Persistent psychopathology in the wake of civil war: long-term posttraumatic stress disorder in Nimba County, Liberia.

Abstract

We assessed the geographical distribution of posttraumatic stress disorder (PTSD) in postconflict Nimba County, Liberia, nearly 2 decades after the end of primary conflict in the area, and we related this pattern to the history of conflict. We administered individual surveys to a population-based sample of 1376 adults aged 19 years or older. In addition, we conducted a historical analysis of conflict in Nimba County, Liberia, where the civil war started in 1989. The prevalence of PTSD in Nimba County was high at 48.3% (95% confidence interval=45.7, 50.9; n=664). The geographical patterns of traumatic event experiences and of PTSD were consistent with the best available information about the path of the intranational conflict that Nimba County experienced in 1989-1990. The demonstration of a "path of PTSD" coincident with the decades-old path of violence dramatically underscores the direct link between population burden of psychopathology and the experience of violent conflict. Persistent postconflict disruptions of social and physical context may explain some of the observed patterns.