Screening for traumatic exposure and psychological distress among war-affected adolescents in post-conflict northern Uganda

The war in northern Uganda has had a debilitating effect on the mental health of children and adolescents in the population. This study measures the prevalence and considers the aetiology of psychological distress in war-affected adolescents 4 years after the end of the conflict. This is a cross-sectional study of 205 adolescents, aged 12-19, from a boarding primary school in Gulu, northern Uganda. A war experiences checklist was developed with the assistance of local professionals. The Impact of Event Scale-Revised (IES-R) measured post-traumatic stress symptoms. Finally, the Acholi Psychosocial Assessment Instrument (APAI) was used to measure locally described mental health constructs similar to the Western concepts of depression and anxiety. Four years after the end of the war, 57% of the students were still found to have clinically significant levels of post-traumatic stress symptoms using a similar cut-off score to previous studies among the same population. Both components of traumatic exposure: (i) the number of types of traumatic event experienced; and (ii) whether the adolescent was abducted were significantly associated with psychological distress. There was a strong correlation between post-traumatic stress symptoms and internalising symptoms. War-affected adolescents may continue to suffer from significant psychological stress in the years following the cessation of conflict. Multiple exposure to a number of different types of traumatic event may directly increase the likelihood of psychological distress especially for those exposed to the most extreme violence. The feasibility of employing a locally developed and validated screening instrument is demonstrated. Implications for future research and intervention in post-conflict areas are considered.