural, n = 181, Mean = 38.882, SD = 11.271, the mean difference, MD = -4.800. This provides answer to the research question 2 and shows that there is a difference between urban and rural students in their experience of Post- traumatic stress in Port Harcourt Metropolis. The mean difference is -4.800 in favour of rural students and shows that rural students have higher post-traumatic stress more than their urban counterparts. 6

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To test the null hypothesis 2, the descriptive statistical outputs of means of the two independent groups and their standard deviations as shown in table 2 were subjected to independent t-test analysis. The computed t-test value, -3.373, df = 268, P<.05 level of significance. Therefore, the hypothesis which states that there is no significant difference between urban and rural students in their experience of post- traumatic stress in the secondary schools in Port Harcourt Metropolis was rejected. The mean difference, MD = -4.800 in favour of rural students, was found to be significant at the 95% confidence interval. The conclusion was drawn that the rural and urban students involved in this study have significant differences in their post -traumatic stress experiences in Port Harcourt Metropolis. Research Question 3: To what extent does the experience of post traumatic incidents differ on the basis of age among secondary school students in Port Harcourt Metropolis? Hypothesis 3: There is no significant difference between 10-14years and 15years above students in their experience of post-traumatic stress in the secondary schools in Port Harcourt Metropolis. To answer research question 3 and test its corresponding null hypothesis 3, the mean, standard deviation and independent t-test statistics were employed. The results obtained from the analysis are presented in table 3. Table 3: T-test analysis of the age differences in the experience of traumatic incidents among secondary school students

Age N Mean SD df t-cal Sig MD 95% C I Lower Bound Upper Bound Decision

10-14yrs 60 40.283 11.841 268 2.610 .010 4.279 1.051 7.507 15yrs 210 36.005 11.013 P<.05 above N = 270, MD = Mean difference, P< .05 level of significance, CI= confidence interval.

As shown in table 3, the descriptive output of traumatic incidents based on age variable include: 10- 14years, n = 60, Mean = 40.283, SD = 11. 841 and 15 years above, n = 210, Mean = 36.004, SD = 11.013, the mean difference, MD = 4.279. This provides answer to the research question 3 and shows that there is a difference between 10-14yrs and 15yrs above students in their experience of post traumatic incidence in Port Harcourt Metropolis. The mean difference is 4.279 in favour of 10-14yrs students and it shows that 10-14years students have higher post-traumatic stress more than their 15years above counterparts. To test the hypothesis 3, the descriptive statistical outputs of means of the two independent groups and their standard deviations as shown in table 3 were subjected to t-test analysis. The computed t-test value, .198, df = 268, P≤ .05 level of significance. Therefore, the hypothesis which states that there is no significant difference between 10-14yrs and 15 years above students in their experience of post-traumatic stress in the secondary schools in Port Harcourt Metropolis was rejected. The mean difference MD = 4.279 in favour of 10-14yrs students, was found to be significant at the 95% confidence interval. The conclusion was drawn that the 10-14 years and 15 years students involved in this study experienced significant differences in their post -traumatic stress in Port Harcourt Metropolis.

DISCUSSION OF FINDINGS Gender and Post-Traumatic Stress among Secondary School Students The finding of the study revealed that there was no significant gender difference in the post traumatic experiences of students. In the post-traumatic stress, the males showed evidence of higher post-traumatic stress disorder. The finding agrees with Christiansen and Elklit (2008) when they reported that depression, negative affectivity/neuroticism, and younger age have sometimes been reported to be related to PTSD in female more than in males.

