TRAUMATIC EXPERIENCES AND POOR MENTAL HEALTH AMONG UNIVERSITY STUDENTS IN UGANDA. Norman Nsereko,1* Janet Nakigudde2 and Denis Ssekiwu3   1* Department of Counseling And Guidance, Nkumba University, Entebbe, Uganda. E-mail: nserekon@gmail.com 2Department of Psychiatry, Makerere University CHS Kampala. Uganda. E-mail: jnakigudde@chs.mak.ac.ug 3Department. of Statistics, Muteesa I Royal University E-mail: Dsekiwu@yahoo.co.uk

INTRODUCTION Mental health problems among university students have been widely reported in the literature (Harper & Peterson, 2005; Hunt, & Eisenberg, 2010; etc Among the many reported causes underlying the increase in these problems have been students experience of traumatic events. Vrana & Lauterbach(1994) reported that students entering university often have significant trauma and stress histories. According to DSM IV, a traumatic event is an experience that causes physical, emotional, and psychological distress or harm.

Students’ Traumatic Experiences And Poor Mental Health Studies in Western countries generally report that 50-80% of young people (including university students) experience traumatic experiences but which could be prevented (Felitti, 2009; Sharfstein, 2006). In Africa, Studies in South Africa found prevalence rates of 70-90% of students experiencing traumatic events which led to their developing psychopathology (Md Yasin & Dzulhifli 2009, Fairbank 2008). The developed psychopathology resulted in drastic life changes, emotional disturbances, behavioural problems, sleeplessness, loss of appetite and feelings of emptiness . (Bulathwatta, 2013) The most commonly reported mental disorders were Post-Traumatic Stress Disorder and Depression and anxiety. (Seedat, Nyamai, Njenga, Vythilingum & Stein, 2004)

Young People’s Traumatic Experiences In Uganda Studies of traumatised adolescents in war-torn areas have found significant association of trauma and development of Post-traumatic Stress Disorder (PTSD), Depression, Substance Abuse and other anxiety disorders (Okello, Onen & Musisi, 2007 ). Recent studies have suggested a possible relationship between childhood trauma and Nodding syndrome as well as PTSD, Depression and epilepsies (Musisi, Nakimuli-Mpungu, Akena, Bangirana, & Kinyanda, 2013). No studies have, however, attempted to investigate the relationship between the experience of trauma and development of psychopathology among university students in Uganda.

AIMS GENERAL OBJECTIVE This study aimed to investigate the relationship between university students’ traumatic experiences and the development of mental health problems (psychopathology) with a view to prevention and treatment of the latter.

SPECIFIC OBJECTIVES To investigate the prevalence of traumatic experiences among university students in Uganda 2. To investigate the emotional and behavioral problems among the university students in Uganda. 3. Finally to establish the association between students’ traumatic experiences and poor academic performance as well as students antisocial behavior on campus

METHODS This study was part of a larger study leading to the award of a PhD degree. Design: The study employed a cross-sectional descriptive survey design. Site: 5 purposively selected Ugandan universities representative of students ethnicity (tribe), religious affiliation, gender, social class and courses of study. Participants: 1101 proportionate by population size randomly recruited students Instrument: University Students Evaluation of Psychosocial Problems scale (USEPP) This instrument has 4 subscales to investigate the students: 1. Traumatic experiences 2. Emotional, problems 3. Academic problems 4. Antisocial behavioral problems. The total score of the 4 subscales of the USEPP denotes the student’s Overall psychosocial problems. USEPP was validated for Ugandan University students (Nsereko, Musisi, Nakigudde & Ssekiwu, 2014).

PROCEDURES. Ethical and scientific clearance to conduct the study was obtained from Nkumba University Research Committee and final IRB approval from the Uganda National Council of Science and Technology (UNCST) The study was advertised on all the 5 university campuses and voluntary written consent was obtained from each participant after being fully informed of the procedures, risks and benefits. No incentives were given to participants. Students were randomly recruited. Each participating student was approached by the researcher and handed the self-administered socio-demographic questionnaire and the self-administered USEPP. All questionnaires were checked for completeness & collected by the researcher. Data was analyzed using descriptive and correlation statistics for associations.

