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Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study

Published online by Cambridge University Press:  03 December 2020

Ameer Kakaje Open the ORCID record for Ameer Kakaje [Opens in a new window] ,
Ragheed Al Zohbi ,
Ayham Alyousbashi ,
Rawan N.K. Abdelwahed ,
Osama Hosam Aldeen ,
Mohammad Marwan Alhalabi ,
Ayham Ghareeb  and
Youssef Latifeh
Ameer Kakaje*
Affiliation:
Faculty of Medicine, Damascus University, Damascus, Syria
Ragheed Al Zohbi
Affiliation:
Faculty of Medicine, Aleppo University, Aleppo, Syria
Ayham Alyousbashi
Affiliation:
Faculty of Medicine, Damascus University, Damascus, Syria
Rawan N.K. Abdelwahed
Affiliation:
Faculty of Medicine, Damascus University, Damascus, Syria
Osama Hosam Aldeen
Affiliation:
Faculty of Medicine, Damascus University, Damascus, Syria
Mohammad Marwan Alhalabi
Affiliation:
Faculty of Medicine, Damascus University, Damascus, Syria
Ayham Ghareeb
Affiliation:
Faculty of Medicine, Damascus University, Damascus, Syria
Youssef Latifeh
Affiliation:
Psychiatry Department, Al-Mowasat University Hospital, Damascus, Syria Department of Internal Medicine, Syrian Private University, Damascus, Syria
*
Author for correspondence: Ameer Kakaje, E-mail: ameer.kakaje@hotmail.com
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Abstract

Background

The Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria.

Methods

This is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters.

Results

This study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lowerPTSD scores but was associated with a worse physical component of HRQL.

Conclusion

This is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.

Keywords

Adolescentsangerhealth-related quality of lifemental healthPTSDpublic healthschool studentsSyrian crisiswar
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 10 , July 2022 , pp. 1923 - 1933
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Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press.

