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Symptoms of post-traumatic stress disorder and depression among Eritrean refugees in Ethiopia: identifying direct, meditating and moderating predictors from path analysis
  1. Berhanie Getnet1,2,
  2. Girmay Medhin3,
  3. Atalay Alem1
  1. 1 Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  2. 2 Department of Psychology, University of Gondar, Gondar, Ethiopia
  3. 3 Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
  1. Correspondence to Berhanie Getnet;{at}


Objective This study aimed at testing the significance of mediating and moderating roles of sense of coherence, adaptive coping styles and social support in the relationship between exposure to trauma and psychological symptoms in a refugee population in sub-Saharan Africa.

Methods A cross-sectional survey design was employed to collect data. The study was carried out in Mai Aini refugee camp in Ethiopia. A total of 562 adult Eritrean refugees aged 18–74 years were selected randomly to screen for depression and post-traumatic stress disorder (PTSD) symptoms and to examine associated factors. Data were collected using the premigration and postmigration living difficulties checklist, Center for Epidemiologic Studies Depression (CES-D) scale, Primary Care PTSD Screener, coping style scale, Sense of Coherence scale and Oslo Social Support scale. Path modelling was used to test the mediation and moderation effects of prespecified factors.

Results Premigration living difficulties were associated directly with symptoms of PTSD (β=0.09, p<0.05), and associated indirectly with PTSD symptoms in paths through duration of stay in the camp, sense of coherence, postmigration living difficulties, task-oriented coping style and depressive symptoms (β=0.26, p<0.01). Premigration and postmigration living difficulties were associated directly with depressive symptoms with standardised estimate of β=0.35(p<0.001) and β=0.23(p<0.05), respectively. Postmigration living difficulties were associated indirectly with PTSD through paths of sense of coherence, task-oriented coping style and depressive symptoms (β=0.13; p<0.01). Social support moderated the effect of postmigration living difficulties on depressive symptoms (p<0.05). Emotion-oriented coping style moderated the effect of premigration threat for abuse on PTSD (β=−0.18, p<0.001) and depressive (β=−0.12, p<0.01) symptoms, as well as moderating threat to life on PTSD symptoms (β=−0.13, p<0.001).

Conclusions Sense of coherence and task-oriented coping style showed a partial mediating effect on the association between exposure to trauma and symptoms of PTSD. An emotion-oriented coping style and social support moderated the effect of premigration and postmigration living difficulties, respectively. Fostering social support, task-oriented and emotion-oriented coping styles may be beneficial for these refugees.

  • mediation
  • moderation
  • PTSD
  • depression
  • eritrean refugees
  • Ethiopia

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  • Patient consent for publication Not required.

  • Contributors BG is the principal investigator (PI) of this study. He led in generating the research idea, design and methods of the study, writing the research protocol, validating measures, data collection, analysis, interpretation and writing of the findings. AA has made contribution in revising the research protocol, the research design, validation of measures, analysis and interpretation of data, and critically reviewing the final manuscript. GM made contribution in checking and editing the statistical analysis, critically reviewing the drafted manuscript. All the authors approved the final version.

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

  • Competing interests None declared.

  • Ethics approval This study had ethical clearance from Institutional Ethical Review Board (IRB) of College of Health Sciences, Addis Ababa University. Participants were provided with information sheet about the study regarding its objective, relevance, beneficence, risk, participant’s rights and others. Ethical issues as outlined by declaration of Helsinki for human participants in medical research were adhered.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All necessary data to understand in manuscript (MS) is included in tables or text within the MS. The row data in SPSS format will be deposited in the Department of Psychiatry, Addis Ababa University (AAU), and can be accessed in accordance with data sharing policy of Institutional Review Board of College of Health Sciences, AAU.

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