'Path of mental illness' follows path of war, 20 years after conflict ends

Particularly interesting was the geographic distribution of PTSD. Investigators found that certain villages in the region had a much higher prevalence of PTSD than did others. When they compared to the historical record about the path of the violent civil conflict that Nimba County experienced from 1989 to 1990 the team found that these were villages that had experienced the greater burden of war.

"This suggests that there is much more to the aftermath of conflict than a 'path of blood' and that populations who are unfortunate enough to have been in the 'path of trauma' experiencing severe, violent conflict are likely to bear a burden of psychopathology for decades thereafter," says Sandro Galea, MD, chair of the Mailman School Department of Epidemiology, and the study's first author.

The pattern of conflict and psychopathology is even more remarkable, observes Dr. Galea, when considering that so many in the sample were very young during the period of these events and did not themselves experience some of the traumatic events firsthand.

Results of the study are currently online in the American Journal of Public Health.

Overall the study also found a very high prevalence of PTSD. "Our demonstration of a high prevalence of PTSD here is not surprising and is consistent with a recent nationally representative survey in Liberia showing that 44% of respondents in the general population reported symptoms consistent with PTSD," Dr. Galea said. "We believe that the prolonged and high prevalence of PTSD is consistent with the greater burden of war experienced in Nimba County as compared with some other parts of the country."

"To put this in perspective, according to the lifetime prevalence of PTSD in the United States, studies suggest that more than one third of all PTSD after traumatic experiences resolves in the first six months after such events," noted Galea.

The investigators based their findings on a representative survey of the population in post-conflict Nimba County, Liberia, combined with a historical analysis. Following 14 years of civil war in the Republic of Liberia, more than 250,000 lives were lost and more than one-third of the population was displaced.