title: Exposure to conflict and disaster: A national survey on the prevalence of psychotic experiences in Sri Lanka.
abstract: Recent research conducted in high-income countries suggests psychotic experiences are common in the general population, but evidence from low- and middle-income countries (LMIC) remains limited. Sri Lanka is a LMIC affected by three decades of civil conflict and, in 2004, a devastating tsunami. This study aimed to investigate the prevalence of psychotic experiences in a general population sample in Sri Lanka and associations with conflict- and tsunami-related trauma. This is a first National Mental Health Survey conducted in Sri Lanka. A cross-sectional, multi-stage, cluster sampling design was used to estimate the prevalence of psychotic symptoms. Data on socio-demographic characteristics, conflict- and tsunami-related trauma, and psychotic experiences were collected using culturally validated measures in a sample of 5927 participants. The weighted prevalence of psychotic symptoms was 9.7%. Exposure to one or more conflict-related events (adj. OR 1.79, 95% CI 1.40-2.31, p<0.001) and loss or injury of a family member or friend through conflict (adj. OR, 1.83, 95% CI 1.42-2.37, p<0.001) were associated with increased odds of reporting psychotic experiences. Psychotic experiences were more common in individuals directly exposed to tsunami disaster (adj. OR, 1.68, 95% CI 1.04-2.73, P=0.035) and in those who had a family member who died or was injured as result of tsunami (adj. OR, 1.42, 95% CI 1.04-1.94, p=0.029). Our findings suggest that psychotic experiences are common in the Sri Lankan population. Exposure to traumatic events in armed conflicts and natural disasters may be important socio-environmental factors in the development of psychotic experiences.
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK. Electronic address: arune.keraite@kcl.ac.uk.
authors.forename: Arune
authors.initials: A
authors.lastname: Keraite
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK; Institute for Research and Development, Colombo, Sri Lanka.
authors.forename: Athula
authors.initials: A
authors.lastname: Sumathipala
authors.affiliation: Institute for Research and Development, Colombo, Sri Lanka; Faculty of Medical Science, Anglia Ruskin University, UK.
authors.forename: Chesmal
authors.initials: C
authors.lastname: Siriwardhana
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Reininghaus
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D004190:Disasters; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology*; D012111:Residence Characteristics; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: National survey; Psychotic experiences; Sri Lanka; Trauma