Background: Sustained political violence (SPV) may have long-term effects.
Aims: To assess mental and residual effects of exposure to SPV. To validate a post-traumatic stress disorder (PTSD) assessment tool in Quechua-speaking Peru.
Method: Survey of 373 individuals aged 15 and over using the General Health Questionnaire (GHQ-12), Hopkins Symptom Checklist (HSCL-25) and a Trauma Questionnaire (TQ), derived from the Harvard Trauma Questionnaire. Sociodemographics were recorded. Reliability was assessed. Data reduction used factor analysis and modelling multiple regressions.
Results: A quarter of the sample had symptoms compatible with PTSD. Questionnaire reliability ranged from 0.81 to 0.89. Factor analysis confirmed high construct validity for TQ and HSCL-25. Modelling showed a strong association of PTSD-related symptoms and expressions of distress with the degree of exposure to SPV, especially among returnees.
Conclusions: Long-term consequences of exposure to SPV take the form of PTSD, anxiety and depressive disorders, and culturally formulated expressions of distress. Some implications for clinicians are discussed.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edition revised) (DSM-IVR). Washington, DC: APA.
2.
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edition) (DSM-III). Washington, DC: APA.
3.
Beiser, M., Turner, R.J. & Ganesan, S. ( 1989) Catastrophic stress and factors affecting its consequences among Southeast Asian refugees. Social Science and Medicine , 28, 183-195.
4.
Bollen, K. & Lennox, R. ( 1991) Conventional wisdom on measurement: A structural equation perspective. Psychological Bulletin, 110, 305-314.
5.
Bracken, A.Y. & Petty, C. ( 2007) Rethinking the Trauma of War. New York : Free Association Books.
6.
Carr, V.J., Lewin, T.J., Webster, R.A. & Kenardy, J.A. ( 1997) A synthesis of the findings from the Quake Impact Study: A two-year investigation of the psychological sequelae of the 1989 Newcastle earthquake. Social Psychiatry and Psychiatric Epidemiology , 32, 123-136.
7.
Comisión de la Verdad y Reconciliación (Truth and Reconciliation Commission) (2003) Informe Final. Lima: CVR.
8.
Fazel, M., Wheeler, J. & Danesh, J. ( 2005) Prevalence of serious mental disorder in 7,000 refugees resettled in Western countries: A systematic review. The Lancet , 365, 1309-1314.
9.
Goldberg, D.P. ( 1972) The Detection of Psychiatric Illness by Questionnaire . London: Oxford University Press .
10.
Gorst-Unsworth, C. & Goldenberg, E. ( 1998) Psychological sequelae of torture and organized violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile. British Journal of Psychiatry, 172, 90-94.
11.
Gorst-Unsworth, C., Van Velsen, C. & Turner, S. ( 1993) Prospective pilot study of survivors of torture and organized violence: Examining the existential dilemma. Journal of Nervous and Mental Disease, 181, 263-264.
12.
Hotopf, M., David, A., Hull, L., Nikalaou, V., Unwin, C. & Wessely, S. ( 2004) Risk factors for continued illness among Gulf War veterans: A cohort study. Psychological Medicine, 34, 747-754.
13.
Jehel, L., Duchet, C., Paterniti, S., Consoli, S.M. & Guelfi, J.D. ( 2001) Prospective study of post-traumatic stress disorder among victims of a terrorist attack. Encéphale, 27, 393-400.
14.
Lie, B. ( 2004) The psychological and social situation of repatriated and exiled refugees: A longitudinal, comparative study. Scandinavian Journal of Public Health, 32, 179-187.
15.
MacCallum, R.C. & Browne, M.W. ( 1993) The use of causal indicators in covariance structure models: Some practical issues. Psychological Bulletin, 114, 533-541.
16.
MacMahon, B. & Pugh, T.F. ( 1970) Epidemiology. Principles and Methods. Boston: Little, Brown and Company.
17.
