Terrorist attack in Army Public School Peshawar, Pakistan left behind more than hundred children dead. It was the highest death toll of children in the world in a single terrorists attack. The attack dominated national and international news, high level security measures have been adopted in all school throughout Pakistan, which created fear and stress in children. The objective of the study was to determine post-traumatic stress disorder among children after six month of terrorist attack inspite of rigorous psychosocial support and rehabilitation.
Methods:
We wanted to determine Post Traumatic Stress Disorder (PTSD) among children of Army Public School of age range 10 to 18 years after 5 months of intervention and rehabilitation following terrorists attack. For this a self-report questionnaire, Child PTSD Symptom Scale (CPSS), which assess and identify symptoms matching DSM (Diagnostic and Statistical Manual of Mental Disorders) IV criteria for post-traumatic stress disorder of children, was filled. Informed consent was taken from school Principal and responders.
Results:
A total 205 students of age range 10 to 18 years participated in the study. The most frequent age group of the study were 16 years and 14 years students with frequency 58 (28.3%) and 46 (22.4%) respectively. Among 205 participated school children PTSD were found in 154 (75.2%) children while only 24.8% students had no PTSD symptoms. In more than 50% PTSD positive school children had functional impairment for each category of fun and hobbies, friendship, school work, family relation, doing chores, general happiness and saying prayers.
Conclusion:
Study found a very high prevalence of PTSD among 10 to 18 years age group students of Army Public School inspite of five months continuous intervention and rehabilitation services. Study showed that this age group needs long term psychosocial treatment in case of trauma.
Keywords: PTSD, CPSS, Terrorist, Functional impairment, Therapies, Trauma
INTRODUCTION
Terrorism and war are the acts of violence emerged with the perpetrated act of human. The impact of war and terrorism occur as the direct result of physical, media exposure and visual impact or through the various form of interpersonal experiences. Intergroup conflict are ancient in the history of world, it estimated that two million children have been killed due to war related injuries, one million orphaned, four million have been disabled and more than 12 million has been displaced from their homes.1
Number of natural and manmade disaster put very devastating psychological impact on the eye witnesses, who may be children. Think of a child who has witnessed the loss of his family members in a war or a natural disaster, and his flash back memories of such event could be very traumatic for that child and need urgent medical attention. Post traumatic stress disorder is a psychiatric disorder that a person may develop after witnessing or experiencing another person receiving actual or potential harm including serious bodily injury or sexual abuse.2
World is experiencing global spread of terrorism these days. Pakistan is the worse terrorism affected country of the world. Major cities of Pakistan were effected due to terrorism but Peshawar city witnessed very high death toll due to terrorism.3 Pakistanis are at highest risk group for developing traumatic stress reactions. Throughout its history, Pakistani citizen have faced many losses in term of lives and material in the form of terrorism in many types of violence, such as political, secessionist, sectarian, ethnic and recently religious fundamentalist. Terrorist attacks staged in Pakistan have killed over 35000 people caused material damage to the Pakistani economy totaling greater than $67 billion.4
In the streamline of terrorism in Pakistan Terrorists attack in Army public school Peshawar on 16 December 2014, left behind more than hundred children dead. It was the highest death toll of children in the world in a single terrorists attack. The attack dominated national and international news, high level security measures have been adopted in all school throughout Pakistan, which created fear and stress in children. Majority of children starts experiencing mental stress, depression, anxiety and shock. Such kind of incident left unforgettable and most horrifying impact in their minds which results in psychological disorder known as Post Traumatic Stress Disoder.5 Trauma impacts children differently at each developmental stage. In order to understand the constellation and severity of PTSD symptoms, it is important to acknowledge the age at which a person experiences a traumatic event.6 Children exposed to traumatic experiences at early ages are at risk for a variety of psychiatric problems.7 Children may be diagnosed with specific psychiatric illnesses (e.g. ADHD, ODD separation anxiety, etc.), but the true underlying issue may be PTSD.
What happened in Army Public School (APS) Peshawar on December 16, 2014 is no less than a traumatic event witnessed in a war setting, say psychologists and psychiatrists. Schoolchildren across the country were experiencing fear as threats continue to emerge in different cities. Parents are reporting children who survived the APS massacre are displaying low-levels of interest in going back to school and in other activities.8
After the tragic and horrifying event of Army Public School number of government and non-government organizations approached and started their interventions through counseling, therapies, medical care’s and relaxation techniques. A similar research looked at the psychometric responses of 358 adolescents randomly selected from war effected Gaza Strip. It concluded that apart from 11.8% of the sample, the rest displayed symptoms or full onset of PTSD.9 Our objective was to determine post-traumatic stress disorder among children after six month of terrorist attack in spite of rigorous psychosocial support and rehabilitation.