Prevalence of Post-Traumatic Stress Disorder and Associated Trauma Exposure Among Inpatients with Substance Use Disorders in Nairobi Rehabilitation Centers

Objective(s): To determine the prevalence of post-traumatic stress disorder (PTSD), describe patterns of trauma exposure, and identify associated factors among inpatients with substance use disorders (SUDs) in Nairobi.
Design: Cross-sectional analytical study.
Setting: Thirteen inpatient rehabilitation centers within a 50-kilometre radius of Nairobi, Kenya.
Subjects or Participants: A total of 222 adult inpatients aged 18–65 years with diagnosed SUDs, stabilized on treatment for at least two weeks.
Interventions: None.
Main Outcome Measures: PTSD prevalence and severity assessed using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), trauma exposure patterns, and substance involvement measured using ASSIST.
Results: Participants were predominantly male (91.0%) with a mean age of 34.1 years (SD 9.0). Trauma exposure was reported by 59.9%, including significant life events (37.4%), physical injury (19.4%), and sexual assault (3.2%). The prevalence of PTSD was 27.5% (95% CI: 22.1–33.3). Independent predictors of higher PTSD severity included divorced/separated/widowed marital status (β = -11.10, p=0.001), physical injury (β = 8.00, p=0.028), and significant life events (β = 9.69, p=0.001). PTSD severity was strongly correlated with depression severity (r=0.545, p<0.001).
Conclusion: PTSD is a common comorbidity among SUD inpatients in Nairobi and is strongly associated with trauma exposure and marital disruption. Routine trauma screening and integration of trauma-informed care into substance use treatment programs are recommended.

Post-traumatic stress disorder; substance-related disorders; dual diagnosis; rehabilitation; Kenya

1. NACADA. National Survey on the Status of Drugs and Substance Use in Kenya 2022. 2022; [Google Scholar] [Crossref]

2. Brady KT, Back SE, Coffey SF. Substance abuse and posttraumatic stress disorder. Curr Dir Psychol Sci 2004;13(5):206–209. [Google Scholar] [Crossref]

3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, 2013; [Google Scholar] [Crossref]

4. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. Journal of Clinical Psychiatry 2000;61:4–14. [Google Scholar] [Crossref]

5. Khantzian EJ. The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harv Rev Psychiatry 1997;4(5):231–244. [Google Scholar] [Crossref]

6. Jacobsen LK, Southwick SM, Kosten TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry 2001;158(8):1184–1190. [Google Scholar] [Crossref]

7. Mills KL, Teesson M, Ross J, Peters L. Trauma, PTSD, and substance use disorders: findings from the Australian National Survey of Mental Health and Well-Being. Am J Psychiatry 2006;163(4):652–658. [Google Scholar] [Crossref]

8. Norman SB, Tate SR, Anderson KG, Brown SA. Do trauma history and PTSD symptoms influence addiction relapse context? Drug Alcohol Depend 2007;90(1):89–96. [Google Scholar] [Crossref]

9. Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci 2011;13(3):263–278. [Google Scholar] [Crossref]

10. Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology 2010;35(1):217–238. [Google Scholar] [Crossref]

11. Driessen M, Schulte S, Luedecke C, et al. Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study. Alcohol Clin Exp Res 2008;32(3):481–488. [Google Scholar] [Crossref]

12. Dore G, Mills K, Murray R, Teesson M, Farrugia P. Post‐traumatic stress disorder, depression and suicidality in inpatients with substance use disorders. Drug Alcohol Rev 2012;31(3):294–302. [Google Scholar] [Crossref]

13. Roberts NP, Roberts PA, Jones N, Bisson JI. Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis. Clin Psychol Rev 2015;38:25–38. [Google Scholar] [Crossref]

14. Gielen N, Havermans RC, Tekelenburg M, Jansen A. Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is. Eur J Psychotraumatol 2012;3. [Google Scholar] [Crossref]

15. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord 2011;25(3):456–465. [Google Scholar] [Crossref]

16. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62(6):617–627. [Google Scholar] [Crossref]

17. Saban A, Flisher AJ, Grimsrud A, et al. The association between substance use and common mental disorders in young adults: results from the South African Stress and Health (SASH) Survey. Pan Afr Med J 2014;17(Suppl 1):11. [Google Scholar] [Crossref]

18. Kuria MW, Ndetei DM, Obot IS, et al. The Association between Alcohol Dependence and Depression before and after Treatment for Alcohol Dependence. ISRN Psychiatry 2012;2012:482802. [Google Scholar] [Crossref]

19. Adam AM. Sample size determination in survey research. J Sci Res Rep 2020;26(5):90–97. [Google Scholar] [Crossref]

20. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress 2015;28(6):489–498. [Google Scholar] [Crossref]

21. Verhey R, Chibanda D, Gibson L, Brakarsh J, Seedat S. Validation of the posttraumatic stress disorder checklist - 5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe. BMC Psychiatry 2018;18(1):109. [Google Scholar] [Crossref]

22. Group WHOAW. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction 2002;97(9):1183–1194. [Google Scholar] [Crossref]

23. Kuria MW, Ndetei DM, Obot IS, et al. The association between alcohol dependence and depression before and after treatment for alcohol dependence. Int Sch Res Notices 2012;2012(1):482802. [Google Scholar] [Crossref]

24. Beck AT, Steer RA, Brown GK. Beck depression inventory. 1996; [Google Scholar] [Crossref]

25. Wang Y-P, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Brazilian Journal of Psychiatry 2013;35:416–431. [Google Scholar] [Crossref]

26. Ndetei DM, Khasakhala LI, Kuria MW, Mutiso VN, Ongecha-Owuor FA, Kokonya DA. The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study. Ann Gen Psychiatry 2009;8(1):1. [Google Scholar] [Crossref]

27. Nwoga CN, Audu MD, Obembe A. Prevalence and correlates of posttraumatic stress disorder among medical students in the University of Jos, Nigeria. Niger J Clin Pract 2016;19(5):595–599. [Google Scholar] [Crossref]

28. Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000;68(5):748–766. [Google Scholar] [Crossref]

29. Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003;129(1):52–73. [Google Scholar] [Crossref]

30. Keyes KM, Pratt C, Galea S, McLaughlin KA, Koenen KC, Shear MK. The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. Am J Psychiatry 2014;171(8):864–871. [Google Scholar] [Crossref]

31. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52(12):1048–1060. [Google Scholar] [Crossref]

32. Whisman MA. Marital dissatisfaction and psychiatric disorders: results from the National Comorbidity Survey. J Abnorm Psychol 1999;108(4):701–706. [Google Scholar] [Crossref]

33. Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA. The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress 2013;26(3):299–309. [Google Scholar] [Crossref]

34. Flory JD, Yehuda R. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues Clin Neurosci 2015;17(2):141–150. [Google Scholar] [Crossref]

35. Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Treatment. Rockville (MD): 2014; [Google Scholar] [Crossref]

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