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THE RELEVANCE OF SOCIAL-REHABILITATION IN POST-TRAUMATIC STRESS
DISORDER SYMPTOM-REDUCTION AMONG INTERNALLY DISPLACED
ELDERLY PERSONS IN BORNO STATE NIGERIA
1Jonathan Musa Dangana, 2Onyekachi Prince David & 1Nnodiemele Onuigbo Atulomah
1Department of Public Health
Babcock University, Nigeria 2Institute of Psychology
University of Copenhagen Denmark
Email: [email protected]
Abstract
There is huge evidence showing that internally displaced persons are highly vulnerable to mental
health problems especially post-traumatic stress disorder (PTSD). In view of this, this study
examined cultural activities relevance to PTSD symptoms reduction of internally displaced
elderly persons (IDEPs) in Borno state, Nigeria. This study used a quasi-experimental design. A
total sample of (N=40) IDEPs were purposively selected from 2 internal displacement camps
with each displacement camp comprising 20 participants. The participants were assigned to
Social Rehabilitation (SR) treatment group and control group. A pre-tested, validated instrument
was adapted to the study. Descriptive and inferential statistics where used to analyze the data (p
˂ 0.05). Results show that, at baseline, PTSD symptoms between the SR treatment group and
control group was (89.25±12.26 and 103.95±14.85) respectively, while post-test values of PTSD
symptoms only dropped for the SR treatment group (64.25±5.77) and not for control group
(104.0±14.90). More so, at the 13th week follow-up, the SR treatment group, demonstrated
higher scores of PTSD symptom-reduction, (64.25±5.77 an aggregate of 28.01%) compared to
the control group. Overall mean score of PTSD symptoms reduction, showed changes of value (-
25.0 and +0.05) on symptoms reduction in the SR treatment group and control group
respectively. The study concludes that, Social Rehabilitation is an effective cultural relevant
means in reduction of PTSD Symptoms among IDEs.
Key words: Social-Rehabilitation, Post-Traumatic Stress Disorder, Internal Displacement,
Elderly, Symptom-reduction
Introduction
Globally conflict and war forces a large numbers of people to flee for safety within and outside
their own country. According to the report of Internal Displacement Monitoring Centre (IDMC,
2014, 2018) respectively, the reality of internal displacement has geometrically been on the
increases, with a global estimate of 42 million people internally displaced in 2014 from various
regional conflicts and natural disasters. However, after the Second World War 2, the international
community’s concern has arisen as a result of internal displacement; a phenomenon that has
brought unease especially in terms of human violation of the displaced arising from intensified
intra-state wars globally (Olarenwaju, 2018). Internal displacement in Nigeria, predates the post
military rulership 49 years ago the Nigerian Civil war, otherwise known as the Biafran war
(1967-1970) occurred, which left about ten million people internally displaced (Anna, 2019).
Series of conflicts arose over the years after the civil war in Nigeria that has given room to
citizens to be internally displaced pivotal to this reality, is insurgency. Insurgency has been a
severe problem facing specifically the North-East Nigeria, and has had overwhelming effects on
the economic, religious, political and social activities of the Nigerian State (Maurice & Uyi,
2013). The Boko Haram insurgency began in 2009, when the jihadist rebel group Boko Haram
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started an armed rebellion against the government of Nigeria especially in the states of Borno,
Yobe, Adamawa, Plateau, Bauchi, Kaduna, and some others (Abiodun, 2013).
The activities of the insurgents have had damaging effects on the physical and psychological
wellness of the people; this has left Borno with a whopping population of 1,496,871 displaced
persons across 259 internal displaced camps in Borno State (IOM-DTM Nigeria, 2019).
