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Monday, 30 October 2017

Symptoms of trauma: beyond PTSD

Written by Professor Athula Sumathipala | www.keele.ac.uk/pchs | @PCSciences

Professor of Psychiatry, Athula Sumathipala attended the 16th Congress of the International Federation of Psychiatric Epidemiology in Melbourne, Australia from 17th-20th October. This year’s event focussed on the priorities in global health - taking psychiatric epidemiology to scale. In this blog,  Athula summarises his keynote address which focused on the epidemiology of conflict, migration and mental health in Sri Lanka, where he stresses that Common Mental Disorders (CMD) and unexplained physical symptoms are often ignored because of an undue emphasis on post-traumatic stress disorder (PTSD).



PTSD has always been considered to be the main consequence of patients who have experienced trauma. Recent research which has been conducted in Sri Lanka shows us though, that non-PTSD psychiatric diagnosis has a higher prevalence in patients exposed to trauma than PTSD itself.

Citizens in Sri Lanka have experienced considerable trauma over the decades. The country was victim to two uprisings since the 1970s by its predominant Sinhala ethnic group, as well as ongoing armed conflict by the Tamil rebels for over 30 years. A devastating tsunami also displaced over 500,000 citizens, killing 35,000 victims and significant outward migration abroad has occurred due to economic crisis.   

A National Mental Health Survey which was commissioned by the Ministry of Health in Sri Lanka assessed a population of 6,000, revealing that 1 in 10 Sri Lankans have some form of common mental health disorder because of experienced trauma. Overall, depression was most prevalent at 9.1%, with Somatoform Disorder (unexplained physical symptoms) at 2.9%. PTSD was only reported at 1.9%.

Reports of common mental health disorders were considerably more prevalent (19%) in a group of individuals who were forcibly displaced by the Tamil Tigers from the Northern Province of Sri Lanka over the last 20 years. Depression was reported at 12% and Somatoform disorders at 14%, PTSD was under 3%.

An alternative study conducted in the Colombo district which has a sample size of 6,000 also showed that although traumatic events were reported at 36.3%, 2% of those individuals experienced PTSD and 19% experienced non-PTSD mental illness over their lifetime.  

On a whole, we know that 1 in 10 Sri Lankan adults experience some form of mental disorder, which doubles in specific groups, such as trauma affected groups. Somatic distress appears to be considerably high, but receive inadequate attention from healthcare professionals.  

These findings have been invaluable in demonstrating that the domination of PTSD as the main psychiatric consequence of trauma is misguided, particularly in Sri Lanka. Mental health clearly has a much wider focus and needs to include depression, anxiety and somatic symptoms. The research has also raised awareness that child and adolescent mental health is a crucial issue which also needs addressing. child and adolescent mental health is a crucial issue which also need desperately addressing.

About the author:


Professor Athula Sumathipala 
Athula qualified as in Sri Lanka and trained as a family physician before re-training as a psychiatrist a the Maudesley and Bethlem Royal Hospitals. Athula later followed an academic career, and completed a PhD at the University of London. Athula has a particular interest in inter-connected disciplines such as the epidemiology of chronic disease and morbidity, the evaluation of complex interventions, using twin methods in study of illness aetiology and ethics related to research. 

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