Posttraumatic Stress Disorder Among The Heads Of Households Of Ethnic Clashes Survivors In The Rift Valley Province, Kenya: A Comparative Study

Abstract

The Rift Valley Province, the largest of Kenya's eight provinces, and which runs along the Great Rift Valley from the Kenya-Ethiopian border in the north to the Kenya-Tanzania border in the south, was before colonialism the home of the mainly pastoral communities among them, the Kalenjin ethnic group, the Maasai, the Samburu, the Pokot, and the Turkana. It is presently a multi-ethnic and cosmopolitan area with a large portion of it under cultivation. In the years 1991 and 1992 ethnic clashes started in the region and many families lost their relatives, other members were seriously injured, their houses were destroyed and they were displaced from their land. Most of these people have been unable to return to their former land to date. The ethnic clash survivors were living in various shopping centres such as Maela, Elburgon and Kamwaura in Nakuru District among others. The Catholic Diocese of Nakuru in collaborations with the donor agents decided to assist these people by temporarily resettling them in Nakuru district. Thus the Catholic Diocese of Nakuru Justice and Peace Commission was established in 1995 to assist ethnic clash survivors. The commission aimed at resettling the survivors who had been unable to find any other alternative residence since 199111992 when they were evicted from their farms. The activities of the commission involved purchasing and subdivision of land for the purpose of allocation; construction of houses and provision of sanitation; purchase and disbursement of seeds and fertilizers; and provision of food and conducting orientation workshops. The study was conducted to establish the prevalence rate of PTSD among the heads of households of ethnic clash survivors and compare with that of heads of the households who were not affected by ethnic clashes; establish the relationship between various variables such as age, sex, occupation, marital status, etc and PTSD; and to find out any co-morbid psychiatric disorder associated with PTSD. This was a descriptive comparative cross sectional study. The study was conducted in Molo Division ofNakuru District, Rift Valley Province, Kenya. The resettlement register of the Catholic Justice and Peace Commission and the Catholic Welfare Register were used. In odd numbered households a male was interviewed followed by a female in the even numbered position. The heads of the

households were visited at their homes and a standardized socio-demographic data questionnaire, exposure to other events questionnaire and Structured Clinical Interview for the Diagnosis and Statistical Manual IV (SCID) screening module were administered. Among the 126 heads of households of ethnic clash survivors interviewed the prevalence of PTSD was found to be 80.2% while among the heads of households who did not experience ethnic clashes it was 10.6%. The following were significantly associated with PTSD: female gender, family history of psychopathology, loss of a relative during clashes, occupation and post-primary level of education. The following variables were not significantly associated with PTSD: marital status, age, past surgical history, past physical illness, and size of land lost. The co-morbid psychiatric disorders associated with PTSD in this study were major depressive disorder 831101 (82%), generalized anxiety disorder 511101 (50.4%), panic disorders 40/101 (39.7%), phobia 131101 (12.9%) and alcohol dependence 4/101 (8.9%) among the heads of households of ethnic clash survivors. Among the heads of households who did not experience ethnic clashes the co-morbid psychiatric disorders were major depressive disorder 7111 (63.6%), generalized anxiety disorder 1111 (9.1%),. panic disorder 1111 (9.1%), phobia Sill (45.5%) and alcohol dependence l/11(9.1%). The high prevalence rate of PTSD and other co-morbidities among the heads of households of clash survivors need to be addressed. The Catholic Church and the government should ensure that the resettled families have access to mental health care services to minimize their distress. An appraisal of psychiatric services offered in provincial and district hospital should be done with the aim of improving mental illness care offered to clash survivors particularly supportive psychotherapy. Clash survivors should be sensitized to seek mental health assistance for then psychological problem, which they experienced. The clinician should be alert to the presence of PTSD and other psychiatric morbidity when they encounter ethnic clash survivors in their practice a comprehensive psychosocial history and psychiatric interview should be conducted to more accurately identify subjective psychic sufferings and to provide appropriate treatment for the survivors. The root cause of ethnic clashes should be addressed to prevent recurrence of clashes.