Post traumatic stress disorder among Mau mau concentration camp survivors in Kenya
Introduction: The last decade of colonialism in Kenya was characterized by an armed insurrection in many parts of the country, but mostly in the Mount Kenya and Rift Valley regions. Termed the 'Mau Mau' uprising, the insurrection was fought vigorously by the British colonial armed forces. Suspected 'Mau Mau' fighters were captured and held in concentration camps where many underwent torture, both physical and psychological. No studies have been carried out in this population to assess the psychological sequelae of the torture. Objectives: To establish the prevalence of PTSD and other psychiatric morbidity and associated factors among the Mau Mau Concentration Camp survivors. Design: Cross-sectional descriptive survey, using consecutive sampling. Setting: The study sample came from Nairobi, Thika, Kajiado, Maragua, Embu and Kiambu districts. Interviews were carried out at four sites: Mau Mau War Veterans' Association (MMWV A) headquarters at Mwea House, Nairobi, Kenya Human Rights Commission headquarters in Nairobi, Tumaini House (Venue of MMWV A elections, 2005) and the MMWV A branch office in Kajiado District, Rift Valley Province, Kenya. Methods: A consecutive sample of 181 survivors meeting the inclusion criteria were interviewed using structured instruments to collect socio-demographic and traumatic events information as well as to make psychiatric diagnoses based on DSM-IV TR. Data was analyzed using the Statistical Package for Social Sciences (SPSS). Results: The study involved 181 subjects aged between 58 and 97, mean age 76 years. Ninety five (52.5%) of them were male and majority were not married (51.4%). Most of the subjects had no formal education (58%), and most were non-Catholic (57.5%). In this study sample, 127 (70.2%) had current DSM-IV-TR psychiatric morbidity. Lifetime PTSD was found in 132 (72.9%) subjects, while current PTSD was present in 119 (65.7%). PTSD prevalence showed a rising trend over the years from 1962 (58%) to the time of the study (65.7%). The IES-R mean scores were higher among those with PTSD (3.48) than among those with no PTSD (1.58). Among those with current PTSD, 63 (52.9%) had a comorbid psychiatric illness, with depression (43.7%) being the leading comorbid disorder. There was statistically significant association (p<0.05) between current PTSD and older age (t 2.648, p<0.05), lower income (RR 1.541), non-Catholic religion (RR 1.409), larger household size (~2, RR 2.050), being adult at incarceration (RR 1.377), incarceration for over 1 year (RR 1.657), incarceration in 2 or more camps (RR 1.769), presence of other traumatic events after incarceration (RR 1.373), family history of mental illness (RR 1.667) and presence of comorbid psychiatric disorders (RR 1.743). There was no association (p>0.05) between current PTSD and gender, marital status, level of education, severity of injuries sustained and past history of mental illness. Conclusions and Recommendations: The prevalence of PTSD and other psychiatric morbidity among the Mau Mau Concentration Camp survivors was higher than that in other Prisoner of War studies. This was found to be associated with poor current living conditions and the incarceration experience itself. It was also established that no interventions had been carried out to alleviate the suffering of this population of veterans. It was therefore recommended that there be established a Veterans' Service to look into the welfare of these and other veterans of military service in Kenya, as well as to facilitate further studies on PTSD among these groups.