Trauma Exposures and Posttraumatic Stress among Zimbabwean refugees in South Africa.

Zimbabwean refugees can be considered a vulnerable group in terms of how they are displaced with many of them having lived through hardships on their way to South Africa and other African countries. Zimbabwe is known to be Africa's most extraordinary producer of migrants and the biggest producer of refugees in Southern Africa. It is estimated that 3.4 million Zimbabweans, a quarter of the country's population, have fled the country. Economic collapse, hunger and political repression have been blamed for the mass exodus. The present study examines the impact of trauma exposures (pre- and post-migration stressors and poor mental health) on posttraumatic stress disorder (PTSD) among homeless Zimbabwean refugees living in South Africa. Through a guided convenient sampling, in-depth interviews using questionnaires were collected from 125 homeless Zimbabwean refugees in Polokwane, Limpopo Province, South Africa. The study was anchored on the hypothesis that predictor variables (pre- and post- migration stressors, poor mental health) would significantly affect outcomes (PTSD). Participants were assessed on demographic variables, pre- and post-migration difficulties checklists, mental health using the General Health Questionnaire (GHQ-28) and the PTSD Checklist (Civilian Version (PCL). Participants ranged from 18 to 48 years with a mean age of 28.3 years (SD = 6.27). The majority of the sample had at least a secondary education (76.8%) and were employed as unskilled labourers (61.6%) in South Africa. Being married was reported by 54.4% in Zimbabwe but changed to only 19.2% in South Africa. Hierarchical multiple regression analyses showed that the overall model significantly predicted PTSD among homeless Zimbabweans (R2 = 0.17, adjusted R2 = 0.11, F (6, 124) = 2.960, p < .01). Thus, the entire set of pre- and post-migration variables (Post total stress, PreThreat to life, Presexabuse, PrePoverty, Postsexabuse, Postpoverty and two mental health symptoms (Anxiety and Insomnia, and Social dysfunction) explained 41.2 % of the total variance on PTSD. However, main significant predictors were Post total stress (t (125) = 2.571, P < .001); Postsexabuse (t (125) = 2.175, P < .003); Postpoverty (t (125) = 3.450, P < .001); Anxiety and Insomnia (t (125) = 2.000, P < .04) and Social dysfunction (t (125) = 2.113, P < .003). Of these variables in order of strong impact predictor is Post total stress (β = 0.737) followed by Postpoverty (β = 0.701), Postsexabuse (β = 0.377) and Social dysfunction (β = 0.196). The Dubin-Watson results (2.252) also showed that the assumption of independent errors was tenable and almost certainly met for this model. Variables excluded in the model were Pre total Stress, Post threat to life, Somatic complaints (GHQ A), Severe depression (GHQ D) and Total GHQ. Zimbabwean refugees constitute a particularly vulnerable group to poor mental health and PTSD. These findings have significant implications for refugees in South Africa and other places where integrating refugee treament in the main stream health system is undermined. As a migratory group, there is need to develop ways of using probability sampling methods in further research and increasing sample size. In addition, there is need to develop culturally relevant interventions to address the sequalaes of pre- and post-migration traumas and poor mental health.