Further, trauma-exposed individuals habitually exhibit feelings of shame, self-blame, and
powerlessness, this contributes a great deal to difficulties in their interpersonal relationships and
self-care (Tummala-Narra, Kallivayalil, Singer, & Andreini, 2012), this and other mental health
related disorders have become prevalent, incapacitating victims and a huge source of suffering
and growing public health burden (Stein et al., 2011; Charles & Albert, 2004). Studies has shown
that people or persons displaced by armed group conflict violence, suffers from various death-
defying problems. The Boko Haram insurgency in North East of Nigeria has over the years,
forced people to move into temporary settlements or camps as a result of the continual and
prolonged activity of insurgents. IDPs affected by insurgents and conflict are oft at a higher risk
of mental health problems. Psychological reactions frequently reported are post-traumatic stress
disorders (PTSD) in reaction to violence and depression due to losses (Getanda, Papadopoulos &
Evans, 2015, Mujeeb, 2015; Asad et al., 2013). In addition, evidence showed that elderly persons
are more vulnerable to mental health problems especially PTSD (Jia, et al., 2010). Although,
elderly people are expose to a range of specific and very significant risks before a crisis. For
instance, elderly people experience reduced mobility, and other health problems. Of much
concern, they are more likely to experience traumatic and other stressful life events amidst of
retirement. However, for displaced elderly persons these stressors could become more
complicated resulting to severity of mental health problems.
Consequently, in internal displacement older people are already being marginalized, often not
factored into assessments of psychological and socio-cultural need and fall between the cracks of
registration systems. Of a fifty (50) country review by the Internal Displacement Monitoring
Centre for its 2011 global IDP survey, only eleven (11) countries had up-to-date sex- and age-
disaggregated data; in only six (6) of the 50 countries did national policies make specific
reference to older people; and only three (3) of these six had gathered any information on older
people. Further, failure to understand socio-cultural dimensions of the definition of ‘older person’
(which in many countries does not only depend on physical age) and the fact that older persons
have quite different levels of vulnerability and capacity may further exacerbate invisibility, and
often exclusion, during displacement. Likewise, United Nation High Commissioner for Refugees
(UNHCR, 2013) report indicated that the challenges faced by older women and men may be very
different, depending on the social and cultural role assigned and the available support to them in
their community, however, that older women are at greater risk of being overlooked because of
their weak socio-economic position.
As aforementioned internally displaced elderly persons, will be more confronted with dare need
of psychological support because of their severe vulnerability to mental health problems such as
PTSD, social and economic problems (Clark & Sieben, 1993). Therefore, to facilitate
interventional support that will reduce PTSD and improve wellbeing of internally displaced
elderly warrant essential consideration of their cultural and socio-economic needs. Thus, to
address this specific need Social-Rehabilitation (SR) interventional support was developed. This
comprises essential strategy that can support displaced elderly persons especially in reducing the
occurrence or development of disability and impact of traumatic exposure (PTSD). For example,
Dangana J.M., Onyekachi P.D. & Nnodiemele O.A: The relevance of social-rehabilitation …
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social-rehabilitation can be in form of occupational therapy, assistive device prescription,
environmental, home living adaptation, and family or caregiver educational training depending
on the condition. Similarly, for internally-displaced elderly person, physical inactivity can stir
dramatic out comes that can lead to hospitalization, functional decline, decreased social activity,
and poor quality of life (Intis et al., 2012). However, social rehabilitation interventional support is
grounded in heuristic frames of reference, which are available from many theories to guide tests
of the efficacy and effectiveness of psychosocial (Social) rehabilitation (e.g. Bandura, 2006;
Moses & Barlow, 2006).
Further, one of the most essential theory that challenges the benefit of psychosocial rehabilitation
is the “agentic” theory of human development, adaption and change advance by Albert Bandura.
The core centrality of this theory is the concept of self-efficacy. The tenets of self-efficacy holds
a clear view that it is the extent to which an individual or people believe they can elicit desired
behavior which is key indicator to change. In testing hypotheses, self-efficacy is used widely in
the treatment of PTSD, similarly, self-efficacy is found to be influenced negatively by trauma
(Bandura, 1997). Psychosocial rehabilitation techniques, designed to improve the capacity of
people to regain mastery over their environment, seem well-suited to increasing self-efficacy and
reducing PTSD symptoms. The theory of psychology of human by Bandura (2006) holds a rich
benefit of psychosocial (Social) rehabilitation strategies for the treatment of PTSD. It can’t be
over emphasized that the devastating effect of Post-Traumatic Stress Disorder (PTSD) amidst
refugee’s and internal displaced persons, is affirmed and its prevalence in both peaceful situations
and when confronted with non-peaceful situation (Hepp et al., 2006, Kessler et al., 1995,
Tagurum et al., 2015, Agbir et al., 2016 & Sheikh et al., 2014). Among internally displaced
persons in Nigeria, the prevalence of PTSD is at an alarming rate hence, its effect eventually lead
to miserable death once the individual suffering such isn’t adequately given supportive attention.
