Complex posttraumatic stress disorder in treatment-seeking refugees: the role of trauma history, post-migration stressors and comorbid symptoms

Abstract

Background: Complex posttraumatic stress disorder (cPTSD) was recently added to the ICD-11. Refugees might be particularly vulnerable to develop this disorder, due to key risk factors including trauma history, comorbid symptoms, and post-migration stressors. However, most prevalence estimates rely on self-report questionnaires, which are less reliable than clinical interviews. This study aimed to assess PTSDICD-11 and cPTSD prevalence in treatment-seeking refugees using clinician ratings, and to examine risk factors influencing diagnostic status and symptom severity. Method: N = 104 treatment-seeking refugees were assessed for cPTSD and PTSDICD-11, as well as symptom severity and single symptom endorsement using a new clinical interview, the Complex PTSD Item Set Additional to the CAPS. Trauma history, comorbid symptoms (dissociation, sleep problems, somatic symptoms, anxiety, depression, social impairment), and post-migration stressors were investigated as predictors for cPTSD diagnostic status and symptom severity using Wilcoxon Rank sum tests, logistic and linear regression. Results: Prevalences for cPTSD and PTSDICD-11 were 14.42% (n = 15) and 63.46% (n = 66), respectively. Participants with and without cPTSD did not differ regarding the frequency of traumatic events experienced. However, cPTSD symptom severity was significantly positively associated with the frequency of experienced traumatic events. In regression analyses, comorbid symptoms were significantly associated with cPTSD diagnostic status and symptom severity with depressive symptoms being a significant predictor. Post-migration stressors were associated with cPTSD diagnostic status and symptom severity, and the perception of the present financial situation was a significant predictor for cPTSD severity. Discussion: The prevalence of cPTSD was relatively low in this refugee sample. This discrepancy to earlier prevalence estimates could be due to the assessment since we used a clinical interview instead of a self-report questionnaire. More investigations into cPTSD diagnostic assessments are needed, and clinical interviews should be used more often.