Prevalence of post-traumatic stress disorder and its association with adverse childhood experiences among refugee and host-community children and adolescents in Jordan.

BACKGROUND

Exposure to adverse childhood experiences (ACEs) is linked to the development of various psychological disorders, particularly post-traumatic stress disorder (PTSD). This study aimed to determine the prevalence rates of ACEs and high PTSD symptoms and to investigate their association among children and adolescents in Jordan.

METHODS

A large-scale school-based national survey was conducted among children and adolescents in the host and refugee populations aged 8-18 years in Jordan, utilizing a multi-stage stratified cluster sampling technique. The study questionnaires contained standardized and psychometrically validated instruments to assess ACEs and PTSD.

RESULTS

A total of 8,000 children and adolescents were included. The most prevalent ACEs among children were COVID-19 infection (43.2%), food insecurity or inadequate clothing (22.1%), and exam failure (21.7%), while for adolescents, COVID-19 infection (60.3%), exam failure (43.2%), and the death of a family member (31.7%). High PTSD symptoms were observed in 31.4%, more prevalent in females than males (33.0% vs. 29.3%, p = 0.003) and adolescents than children (35.5% vs. 24.6%, p < 0.001). For both children and adolescents, feeling unloved by family was significantly associated with high PTSD symptoms (OR = 2.1, p < 0.001). Other significant ACEs included death of a family member (children: OR = 1.9; adolescents: OR = 1.8) and food insecurity/inadequate clothing (OR = 1.7 for both). In children, exam failure was significant (OR = 1.5), while in adolescents, it included physical assault (OR = 1.4), COVID-19 infection (OR = 1.3), serious accidents (OR = 1.3), and emotional abuse (OR = 1.6). Experiencing ≥4 ACEs greatly increased PTSD odds (children: OR = 5.0, adolescents: OR = 4.3; p < 0.001).

CONCLUSION

Findings highlight a high prevalence of PTSD among children and adolescents exposed to ACEs, with multiple ACEs linked to higher PTSD symptoms and a cumulative pattern further increasing this risk. Results underscore the need for targeted interventions addressing key ACEs by age group and the development of comprehensive prevention programs involving parents, families, schools, communities, and broader society. Interventions should also aim to mitigate the cumulative impact of multiple ACEs and address them collectively rather than individually.