Cumulative trauma and refugee alcohol misuse in eritrean refugees living in Ethiopia: Structural equation modeling

Title : Cumulative trauma and refugee alcohol misuse in eritrean refugees living in Ethiopia: Structural equation modeling

Abstract:

Aim: This study was aimed at testing an established model, indicating co morbidity of alcohol misuse with psychological symptoms (PTSD and depression) and its association with cumulative trauma.  

Methods: In a cross-sectional survey, 562 adults were randomly selected from Eritrean refugees living in Mai Aini camp, Ethiopia. The Tigrigna versions of measures, namely: Pre and Post-Migration Living Difficulties checklist, Primary Care PTSD screener (PC-PTSD), Oslo Social Support Scale (OSS-3), Sense of Coherence Scale (SoC-13),Center for Epidemiologic Depression Scale (CES-D), Coping Style scale and Fast Alcohol Screening Test (FAST) were administered. Confirmatory Factor Analysis and structural equation modeling (SEM) were employed to test pre-specified models.

Result: Alcohol misuse has significantly loaded onto the second-order common factor (β =0.21, p<0.001) with symptoms of PTSD and depression. Cumulative trauma is associated with this co morbid 'poor mental health' defining depression, PTSD and alcohol misuse both directly (β=0.76, p<0.001), and indirectly through psychological and social protective factors (indirect standardized coefficient=0.153, p=0.002) in a model which fitted to the current data [χ2/df =2.508, CFI=0.868; TLI=0.855, RMSEA= 0.052 (0.055 0.066)]. 

Conclusion: Cumulative trauma has directly and indirectly predicted poor mental health. Integrated assessment and intervention of alcohol misuse should be considered in refugee mental health care.

Funding Statement: This study was financially supported by Addis Ababa University and University of Gondar, Ethiopia.

Declaration of Interests: Authors declare that there is no conflict of interest.

Ethics Approval Statement: This study was conducted after obtaining an ethical clearance from Institutional Ethical Review Board (IRB) of College of Health Sciences in Addis Ababa University (AAU) under approval letter (protocol number: 052/14/Psy). Indeed, Ethical issues as outlined by declaration of Helsinki for human participants in medical research were adhered. 

Keywords: Alcohol Misuse, Poor Mental Health, Cumulative Trauma, Eritrean Refugees, Structural Equation Modeling

Biography:

Dr. Berhanie Getnet has earned three degrees from Addis Ababa University: Bachelor of Arts degree in Psychology in 1997, M.A degree in Counseling Psychology in 2006, and PhD in Mental health Epidemiology in 2019. In addition to his engagement in teaching psychology, mental health and student research advisement for undergraduate and graduate programs in three Universities of Ethiopia, namely University of Gondar, Jimma University and Unity University from 2001 to present. Dr. Berhanie has been actively engaged in rendering professional duties of counseling to clients having psychosocial problems both in universities as well as humanitarian settings. In addition, Dr Berhanie has been engaged in assessment, diagnosis, and research on mental health of Eritrean refugees living in Mai Aini camp for close to three years under the supervision of his PhD dissertation advisor, professor Atalay Alem (based in Addis Ababa University) and mentored by Dr. Peter Ventevogel, a senior mental health officer in UNHCR (based in Switzerland ) from 2013 to 2018 as part of his PhD field research work.

Moreover, Dr. Berhanie Getnet is currently an assistant professor of mental health epidemiology at the department of psychiatry in college of medicine and health sciences, University of Gondar. Besides his duties of engagement in the development of PhD curriculum and research advisement to graduate students, Dr. Berhanie is currently offering courses including advanced psychotherapy and psychosocial implications of mental health to post graduate students of mental health. Simultaneously, Dr. Berhanie is also working as senior consultant of psychotherapy at present time in University of Gondar Specialized Hospital and provide varieties of psychotherapeutic and psychosocial intervention services to the needy patients suffering from mental health problems.