This study, opines that, given the reality of global internal displacement increase, and financial
resources shrinking also, a closer examination of resources among individual that can be more
sustainable rehabilitative measures are required, inPTSD symptoms reduction among internally
displaced elderly persons Nigeria. Therefore, the following research questions were explored.
What is the effect of social-rehabilitation on symptom-reduction in PTSD among internally
displaced elderly persons? Is social-rehabilitation effective in predicting symptom-reduction in
PTSD among internally displaced elderly persons? what is the interaction effect of gender and
social-rehabilitation on symptom-reduction in PTSD among internally displaced elderly persons?
Further, for experimental preciseness, the following was hypothesized and tested.
There will be no significant interaction effect of gender and social-rehabilitation on symptom-
reduction in PTSD among internally displaced Elderly persons.
There will be no significant effect of social-rehabilitation on symptom reduction in PTSD among
internally displaced elderly persons.
Method
Study design: We conducted a quasi-experimental study among male and female IDPs aged ≥
60years. We defined internally displaced elderly persons (IDEP) as elderly people living within a
formal camp, who have been displaced from their original communities as a result of Boko
Haram insurgency in Borno, North East Nigeria. Elderly persons below the age of 60years, were
excluded and those who refused consent.
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Sample size determination: The sample size which was used for the study was derived from the
computation using a level of significance of 95% and 80% power. There was no given estimate of
the prevalence of PTSD among displaced elderly persons. As Opined by McLeod (2019) This
formula is important to this study because, the normal distribution is the most important
probability distribution, it is also the most powerful (parametric) statistical tests used by
psychologists; especially the thrust of this study is psychology: this formula is further important
because, it standardized the values (raw scores) of a normal distribution by converting them into
z-scores. This procedure also allows researchers to determine the proportion of the values that fall
within a specified number of standard deviations from the mean. Thus, the sample size was
determined by utilizing the normal distribution formula
N = (Zα + Zβ)2 X P0 (1 - P0)
(P1 - P0)2
N = Sample size
Zα = Standard normal deviation at 95% confidence interval (1.96)
Zβ = Statistical power at 80% confidence interval; 0.84
P0 = prevalence at 30%
P1 = 80% (desired level of PTSD Symptom reduction from the intervention)
n = (1.96 + 0.84)2 × 0.5 (1 - 0.5)
(0.8 – 0.3)2
(2.8)2 × 0.5 (0.5)
(0.8 – 0.3)2
7.84 × 0.25
0.25
=7.84 ≃8
Twenty percent of the sample size will be added to take care of attrition.
8+ 1.6 ≃ 10.
The formula for estimating proportions for 2 independent groups was used to generate a
maximum of 20 participants per IDP camp. Hence, based on computation, the minimum total
sample size was 40 participants (20 x 2 Camps).
Sampling technique: We used purposive sampling technique to select the participant’s for the
study. IDEPs who were <60years of age, were excluded. 40 IDEPs, were purposively included in
the final sampling frame for the study. We divided the study sample size into male and female
groups of 10 for each gender group.
Study instrument: A questionnaire was designed to measure the socio-demographic
characteristics of IDPs and their living conditions, which was assessed by asking the following
questions: availability of sleeping mat, private facility, toilets or latrine, sufficient food, and
protection from animals and insects for individual IDPs.
