Screening for Posttraumatic Stress Disorder among Somali ex-combatants: A validation study

Michael Odenwald¹^,2 , Birke Lingenfelder¹ , Maggie Schauer¹^,2 , Frank Neuner¹^,2 , Brigitte Rockstroh¹^,2 , Harald Hinkel³ and Thomas Elbert¹^,2

¹University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany

²vivo international, Ancona, Italy

³GTZ International Services, Addis Abbeba, Ethiopia, and The World Bank MDRP (Multi-Country Demobilization and Reintegration Program of the Greater Great Lakes Region in Africa), Goma, Democratic Republic of Congo

author email corresponding author email

Conflict and Health 2007, 1:10doi:10.1186/1752-1505-1-10


Published:	6 September 2007

Abstract

Background

In Somalia, a large number of active and former combatants are affected by psychological problems such as Posttraumatic Stress Disorder (PTSD). This disorder impairs their ability to re-integrate into civilian life. However, many screening instruments for Posttraumatic Stress Disorder used in post-conflict settings have limited validity. Here we report on development and validation of a screening tool for PTSD in Somali language with a sample of ex-combatants.

Methods

We adapted the Posttraumatic Diagnostic Scale (PDS) to reflect linguistic and cultural differences within the Somali community so that local interviewers could be trained to administer the scale. For validation purposes, a randomly selected group of 135 Somali ex-combatants was screened by trained local interviewers; 64 of them were then re-assessed by trained clinical psychologists using the Composite International Diagnostic Interview (CIDI) and the Self-Report Questionnaire (SRQ-20).

Results

The screening instrument showed good internal consistency (Cronbach's α = .86), convergent validity with the CIDI (sensitivity = .90; specificity = .90) as well as concurrent validity: positive cases showed higher SRQ-20 scores, higher prevalence of psychotic symptoms, and higher levels of intake of the local stimulant drug khat. Compared to a single cut-off score, the multi-criteria scoring, in keeping with the DSM-IV, produced more diagnostic specificity.

Conclusion

The results provide evidence that our screening instrument is a reliable and valid method to detect PTSD among Somali ex-combatants. A future Disarmament, Demobilization and Reintegration Program in Somalia is recommended to screen for PTSD in order to identify ex-combatants with special psycho-social needs.