Manson, S.M. ( 1997) Cross-cultural and multi-ethnic assessment of trauma. In Assessing Psychological Trauma and PTSD (eds J.P. Wilson & T.M. Keane), pp. 239-266. New York: Guilford Press.
18.
Mattsson, N.B., Williams, H.V., Rickels, K., Lipman, R.S. & Uhlenhuth, E.H. ( 1969) Dimensions of symptom distress in anxious neurotic outpatients . Psychopharmacology Bulletin, 5, 192-232.
19.
Mollica, R.F. ( 1991) Harvard Trauma Questionnaire - Cambodian Version. Boston: Harvard Program in Refugee Trauma, Harvard School of Public Health.
20.
Mollica, R. & Lavelle, J. ( 1988) The trauma of mass violence and torture: An overview of psychiatric care of the Southeast Asian refugee. In Clinical Guidelines in Cross-Cultural Mental Health (eds L. Comas-Diaz & E.E. Griffith), pp. 262-304. New York: Wiley.
21.
Mollica, R.F., Wyshak, G., de Marneffe, D., Khuon, F. & Lavelle, J. ( 1987) Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of the refugees. American Journal of Psychiatry, 144, 497-500.
22.
Netland, M. ( 2001) Assessment of exposure to political violence and other potentially traumatizing events: A critical review. Journal of Traumatic Stress, 14, 311-326.
23.
Norris, F.H. & Riad, J.K. ( 1997) Standardized self-report measures of civilian trauma and post-traumatic stress disorder. In Assessing Psychological Trauma and PTSD (eds J.P. Wilson & T.M. Keane), pp. 32-34. New York: Guilford Press.
24.
Nunnally, J.C. ( 1978) Psychometric Theory (2nd edition) New York: McGraw-Hill.
25.
Pedersen, D., Gamarra, J., Planas, M. & Errazuriz, C. ( 2004) Violencia política y salud en las comunidades alto-andinas de Ayacucho, Perú. In Health as a Civic Right. Perspectives and Propositions from Latin America (eds C. Cáceres, M. Cueto, M. Ramos & S. Vallenas ), pp. 289-307. Lima: Universidad Peruana Cayetano Heredia.
26.
Pedersen, D., Tremblay, J., Errazuriz, C. & Gamarra, J. ( 2008) The sequelae of political violence: Assessing trauma, suffering and dislocation in the Peruvian highlands. Social Science & Medicine, 67, 205-217.
27.
Ramsay, R., Gorst-Unsworth, C. & Turner, S. ( 1993) Psychiatric morbidity in survivors of organized state violence including torture. A retrospective series. British Journal of Psychiatry, 162, 55-59.
28.
Rona, R.J., Jones, M., French, C., Hooper, R. & Wessely, S. ( 2004) Screening for physical and psychological illness in the British Armed Forces. 1: The acceptability of the programmeJournal of Medical Screening, 11, 148-152.
29.
Shalev, A.Y. ( 2007) PTSD: A disorder of recovery? In Understanding Trauma. Integrating Biological, Clinical, and Cultural Perspectives (eds L.J. Kirmayer, R. Lemelson & M. Barad), pp. 207-223. New York: Cambridge University Press.
30.
Tabachnick, B.G. & Fidell, L.S. ( 2001) Using Multivariate Statistics (4th edition). Boston: Allyn and Bacon .
31.
Vatshelle, A. & Moen, B.E. ( 1997) Serious on-the-track accidents experienced by train drivers: Psychological reactions and long-term health effects. Journal of Psychosomatic Research, 42, 43-52.
32.
Yehuda, R. & Hyman, S.E. ( 2005) The impact of terrorism on brain and behaviour: What we know and what we need to know. Neuropsychopharmacology, 30, 1773-1780.
33.
Yehuda, R., Southwick, S.M. & Giller, E.L. ( 1992) Exposure to atrocities and severity of chronic post-traumatic stress disorder in Vietnam combat veterans. American Journal of Psychiatry, 149, 333-336.
34.
Young, A. ( 1995) The Harmony of Illusions. Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.