We also asked of the type of accommodations, if it were tent or shelter or rooms, if their health
was good, and if they had any form of livelihood support. Conflict-related trauma was assessed
with a shortened version of the communal traumatic events inventory used to study Bosnian
refugees (Weine, et al., 1995).We included only trauma events, the IDEPs were likely to have
experienced and respondents were to indicate “yes” or “no” depending on experience during the
conflict. To measure the IDEPs Social-Rehabilitation, construct from the social provision scale
developed by Cutrona and Russell was adapted (Moti, et al., 2004) and further strengthened with
Dangana J.M., Onyekachi P.D. & Nnodiemele O.A: The relevance of social-rehabilitation …
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cultural perspectives, generated from focus Group Discussion (FDG). We defined good Social-
Rehabilitation as answering “strongly agree” or “agree” to questions. Finally, we used the
Harvard trauma questionnaire (HTQ) (Mollica, 1992) designed by Harvard Program in Refugee
Trauma, Massachusetts General Hospital (Cambodia version) to establish PTSD likelihood. The
PTSD section consists of 16 questions based on the diagnostic criteria of the diagnostic and
statistical manual for mental disorders fourth edition (DSM IV) (APA, 2000). The questions were
measured on a 5-point severity scale of 1–5. Scores for each respondent were summed up and
divided by the number of items (16) to derive the score for each individual. Individuals with total
score >2.5 were considered symptomatic for PTSD (Mollica, 1992). The cut off score of 2.5 had
been standardized for several version of HTQ (Choi, et al., 2006; Ichikawa, et al., 2006 & Silove,
et al., 2007) and the HTQ had been validated for use in displaced persons in several cross-cultural
studies (Fawzi, et al., 1997; Kleijn, et al., 2001 & Roberts, et al., 2008). The questionnaire was
translated to Kanuri the main language spoken in Borno North East Nigeria and back translated to
English. The translation underwent detailed review by the study team and followed recommended
guidelines (Mollica, et al., 1992 & Mollica, et al., 2004).
Data collection and procedure Six research assistants were recruited and trained (for 5 days) to collect data who could speak
both Kanuri and English language fluently and were experienced in data collection from prior
activities. Data collection took place over a period of three months, August-October 2019, with
the aid of a questionnaire and semi-structured interview guide to discover experiences of IDEPs.
Open-ended and culture-sensitive questions were utilized, initial questions permitted instituting
rapport with participants; this made participants feel relaxed and comfortable in answering
questions about their experiences especially personal ones that characterised traumatic events,
traumatic symptoms and coping strategies.
The interview guide, originally developed in English and translated into Kanuri which was the
language used with participants. The interview sessions were audiotape-recorded and lasted from
40 minutes to 45 minutes.
Data analysis
Qualitative data gathered through focus group discussion, were transcribed verbatim, except for
names, which were substituted with functional codes to ensure confidentiality. The transcripts of
the data were subjected into coding to identify specific patterns; themes, and illustrative
quotations reflecting these themes. This involved a number of stages: First, transcribed interviews
were read several times to identify initial codes. The second stage was the development of
focused codes (sub-themes and themes) that applied to all the interviews. Thirdly, a meaning unit
approach was adopted, which was chunking together groups of themes into categories. This
process produced two categories, which are itemizing various hands on activities they consider
culturally relevant that will represent social rehabilitation, armed conflict experience and their
effects’ and coping mechanisms. Key sub-themes and themes that emerged from the data,
strengthen line items in the questionnaire that dealt with social-rehabilitation. However,
Credibility, Dependability, Transferability and Confirmability were all followed to ensure
trustworthiness (Creswell, 2007).
Quantitative data was analyzed with the use of SPSS version 20.0. Descriptive and inferential
statistics where used to analyze quantitative data.
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Results
Table 1: Socio-demographic characteristics distribution of participants (n=40) Variable Options Social Rehabilitation Control Total
Sex
Male 10 10 20
Female 10 10 20
Total 20 20 40
Marital status
Single 01 0 01
Married 12 13 25
Divorced 0 02 02
Separated 07 05 12
Total 20 20 40
Educational status
NCE 0 0 0
Primary Education 01 09 10
Quranic school 19 10 29
Secondary education 0 01 01
Total 20 20 40
Religion
Islam 20 20 40
Total 20 20 400
Ethnic group
Hausa 2 0 02
Kanuri 16 13 29
Marghi 01 0 01
Mulwe Damboa 0 02 02
Shua 01 05 06
Total 20 20 40
Type of marriage
Monogamous 13 09 22
Polygamous 07 11 18
Total 20 20 40
Occupation before the
incidents
Cattle rearing 0 10 10
Cattle trading 01 0 01
Farming 09 11 20
Pensioner 01 0 01
Trader 09 08 17
Total 20 20 40
Types of accommodation Tent 20 20 40
Sources of social support
Brother 0 0 0
Daughter 02 03 05
Daughter in law 0 01 01
Neighbours 1 0 01
None 5 05 10
Son 07 07 14
Son in law 02 02 04
Spouse 03 02 05
Total 20 20 40
The table above, presents the socio-demographic characteristics of the three internal displaced
camps. The analyses revealed a unique structure in participants’ demographic information studied
in terms of sex, marital status, highest level of education, religion affiliations, ethnic group, and
type of marriage, occupation, type of accommodation and sources of social support. Socio-
demographic distribution by sex revealed that females and males were equally represented in the
study in the three groups (Social Rehabilitation: male=10, female=10; Control group: male=10,
female=10). This suggests that female to male ratios in the group is 1:1. Total responses on
marital status shows that most participants were married (n=25), separated (n=12), divorced
Dangana J.M., Onyekachi P.D. & Nnodiemele O.A: The relevance of social-rehabilitation …
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(n=2) and single (n=1). Analysis on marital responses across the different groups were (Social
Rehabilitation: single=1, married=12, separated=07; Control group =13, divorced=2,
separated=5).
