Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex

Background. Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents. Methods. The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study. Results. Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy. Conclusions. Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education