Posttraumatic stress disorder in students exposed to trauma

Summary:-A total of (300) students of secondary school in Diwaniya province were interviewed to assess the psychological impact of the trauma. A post traumatic stress checklist was used for the interview. The result of this study showed that the majority of the students suffer from post traumatic stress disorder.


Introduction:-
PTSD is a relatively common &often chronic illness & an increasing public health concern. According to the national Co morbidity Survey(1), the lifetime prevalence of PTSD is 10% for women & 5% for men, with an overall prevalence of 7% during the course of their live, men are exposed to trauma more often than women, except for sexual trauma woman are at least 10 times more likely to be raped than man. The traumatic events that can lead to PTSD involve interpersonal violence, such as rape, assault, & torture; life threatening accidents, such as automobile or industrial accidents; &disasters, such as fires &hurricanes. interpersonal violence is more likely to cause PTSD than are accidents & natural disasters .the likelihood of developing PTSD correlates with the proximity of the person to the traumatic event .PTSD is also more likely to occur in people who are directly exposed to these events .People who develop PTSD are at high risk for significant work impairment , suicide ,physical complaints ,medical illnesses ,lower quality of life ,less ability to be intimate ,& social & family dysfunction.(2). Pupils experiencing conflict at close range is invariably forced to endure conditions of severe hardship & stress leading to long -term psychological manifestation of such exposure. Psychological symptoms in students from exposure to trauma recorded as early as World War II in Europe(3). Those students were most at risk for signs of psychological stress, the symptoms of PTSD can be disabling & persistent (4).
The clinical features of PTSD are:-1-Hyper arousal:-. Persistent anxiety Irritability Poor concentration 2-Intrusion:-Difficulty in recalling stressful at will. Intense intrusive imagery (flash back ) .
3-Avoidance:-Avoidance of reminders of the events . Detachment . In ability to feel emotion (numbness ). Diminished interest in activities . Guilt is often present among survivors .there may be maladaptive coping responses of persistent aggressive behavior , excessive use of drugs &deliberate self harm(5)&suicide(6). After some traumatic events survivors feel forced in to a painful reconsideration of their beliefs about the meaning &purpose of life (7). It has been suggested that dissociative symptoms and depersonalization are important symptoms of the disorder (8). PTSD may coexist with major depressive disorder, may present as combination of the above symptoms and typical grief often lead to drug &an alcohol abuse( 9)

Aim of the study
The aim is to describe some of the features of psychological stress observed in students exposed to trauma..

Materials &Methods
From first January to first May2007 a total of (300) students from four schools in Diwania who accepted to participate in this study, were interviewed to assess the psychological impact of the trauma. Those students who suffer from psychiatric disorder were excluded from the interview .The interview was done using Posttraumatic Stress Reaction Checklist (10). The diagnosis of PTSD was based on the criteria of DSM-IV (Diagnostic &statistical Manual IV) (11).The students were randomly selected. The questions were administered by the researchers &during answering the questions the students were not allowed to be in contact with each other in order not to be influenced by others response Results Result of post traumatic stress reaction demonstrate that the large majority of students interviewed suffer from anxiety &fear associated with memories of trauma. Most of them think about the events and get upset when think about them .Students still suffer from the immediate impact of the event as well as the grief associated with the loss of close friends &relatives.
(58 %) of interviewed students continue to dream of the event, (70%) were having difficulties falling or staying asleep because of the memory, ( 65 %) find difficulty in concentration or paying attention on things more than before, (80 %) of the pupils find little joy in sport, in playing with friends &other similar activities, (63 %) of the pupils worry that they may not live to become an adult .The other results are as in the posttraumatic stress reaction checklist.
The Percent answering yes to question includes students answering either sometime or always.

Discussion :-
PTSD denotes an intense,prolonged &some time delayed reaction to an intensely stressful event .DSM-IV suggest that the stressful event must be exceptionally threatening or catastrophic in nature , & are outside the range of every day human experience , which would be likely to cause distress in almost every one the events include e .g. natural disaster ,circumstances of war , witnessing the violent death of some one , or serious accident , terrorist activity .( 12) PTSD has received much interest recently because of studies of American Vietnam veterans whom 90% of them met the diagnostic criteria for PTSD(13) .
The result of our study had been supported by many studies. One study evaluated 52Cambodian high school students, half of these participants met the diagnostic criteria for PTSD (14, 15). Another study of 28 Salvadoran students(10) of them met the DSMIV criteria for PTSD (16) .studies of Chilean student recorded frequent symptoms associated with PTSD including nightmares &anxiety (17)(18).
Cervantes etal . , found that Central Americans reported more PTSD (19). Even when the nuclear family escape injury growing up in a war affected community can promote aggression in students, at least in some cultural context (20). These studies reveal a highly disturbed population of students who are exceedingly bothered by intrusive thoughts of the trauma. The entry of these thoughts into the students waking sleeping mind are out of their control and in many cases, remain the dominant thought making up their conscious memory. Affected students try to avoid thinking of such painful thoughts & try to remove such thoughts from their memory but it is impossible for them to keep these disturbing memories at a reasonable distance. It is important to inform families fully about their students trauma-related problems, helping parents to understand & acknowledge behavior that is common in other similarly stressed students. 4

Conclusion:-
The most important conclusion to be drawn from this study is that what happened to these students during the severe psychological trauma -may cause them serious problems for years to come .for some students, these problems may endure for their entire lifetime. They are affected in their emotional life by grief, sadness and desperate fear.