Factors Associated with Post Traumatic Stress Disorder and Depression among Nepalese Combatants during Armed Insurgency

Abstract

Introduction: Mental illness is major global public health problem affecting over 450 million people, most of whom live in developing countries. Nepal just overcame ten years long conflict situation. Post-traumatic stress disorder (PTSD) and depression is most prevalent in conflict inflicted areas as per most literatures. Much is not known about the psychological effects of the conflict situation, even after six years of peace process in Nepalese context.Material and Method: This is a cross sectional descriptive study carried out to explore the prevalence of Post-traumatic stress disorder and Depression in Nepalese army combatants involved during the armed insurgency period and its relationship with different. It was conducted in two randomly selected battalions of tenth brigade in Kathmandu. The PTSD was assessed using Post traumatic stress disorder checklist - military version (PCL-M), depression was assessed using the Beck depression inventory (BDI) and degree of combat exposure was assessed using Combat exposure scale (CES). The quantitative assessment was done using appropriate methods and tools.Results The degree of combat exposure showed 48.8% exposed to moderate and above degree of combat exposure. PTSD was found in 21.9% of the combats and 20.5% were found to have depression. Both PTSD and depression were found to be associated with degree of combat exposure. There was statistically significant association between degree of combat exposure and PTSD (p= 0.001, 95% CI (1.567-6.303)) and depression (p=0.011, 95% CI (1.209-4.830)).Conclusion: PTSD and depression exists even six years after the peace process in Nepalese army and is related to the degree of combat exposure regardless of other attributes like age, sex, rank, marital status.J Psychiatrists’ Association of Nepal Vol .6(1), 2017, p.24-28

Prevalence of Post-Traumatic Stress Disorder and its Associated Factors among Nepali Army Service Members and Veterans: 15 Years Post Insurgency

“…Present study has not showed the association between PTSD and age group as well as education of respondents which was the same in a study of Rawal et al 12 However, there was significant association between PTSD and years of service, shown by Chi-Square value of 21.575 with p-value of 0.00 between PTSD and years of service (i.e., significant) which supports the findings of Rawal et al 12 Similarly, there was also association between the rank and PTSD with the Chi-Square value of 44.184 with p-value of 0.01 showing rank affect the PTSD. It could be due to the experience, their coping mechanism, environmental factors, lifestyle, family support and many more.…”

“…In the study PTSD was based on validated standardized tool PCL-M with the cut off scale of greater or equal to 50. It was found that only 9% fulfill the criteria of PTSD which is less than study of Rawal et al (2018) 12 where 21.9% of PTSD was found, in mid 1990s which was conducted after 6 years of post-insurgency. Similar differences of PTSD was found in the study conducted among US military personnel and veterans with baseline and follow-up (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) where data was collected approximately every 3 years later, were found to have PTSD though the percentage varies.…”

“…13 In one of the main studies of 60,000 Iraq and Afghanistan veterans, it was found that 13.5% of deployed and non-deployed veterans had PTSD. 14 One of the reasons behind lower PTSD is the time factor because study was conducted 8 years later than Rawal et al's study 12 and there is lot of time gap between post insurgency period and present time.…”

“…11 Similarly, study conducted to assess the "Factors Associated with PTSD and Depression among Nepalese Combatants during Armed Insurgency", PTSD was found in 21.9% even after six years of peace process in Nepali context. 12 In one of the studies conducted by from Deployment Health Research Department, Naval Health Research Center, USA, in order 283 NMCJ Rawal et al to study associated factors in persistent PTSD among US military personnel and veterans with baseline and follow-up (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013), data was collected 12 approximately every 3 years later, those who were found to have PTSD taken as participants using the PTSD Checklist-Civilian Version at baseline (N = 2409). (N = 1132; 47%) met criteria which is almost half of the participants with persistent PTSD at the first follow-up; and 804 (71%) had PTSD symptoms at the second follow-up.…”

“…Many people are injured, and some people suffered from mental illness. The study conducted in 2012 in Nepal to measure the PTSD among the army personnel to find out PTSD and depression level where (21.9%) of army personnel were involved in army conflict meet the criteria of PTSD 12. Similarly, present study also shows (9%) in total (n=300) of people with PTSD as of now 15 years of insurgency indicating it remains persistent in some cases due to several factors like age, education, service years, retirement and mainly number of times of exposure to combat.…”