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

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Prevalence of Violence Exposure and Post Traumatic Stress Disorder (PTSD) Among Adolescents in Udugama, Sri Lanka Prevalence of Violence Exposure and Post Traumatic Stress Disorder (PTSD) among Adolescents in Udugama, Sri Lanka by Grace E. Lowitzer Duke Global HealtH Institute Duke University Date:_______________________ Approved: ___________________________ Truls Ostbye, Advisor ___________________________ Lawrence P. Park ___________________________ JosepH R. Egger Thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the Duke Global Health Institute in the Graduate ScHool of Duke University 2021 ABSTRACT Prevalence of Violence Exposure and Post Traumatic Stress Disorder (PTSD) among Adolescents in Udugama, Sri Lanka by Grace E. Lowitzer Duke Global HealtH Institute Duke University Date:_______________________ Approved: ___________________________ Truls Ostbye, Advisor ___________________________ Lawrence P. Park ___________________________ JosepH R. Egger An abstract of a tHesis submitted in partial fulfillment of the requirements for the degree of Master of Science in the Duke Global HealtH Institute in the Graduate ScHool of Duke University 2021 CopyrigHt by Grace E. Lowitzer 2021 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 grade 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. iv WitHin tHe two scHools, four classes were selected randomly. All children present at 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 v 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 it 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. vi Dedication I dedicate this thesis to everyone wHo has believed in me and supported me througH my educational journey. To my husband, thank you for your patience and love througH the long nigHts and difficulties. To my family, thank you for always encouraging me to follow my dreams. Finally, I dedicate this to Dr. Thyaggi Ponnamperuma for all of her hard work and dedication to compile this data and to the adolescents in Udugama, Sri Lanka for courageously accepting to take part in this study. vii Contents Abstract .......................................................................................................................................... iv List of Tables .................................................................................................................................. x 1. Introduction ............................................................................................................................... 1 1.1 Adolescent Exposure to Community and Domestic Violence ................................... 1 1.2 Exposure to Violence and the Psychological Outcomes ............................................. 2 1.3 Adolescent Exposures to Violence and Trauma in Sri Lanka .................................... 4 1.3.1 Background and History ............................................................................................ 4 2. Methods .................................................................................................................................... 10 2.1 Setting ............................................................................................................................... 10 2.2 Participants ...................................................................................................................... 10 2.3 Procedures ....................................................................................................................... 11 2.4 Measures .......................................................................................................................... 12 2.4.1 Demographic Survey ................................................................................................ 12 2.4.2 Child Exposure to Domestic Violence (CEDV) Scale ........................................... 13 2.4.3 UCLA PTSD Index .................................................................................................... 14 2.5 Analysis ............................................................................................................................ 14 3. Results ....................................................................................................................................... 17 3.1 Description of Sample .................................................................................................... 17 3.2 Prevalence of Community and Domestic Violence Among Adolescents in Sri Lanka ...................................................................................................................................... 18 3.3 Violence exposure and the prevalence of partial and full PTSD ............................. 18 viii 3.3 Associations between characteristics of individuals experiencing violence and PTSD ....................................................................................................................................... 22 Individual CHaracteristics, Violence Exposure, and Outcome .................................... 24 4. Discussion ................................................................................................................................ 26 4.1 Implications for policy and practice ............................................................................ 30 4.2 Implications for further research .................................................................................. 30 4.3 Study strengths and limitations ..................................................................................
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