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References

Alhaffar, B. A., Alawabdi, R., Barakat, L., & Kouchaji, C. (2019). Oral health and socio-economic status among children during Syrian crisis: A cross-sectional study. BMC Oral Health, 19(1), 165. doi:10.1186/s12903-019-0856-8.CrossRefGoogle ScholarPubMed
Aljurany, K. A. H. (2013). Personality characteristics, trauma and symptoms of PTSD: A population study in Iraq. Heriot-Watt University. https://www.ros-test.hw.ac.uk/bitstream/handle/10399/2641/Al-JuranyKAH_0913_sls.pdf?sequence=1&isAllowed=y.Google Scholar
American Psychiatric Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). USA: American Psychiatric Pub.Google Scholar
Asmundson, G. J. G., LeBouthillier, D. M., Parkerson, H. A., & Horswill, S. C. (2016). Trauma-exposed community-dwelling women and men respond similarly to the DAR-5 anger scale: Factor structure invariance and differential item functioning. Journal of Traumatic Stress, 29(3), 214–220. doi: 10.1002/jts.22098.CrossRefGoogle Scholar
Bahaa Aldin Alhaffar, M. H., Mustafa, K., Sabbagh, S., Yabrode, K., Shebib, G., & Kouchaji, C. (2018). Seven years of war in Syria: The relation between oral health and PTSD among children. Indian Journal of Oral Health and Research, 4(1), 10. 10.4103/ijohr.ijohr_8_18.CrossRefGoogle Scholar
Child Revised Impact of Events Scale. (2017). Available at https://www.corc.uk.net/outcome-experience-measures/child-revised-impact-of-events-scale/.Google Scholar
Forbes, D., Alkemade, N., Mitchell, D., Elhai, J. D., McHugh, T., Bates, G., … Lewis, V. (2014). Utility of the dimensions of anger reactions-5 (DAR-5) scale as a brief anger measure. Depression and Anxiety, 31(2), 166–173. doi: 10.1002/da.22148.CrossRefGoogle ScholarPubMed
Forbes, D., Alkemade, N., Waters, E., Gibbs, L., Gallagher, C., Pattison, P., … Bryant, R. A. (2015). The role of anger and ongoing stressors in mental health following a natural disaster. Australian & New Zealand Journal of Psychiatry, 49(8), 706–713. doi: 10.1177/0004867414565478.CrossRefGoogle ScholarPubMed
Forbes, D., Hawthorne, G., Elliott, P., McHugh, T., Biddle, D., Creamer, M., & Novaco, R. W. (2004). A concise measure of anger in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 17(3), 249–256. doi: 10.1023/B:JOTS.0000029268.22161.bd.CrossRefGoogle ScholarPubMed
Gibbs, L., Nursey, J., Cook, J., Ireton, G., Alkemade, N., Roberts, M., … Forbes, D. (2019). Delayed disaster impacts on academic performance of primary school children. Child Development, 90(4), 1402–1412. doi: 10.1111/cdev.13200.CrossRefGoogle ScholarPubMed
Haravuori, H., Kiviruusu, O., Suomalainen, L., & Marttunen, M. (2016). An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: Factor analysis and comparisons to ICD-10 and DSM-IV. BMC Psychiatry, 16(1), Article number: 140. doi:10.1186/s12888-016-0849-y.CrossRefGoogle Scholar
Hosseinpour, M. (2016). The effect of consanguineous marriage on mental health among the students of the Shahrekord University of Medical Sciences. Journal of Clinical and Diagnostic Research, 10(11), GC01–GC04. doi:10.7860/jcdr/2016/21389.8794.Google ScholarPubMed
Kakaje, A., Alhalabi, M. M., Alyousbashi, A., Ghareeb, A., Hamid, L. (2020a). Smoking habits in Syria and the influence of war on cigarette and shisha smoking. doi: 10.21203/rs.3.rs-15601/v1.CrossRefGoogle Scholar
Kakaje, A., Alhalabi, M. M., Alyousbashi, A., Hamid, A., & Hosam Aldeen, O. (2020b). Allergic rhinitis and its epidemiological distribution in Syria: A high prevalence and additional risks in war time. BioMed Research International, 2020, 1–9. doi: 10.1155/2020/7212037.Google Scholar
Kakaje, A., Alhalabi, M. M., Alyousbashi, A., Hamid, A., & Mahmoud, Y. (2020c). Laryngopharyngeal reflux disease in war-torn Syria and its association with smoking and other risks. doi: 10.21203/rs.3.rs-29417/v1.CrossRefGoogle Scholar
Kakaje, A., Alsamara, K., & Forbes, D. (2020d). Assessment of problematic anger using an Arabic adaptation of the dimensions of anger reactions scale-5 (DAR-5). doi: 10.21203/rs.3.rs-39178/v2.CrossRefGoogle Scholar
Kakaje, A., Zohbi, R. A., Aldeen, O. H., Makki, L., Alyousbashi, A., & Alhaffar, B. A. (2020e). Mental disorder and PTSD in Syria during wartime: a nationwide crisis. doi: 10.21203/rs.3.rs-19902/v1.CrossRefGoogle Scholar
Kolaitis, G. (2017). Trauma and post-traumatic stress disorder in children and adolescents. European Journal of Psychotraumatology, 8(Suppl 4), Article: 1351198. doi:10.1080/20008198.2017.1351198.CrossRefGoogle Scholar
McLaughlin, K. A., Costello, E. J., Leblanc, W., Sampson, N. A., & Kessler, R. C. (2012). Socioeconomic status and adolescent mental disorders. American Journal of Public Health, 102(9), 1742–1750. doi: 10.2105/ajph.2011.300477.CrossRefGoogle ScholarPubMed
Meiser-Stedman, R., Smith, P., Yule, W., Glucksman, E., & Dalgleish, T. (2017). Posttraumatic stress disorder in young children 3 years posttrauma. The Journal of Clinical Psychiatry, 78(3), 334–339. doi: 10.4088/JCP.15m10002.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (UK). N. C. C. f. M. H. (2005). Post-Traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Leicester, UK: Gaskell. (NICE Clinical Guidelines, No. 26.) 2, Post-traumatic stress disorder.Google Scholar
Okuda, M., Picazo, J., Olfson, M., Hasin, D. S., Liu, S.-M., Bernardi, S., & Blanco, C. (2014). Prevalence and correlates of anger in the community: Results from a national survey. CNS Spectrums, 20(2), 130–139. doi: 10.1017/s1092852914000182.CrossRefGoogle Scholar
Perkins, J. D., Ajeeb, M., Fadel, L., & Saleh, G. (2018). Mental health in Syrian children with a focus on post-traumatic stress: A cross-sectional study from Syrian schools. Social Psychiatry and Psychiatric Epidemiology, 53(11), 1231–1239. doi: 10.1007/s00127-018-1573-3.CrossRefGoogle ScholarPubMed
Perrin, S., Meiser-Stedman, R., & Smith, P. (2005). The Children's revised impact of event scale (CRIES): Validity as a screening instrument for PTSD. Behavioural and Cognitive Psychotherapy, 33(4), 487–498. doi: 10.1017/s1352465805002419.CrossRefGoogle Scholar
R, M., & Kazarian, S. (2012). Validation of the Arabic translation of the multidimensional scale of social support (Arabic MSPSS) in a Lebanese community sample. Arab Journal of Psychiatry, 23, 159–168.Google Scholar
Rosenfield, S., & Mouzon, D.. (2013). Gender and mental health. In Aneshensel, C. S., Phelan, J. C., & Bierman, A. (Eds.), Handbook of the Sociology of Mental Health. Handbooks of Sociology and Social Research (pp. 277–296). Dordrecht: Springer.CrossRefGoogle Scholar
Santa Barbara, J. (2006). Impact of war on children and imperative to end war. Croatian Medical Journal, 47(6), 891–894.Google ScholarPubMed
Shang, F., Kaniasty, K., Cowlishaw, S., Wade, D., Ma, H., & Forbes, D. (2019). Social support following a natural disaster: A longitudinal study of survivors of the 2013 Lushan earthquake in China. Psychiatry Research, 273, 641–646. doi: 10.1016/j.psychres.2019.01.085.CrossRefGoogle ScholarPubMed
Strøm, I. F., Schultz, J.-H., Wentzel-Larsen, T., & Dyb, G. (2016). School performance after experiencing trauma: A longitudinal study of school functioning in survivors of the Utøya shootings in 2011. European Journal of Psychotraumatology, 7(1), Article: 31359. doi:10.3402/ejpt.v7.31359.CrossRefGoogle ScholarPubMed
United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) (2020) Syria crisis overview. Available at https://www.unocha.org/syrian-arab-republic/about-ocha-syria.Google Scholar
Ware, J., Kosinski, M., Dewey, J., & Gandek, B.. (2001). How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. Lincoln, RI: Quality Metric Inc..Google Scholar
Zimet, G. (2016). Multidimensional scale of perceived social support (MSPSS) – scale items and scoring information.Google Scholar