Aggregately, responses on highest educational level reveals that majority of the participants
attended quranic school (n=40) while the breakdown on educational status by categories shows
(Social Rehabilitation: primary education=10, quranic school=19; Control group: primary
education=9, quranic school=10, secondary education=1). This result suggests the likelihood of
most participants belonging to the Islamic group. The religious status shows that all the
participants represented in the study were Muslims and equally spread across the three groups
(Social Rehabilitation: n=20; Control group: n=20). Analysis by ethnic group shows that the
Kanuri’s (n=29) were largely represented among the five ethnic affiliations. When segregated
into categories, the social-rehabilitation group had the highest number of Kanuri’s (Social
Rehabilitation: n=16; Control group: n=13).
Distribution by type of marriage shows that most participants were monogamous (n=43) with the
social rehabilitation group emerging the highest number (Social Rehabilitation: n=13; Control
group: n=9). The main occupation of participants, before the insurgency was farming (n=30) and
this was predominant among Control group than the social rehabilitation group (Social
Rehabilitation: n=9; Control group: n=11). Distribution by type of accommodation shows that all
the participants lived in tents and the number was equally dispersed among the two groups
(Social Rehabilitation: n=20; Control group: n=10). The main source of social support (n=18)
was the son (Social Rehabilitation: n=7; Control group 3: n=7).
Research question one
What is the effect of social-rehabilitation on symptom-reduction in PTSD among internally
displaced elderly persons?
Table 2: Descriptive statistics on effect of social-rehabilitation on symptom-reduction in PTSD Aggregate PTSD Symptom Reduction Score
Group Mean
Pre-test
SD
Pre-test
Mean
Post-test
SD
Post-test
Mean
Difference
Percentage (%)
Increase/
Decrease in Symptoms
Social
Rehabilitation
89.25 12.26 64.25 5.77
-25 -28.0
Control 103.95 14.85 104.00 14.90 +0.05 0.0
Table 3 above, describes the effect of social-rehabilitation on symptom reduction in PTSD among
internally displaced Elderly persons in the social rehabilitation and control groups. The pretest
and posttest experimental group of means and standard deviation scores on aggregate PTSD
symptom reduction score for social rehabilitation (89.25±12.26 and 64.25±5.77) and control
(103.95±14.85 and 104.0±14.90). The mean difference scores shows -25.0 for social
rehabilitation and +0.05 for the control group. There was 28.0% decrease in aggregate PTSD
symptom score in the social rehabilitation group while the pre and post PTSD symptoms
remained the same in the control group. This result suggests an effect of social rehabilitation
intervention on aggregate PTSD symptom reduction score among internally displaced elderly
persons in Borno state. The researcher’s assumption of significant effect of social-rehabilitation
on symptom-reduction in PTSD among internally displaced elderly persons was tested under the
test of hypotheses.
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Research question two
Is social-rehabilitation effective in predicting symptom-reduction in PTSD among internally
displaced Elderly persons?
