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Among the 100 million refugees globally, the vast majority live in the Global South. Yet, most mental health research comes from resettled refugee populations in the U.S. or other high-income countries. Research on the prevalence of mental health conditions, including post-traumatic stress disorder (PTSD) and associated factors, of young refugees living in humanitarian settings in the Global South is particularly limited. Although social support and connectedness are established protective factors for various mental health conditions, a need exists to better understand this relationship within the unique social context of young people living and attending school in a refugee camp. Therefore, the primary purposes of this study are to (1) Determine the variance in PTSD scores attributable to students' characteristics and schools in the Nyarugusu Refugee Camp, (2) Examine the relationship between social support and levels of connectedness with PTSD symptoms, and (3) Examine whether school characteristics are associated with PTSD scores among students while controlling for other factors in Nyarugusu Refugee Camp, Tanzania.
Methodology
This study analyzed data from the 2018 Preventing Violence Against Children Survey (PVACS) study conducted in the Nyarugusu Refugee Camp in Tanzania. The sample size included 711 students aged 11-27 nested in 27 schools within the camp. The association between PTSD symptoms (measured by Child PTSD Symptoms Scale (CPSS)) and independent variables (i.e., social support, family connectedness, peer connectedness, and school connectedness measured continuously, and school nationality measured dichotomously); were examined using three multilevel linear regression models. Maximum likelihood (ML) estimation, especially Bayesian Information Criteria (BIC), was utilized to estimate the model fit. Descriptive analyses were obtained by calculating the means and standard deviations for continuous variables, and frequencies and percentages for categorical variables were obtained. Data analyses were performed using SPSS vs.28.
Results
The average age of students was 14.5 years. More than half were male (57.9%), and 30% did not live with biological parents. Slightly more students identified as Burundians (52.5%) relative to Congolese (47.5%). Schools accounted for 7.6% of the variance in PTSD scores, while student characteristics accounted for 92.4% of the PTSD scores. Results of multilevel linear regression showed that social support (B= -0.97, p<.001), family connectedness (B= -0.29, p<.05), and school connectedness (B= -0.30, p<.05) were negatively associated with PTSD scores. This implies that as social support, family connectedness, and school connectedness decreased, students increased their PTSD scores and vice-versa. Additionally, at the school level, school nationality (Burundian/Congolese) was not associated with PTSD scores of the students.
Conclusions and Implications
Overall findings highlight that 24.5% of the students met the criteria for PTSD. Results also suggest the importance of reciprocal relationships between social support and connectedness levels and PTSD symptoms. Humanitarian settings are often characterized by a lack of social support whereby children and youth may have disrupted relationships with their families, community, and school. Programming efforts should focus on increasing social support and connectedness within families and schools to improve the quality of life and prevent the risk of PTSD symptoms among refugees in the camps.