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Reacting to this, Zeidner (2006) submitted that higher degree of negative affectivity in females may result in more reactive emotional and somatic responses in females compared to males. The two citations given earlier showed that female students are more vulnerable to traumatic stress disorder than their male counterparts therefore, suffer post-traumatic stress mostly. More so, Breslau and Davis (1992) reported that subsequent epidemiological studies have suggested that PTSD may be more experienced among women and girls than men and boys. Breslau, Davis, Peterson and Schultz (1997) reported that some differences in PTS were markedly greater if exposure occurred in childhood than likely to develop in females than in males after exposure to a traumatic event. The ratio of female students who are exposed to PTS is usually higher if apt comparison is done. That is why, Breslau (2001) noted that the possible reasons for the observed difference in life time experience of PTS between the sexes ( a female – to – male life time experience ratio of 2:1 is typically reported) and factors thought to be associated with an increased risk for the disorder after exposure to trauma are reviewed. In conclusion, an analogy has been drawn to the fact based on the finding that female students suffer from PTDS more than their male counterparts. Age and Post-Traumatic Stress (PTS) among Secondary School Students The finding of age differential revealed that the students with the ages of 10-14 years had a higher mean score more than their counterpart who are within the ages of 15 years above and are more prone to experience PTS. There was a significant difference in the post-traumatic stress experience between the age groups. For instance, the findings showed that students between the age brackets of 10-14 years experienced higher level of post traumatic experience than their counterparts of 15 yrs and above. This could be expected because of their tender age and being close to the early adolescent period. In consonance with this findings Australian Centre for Post Traumatic Mental Health (N.D) reported that by the age of 16years, more than two thirds of children will have experienced exposure to at least one traumatic event. This could be the reason why majority of the children at about this age as reportedly noted and shown in the finding are more experience to Post Traumatic Stress disorder than the younger ones. This notwithstanding, The National Child Traumatic Stress Network (N.D) has been able to establish the fact that traumatic experiences, long after they are over, continue to take priority in the thoughts, emotions and behaviours of children, adolescents and adults. This fact is made clear when they further stressed that age, development maturity, and experience in contrast to the finding of this study, Zhu, Situ, Zhang, Fang, Jing, Wang, Yang and Huang (2011) reported from their study that age 9 less than 12 years old), gender (female) having family member injury and death, witnessing injury and death, and deprivation were the main risk factors that affected the children and adolescent’s mental health. Geographical Location Differences in the Experience of Post-Traumatic Stress (PTS) among Secondary School Students The findings on geographical location differences revealed that there was a significant difference in the post-traumatic stress experienced by the urban and rural students. The rural students experienced higher Post traumatic stress more than their urban counterparts. The finding revealed that students from rural areas have higher mean scores than those in urban areas which shows that the students from rural areas are more prone to the effect of post-traumatic stress. Hence. they need therapeutic intervention. This result was not expected because the researchers felt that irrespective of the students’ location, they should experience equal post-traumatic stress. However, this finding agrees with Biefka and Barlow (2005) who reported that veterans exposed to a high level of combat were nine times more likely to have PTS than military personnel who did not serve in the war zone. The disagreement between the findings resulted from different variables used.

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CONCLUSIONS Based on the findings of this study it was concluded as follows; 1. The male and female students involved in this study experienced similar Post- Traumatic Stress in Port Harcourt Metropolis. 2. The rural and urban students involved in this study have significant differences in their post- traumatic stress experiences in Port Harcourt Metropolis. 3. The 10-14 years and 15 years students involved in this study experienced significant differences in their post-traumatic stress in Port Harcourt Metropolis.

5.4 RECOMMENDATIONS Based on the findings of this study, the following recommendations were made: 1. There should be counselling intervention in handling post-traumatic stress all secondary schools in Rivers State irrespective of school location. Therefore, every secondary school should be provided guidance and counselling unit. 2. Uniform therapeutic attention for promoting preventive and curative measures of trauma and Post-Traumatic Stress should be provided in the secondary schools in Rivers State. 3. There should be effort at reducing incidents of trauma and hence reduce Post Traumatic Stress among secondary school students on this strength, Government should endeavour to bring about peace and tranquility in the state by combating social vices that could be traumatizing.

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