Psychiatric comorbidities of posttraumatic stress disorder among adolescent refugees in Uganda: A latent class analysis of patterns and covariates

Abstract

Background: Although psychiatric comorbidities are common among trauma-exposed individuals with PTSD, their patterns and covariates among refugee adolescents in low-resource settings remain understudied. This study aimed to identify distinct patterns of psychiatric comorbidities and their associated factors among adolescent refugees with PTSD in Nakivale refugee settlement, Uganda. Methods: In this cross-sectional study, 325 refugee youth were assessed on various PTSD psychiatric comorbidities and covariates of (age, gender, war trauma, post-migration stressors) using MINI International Neuropsychiatric Interview 7.02 and standardized measures of war trauma and post-migration stressors. Latent class analysis (LCA) was used to identify patterns and covariates of comorbidity. Results: Of 269 adolescents with PTSD, 97% had at least one comorbid disorder: panic disorder (88.9%), generalized anxiety disorder (84%), agoraphobia (75.1%), depressive disorder (62.8%), obsessive compulsive disorder (60.6%), attention deficit disorder (43.9%), oppositional defiant disorder (40.9%), conduct disorder (33.8%), and alcohol use disorder (10.8%). LCA revealed three classes: low-moderate comorbidity (n = 66, 24.5%), high internalizing comorbidity (n = 101, 37.5%) with high probabilities of depression and anxiety disorders, and high overall comorbidity (n = 102, 37.9%) with relatively high probabilities of all disorders. The high overall comorbidity class had more girls than the other two classes. Both high comorbidity classes had higher war trauma and post-migration stressors than the low-moderate comorbidity class. Conclusions: Adolescent refugees with PTSD exhibit high psychiatric comorbidity that clusters in distinct patterns. These findings highlight the need for interventions that address the identified comorbidity patterns, consider gender disparities, and account for cumulative trauma and post-migration stressors to effectively support traumatized youth.