RESULTS

SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLE NUMBER (N=1101) PERCENTAGE Gender Male Female 472 504 48.4 51.6 Age (Years) 18-24 ≥25 714 387 73.4 26.4 Religion Christian Moslem Other 743 217 16 76.2 22.2 1.6 Marital Status Single Married 856 94 26 87.7 9.6 2.7 Nationality Ugandan 916 60 93.8 6.2

Frequency Of Caseness On USEPP Scale & Subscales Number (N = 1101) Percentage % Overall Psychosocial Problems (USEPP Score ≥ 18)   357 36.5 Subscale Caseness: Traumatic Experiences Emotional Problems Antisocial Behaviour Problems Academic Problems 478 337 209 369 48.9 34.5 21.4 37.8

Severity of psychosocial problems Measured construct Mild Moderate Severe   Overall psychosocial problems 63.5% 30.8% 5.7% Traumatic experiences 51% 46.6% 2.4% Antisocial behaviour 78.5% 19.6% 1.9% Emotional problems 65% 32.5%, 2.5% Academic problems 62.2% 36.6% 1.2%

The Specific Traumatic Experiences Among The University Students (N=1101) PSYCHO-TRAUMATIC EXPERIENCE NUMBER PERCENTAGE (%) Lacking welfare / support funds 689 70.6 Adjusting to new (campus) life 595 61 Serious Family Problems 553 56.7 No/Insecure fees availability

ASSOCIATION OF TRAUMATIC EXPERIENCES, EMOTIONAL PROBLEMS, ACADEMIC PROBLEMS AND ANTISOCIAL BEHAVIOUR SYMPTOMS The correlation of traumatic experiences and the three subscales of emotional, academic problems and antisocial behavior symptoms indicated low to moderate significant relationships as follows: Academic Problems: r= .16 Emotional Problems: r= .30 Antisocial Behaviour: r= .40 

DISCUSSION This study aimed to investigate the relationship between Ugandan University students’ problems of traumatic experiences and the manifest mental ill-health of emotional and behavioral problems as well as academic problems on Ugandan University campuses Our findings reflected the general socio-demographic distribution of students attending University in Uganda. The prevalence of psychosocial problems as measured by the USEPP scale was found to be 36.5% . This rate was similar to that of the manifest psychological distress/mental ill-health prevalence of 34.8% measured by the HSCL-10 from an earlier study (Nsereko, Musisi, Nakigudde & Ssekiwu, 2014). This finding showed that Ugandan University students manifested mental health problems of anxiety and or depression as has been reported in studies in Western countries and other African countries who report similar prevalence ratess (Stallman, 2008; Hunt & Eisenberg, 2010; Sherina, Med, Rampal, & Kaneson, 2004). .

DISCUCUSSION Contd. The traumatic experiences contributed the most to the USEPP cases (48.9%) of the overall psychosocial problems, (Nsereko, Musisi, Nakigudde, & Holtzman, 2014). About half (49%) of these psycho-traumatic experiences were of moderate to severe degrees indicating that they caused significant stress to the students and likely to interfer with the students academic . Indeed 37.8% of the students indicated having academic problems on the USEPP and 34.5% had emotional problems, probably depression and anxiety. The specific psycho-traumatic experiences of our student participants were: (i) Economic stress (poverty with insecure tuition and no money for personal use, (ii) Family problems (illness, death, family relationship problems), (iii) Problems adjusting to university campus life (hostels, dates, independence, sexual abuse taking the form of harassment, sexual coercion/trickery and even rapes or attempted rapes including date rapes, sex for marks etc).

CONCLUSIONS AND RECOMMENDATIONS Traumatic Experiences were found at a high rate among Ugandan University students, involving almost half of the student population (48.9%). These gave rise to Emotional Problems & Academic Problems in more than a third of the students. Antisocial behavior occurred in almost a quarter of the students. These findings call for effective screening for psychosocial problems among university students in Uganda at the beginning of each academic year as part of their medical check-ups via set up mental health services at university campuses. This way, problems can be detected early and interventions implemented to prevent them from developing into full blown psychopathologies which may interfere with the students’ academic performance and eventual outcome in life.

ACKNOWLEDGEMENT The authors would like to thank Prof. Seggane Musisi, Senior Researcher at the Department of Psychiatry of Makerere University College of Health Sciences who supervised the authors in their PhD studies from which this paper and many others have been derived.

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