Table 3: Mean and standard deviation of the effect of social rehabilitation in PTSD Symptoms Group Mean
Pre-test
SD
Pre-test
Mean
Post-test
SD
Post-test
Mean
Difference
Percentage (%)
Increase/
Decrease in Symptoms
Social rehabilitation
89.25 12.26 64.25 5.77 -25.00 -28.01
Control 103.95 14.85 104.00 14.90 0.05 0.05
Table 4 above, describes the effect of social rehabilitation on aggregate PTSD symptoms
reduction. The pretest and posttest experimental group of means and standard deviation scores on
aggregate PTSD symptom reduction score for social rehabilitation (89.25±12.26 and 64.25±5.77)
and control (109.35±14.85 and 104.0±14.90). The mean difference scores shows +0.05 for the
control group and -25.0 for the social rehabilitation group. There was a 28.01% and 0.05%
reduction in aggregate PTSD symptom scores in the social rehabilitation group and control group
respectively. The pre and post PTSD symptoms remained the same in the control group. This
result suggests that social rehabilitation had a positive effect in reducing PTSD symptom among
internally displaced elderly person. The significance of this result is presented in table 4.
Research question three
What is the interaction effect of gender and social-rehabilitation on symptom-reduction in PTSD
among internally displaced Elderly persons?
Table 4: Mean and standard deviation of the interaction effect of gender and social-rehabilitation
on symptom-reduction in PTSD among internally displaced Elderly persons Aggregate PTSD Symptom Reduction Score
Group Sex Mean
Pre-test
SD
Pre-test
Mean
Post-
test
SD
Post-
test
Mean
Difference
Percentage (%)
Increase/
Decrease in
Symptoms
Control
Male 106.30 17.09 106.40 16.96 0.10 0.00
Female 101.60 12.69 101.60 12.98 0.00 0.00
Total 103.95 14.85 104.00 14.90 0.05 0.00
Social rehabilitation
Male 96.70 10.06 60.30 3.34 -36.40 -0.38
Female 81.80 9.62 68.20 4.94 -13.60 -0.17
Total 89.25 12.26 64.25 5.77 -25.00 -0.28
Table 5 describes the interaction effect of gender and social-rehabilitation on symptom-reduction
in PTSD among internally displaced elderly persons. Male and female participants in the control
group experienced the same PTSD symptom reduction scores. However, male participants
exposed to the social-rehabilitation intervention experienced a higher reduction in PTSD
symptom than their female counterparts. This result suggests an interaction effect of gender and
social rehabilitation on PTSD symptom reduction score among elderly persons in Borno state.
However, the significance of this result was tested and presented in table 5.
Dangana J.M., Onyekachi P.D. & Nnodiemele O.A: The relevance of social-rehabilitation …
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Hypothesis one
There is no significant effect of social-rehabilitation on symptom reduction in PTSD among
internally displaced elderly persons.
Table 5: A Generalized Linear Model (GLM) model of the effect of social-rehabilitation on
symptom-reduction in PTSD Source Type III Sum
of Squares
Df Mean
Square
F p Partial Eta
Squared
Corrected Model 6579.225 1 6579.225 60.804 .000 .615
Intercept 6734.025 1 6734.025 62.235 .000 .621
Social rehabilitation 6579.225 1 6579.225 60.804 .000 .615
Error 4111.750 38 108.204
Total 17425.000 40
Corrected Total 10690.975 39
R Squared = .615 (Adjusted R Squared = .605)
Table 6 presents the Generalized Linear Model (GLM) model result for the main effect of social-
rehabilitation on symptom-reduction. The result showed that there is a significant effect of social
rehabilitation on symptom-reduction in PTSD among internally displaced Elderly persons (F (1, 39)
= 60.804; p = 0.000, Partial Eta Squared = 0.615). The Partial Eta Squared value (0.615) indicates
that social-rehabilitation intervention accounted for 61.5% of the variability in symptom
reduction in PTSD leaving 38.5% to variables not considered in the GLM model. Therefore, the
null hypothesis which states that there is no significant effect of social-rehabilitation on symptom
reduction in PTSD among internally displaced Elderly persons is rejected. By implication, social-
rehabilitation intervention reduces PTSD symptoms among internally displaced elderly persons
in Borno state.
Hypothesis two
There is no significant interaction effect of gender and social-rehabilitation on symptom-
reduction in PTSD among internally displaced Elderly persons.
