Post-traumatic stress disorder, depression, anxiety, and their predictors among internally displaced persons in a conflict-affected area of Metekel Zone, Northwest Ethiopia: structural equation modeling

Abstract

Introduction: Internally displaced persons (IDPs) are people forced to leave their homes due to natural or man-made disasters. Mental health illnesses were linked to conflict and displacement. Post-traumatic stress disorder, depression, and anxiety have the highest rates. However, there are few studies on mental health among internally displaced persons in conflict-affected areas in Ethiopia. To fill this information and methodological gap, structural equation modeling was used to investigate the direct and indirect effects of factors.

Objective: The study aimed to assess the magnitude and determinants of post-traumatic stress disorder, depression, and anxiety among internally displaced persons in the conflict area of Metekel Zone, Northwest Ethiopia, 2023.

Method: A community-based cross-sectional study was conducted among 1,042 participants selected by systematic sampling. Data were collected using face-to-face interviews, and structural equation modeling was used to assess the interrelationship among the variables.

Result: The magnitude of anxiety, post-traumatic stress disorder, and depression was 74.56%, 76.9%, and 79.53%, respectively. Being female, death of a loved one displaced two times, and social support were factors that affected anxiety. The significant factors for post-traumatic stress disorder were being female, death of a loved one, social support, and anxiety. In addition to the significant independent variables, the factors anxiety and post-traumatic stress disorder had an impact on depression.

Conclusion: The magnitude of anxiety, post-traumatic stress disorder, and depression was found to be high. Older-aged IDPs, female IDPs, and those who were not supported by friends or the government were found to be most at risk. Emphasis is needed on the promotion of mental health practices for internally displaced persons due to a conflict, especially for IDPs with poor social support and who have a history of death of loved ones.

Keywords: IDPs; Metekel zone; PTSD; anxiety; depression; structural equation modeling.

Figure 1

Hypothetical model for PTSD and depression anxiety and determinants among IDPs in the Metekel conflict area, 2023. Rectangles indicate observed variables; circles or ellipses indicate latent (unobserved) variables, including error terms; a single arrow indicates hypothesized directional causal effects or direct effects; on endogenous variables, a line with a single arrowhead indicates the covariance between latent variables, and a double arrow indicates the covariance between latent variables. PTSD1-20, items measuring post-traumatic stress disorder; GDA1-7, items measuring generalized anxiety disorder; PHQ1-9, items measuring depression; SS1–SS3, items measuring social support. Accordingly, from the total of 1,042 recruited individuals, 1,026 were interviewed and completed the questionnaire, and the response rate was 98.5%.

Figure 2

Proportion of anxiety severity level among IDPs in Metekel Zone, 2023.

Figure 3

Proportion of post-traumatic stress disorder among IDPs in Metekel Zone, 2023.

Figure 4

Proportion of depression severity level among IDPs in Metekel Zone, 2023.

Figure 5

Final structural equation model showing the association between predictors and outcomes and between anxiety, post-traumatic stress disorder, and depression among conflict-affected internally displaced persons in Metekel Zone, 2023. Unstandardized estimates: Rectangles indicate observed variables; circles or ellipses indicate latent (unobserved) variables, including error terms; a single arrowhead indicates directional causal effects, or direct effects, on endogenous variables; a line with a double arrowhead indicates the covariance between latent variables or error terms. pq1-pq20, items measuring post-traumatic stress disorder; aq1–aq7, items measuring generalized anxiety disorder; dq1–dq9, items measuring depression; SS1–SS3, items measuring social support; PTSD, post-traumatic stress disorder; sex, being of female gender; edu1, educational status (unable to read and write or no formal education); Occup_Status1, having occupational status farmer; frq_disp2, frequency of displacement being displaced two times; chronic_illness1, having no medically confirmed chronic illness; death_beloved, having a history of the death of a beloved one during the past 6 months.