Table 7: A Generalized Linear Model (GLM) model of the interaction effect of gender and
social-rehabilitation on symptom-reduction in PTSD Source Type III
Sum of
Squares
Df Mean
Square
F P Partial
Eta
Squared
Corrected Model 8826.475a 3 2942.158 56.808 .000 .826
Intercept 6734.025 1 6734.025 130.021 .000 .783
Social rehabilitation 6579.225 1 6579.225 127.033 .000 .779
Sex 1113.025 1 1113.025 21.490 .000 .374
Social rehabilitation
* Sex
1134.225 1 1134.225 21.900 .000 .378
Error 1864.500 36 51.792
Total 17425.000 40
Corrected Total 10690.975 39
R Squared = .826 (Adjusted R Squared = .811)
The effects of gender and social-rehabilitation on symptom-reduction in PTSD is presented in the
table above. The result F (1, 39) value of 21.90 (p = 0.000, Partial Eta Squared = 0.378) is significant
at 0.05 level of significant. Therefore, the null hypothesis which states that there is no significant
interaction effect of gender and social-rehabilitation on symptom-reduction in PTSD among
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99
internally displaced Elderly persons is rejected. This means that there is significant interaction
effect of gender and social-rehabilitation on symptom-reduction in PTSD among internally
displaced Elderly persons. Gender and social-rehabilitation jointly interact to explain 82.6% (R
Squared = .826) symptom-reduction in PTSD among internally displaced Elderly persons.
Discussion
The challenges experienced by elderly persons, are often chronic and disabling especially in the
event that they are hunted by disaster or conflict. For the elderly persons who experienced forced
displacement their conditions seems often, more complex and complicated which poses
difficulties to manage. Thus developing support intervention for the elderly persons in internal
displacement requires a number of multiple treatment approaches one of which includes social-
rehabilitation.
However, rehabilitation which is a set of therapeutic interventions that enables a person’s
potential: while handing her/him back power to improve her/his life (Farkas, 2010). Therefore,
this study implemented social-rehabilitation as a therapeutic intervention this included:
vocational skill driven which is peculiar to the participants cultural activities and hands-on
activities (micro-gardening, irrigation farming, knitting, cattle fattening, hunting, hand craft,
storytelling, cooking lessons, and local games). However, the discussion of the findings from this
study will be based on the tested hypotheses.
Comparisons of PTSD and related symptoms among participants showed that the two groups
(Social-Rehabilitation and the Control) presented near similar at the base line, further,
comparison of PTSD prevalence and symptom among participants at posttest and follow up,
shows a more significant decrease difference between the social-rehabilitation group and the
control group especially in the direction of the postulated hypothesis, this agrees with observation
made by Nena, et al., 2014 where they examined trauma informed treatment decreases PTSD
among women offenders, they poised that between-group comparison PTSD related
symptomatology were similar at baseline and at follow-up presented significant difference for
each of the measures of PTSD symptomatology between groups in the hypothesized direction.
After controlling for noted baseline differences, repeated measure whilst analyzed, presented
significant interaction effect between the two groups, gender and social-rehabilitation on
symptom-reduction in PTSD among IDEP for two of the three GLM analysis (gender and social-
rehabilitation). Venturing into why the interaction was significant is difficult for some of the
symptoms. Recurrent experiences about the trauma, reprisal attacks, sleeplessness, emotional
instability such as getting upset intermittently, nightmares, feeling of hopelessness this are
indicators of re-experiencing or trigger of PTSD symptoms. Such results may help to identify the
survivors with an increased risk for either PTSD or psychiatric morbidity (Jia, et al., 2010),
because disaster-related psychological sequelae may last for many years (Fichter, et al., 2008;
Yule, 2001)
Further, considering that the interventive recovery thrust, specifically driven from cultural
activities has helped to ensured that participants altered function is redefined from a practical
standpoint. Given to this evidence our finding suggested that social rehabilitation can only be
achieved through non-clinical intervention which aims at developing abilities and cultural
support. Moreover, factors such as social isolation is one of the primary trigger of PTSD
symptom hence the need of providing social-rehabilitation in form of hands-on vocational and
non-hands-on vocational activities is apparently suitable.
Dangana J.M., Onyekachi P.D. & Nnodiemele O.A: The relevance of social-rehabilitation …
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Conclusion
Hence, granting support with engaging the elderly with hands-on activities which are culturally
relevant emanating from amongst them will be recommended as it would reduce traumatic
symptoms. As functional decline advances, specific multi rehabilitative interventions can be
planned and explored among the elderly.
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