10 Some evidence in this regard comes from observations that a disproportionate burden of mortality after conflict comes from indirect causes, including disruption in basic services, social functioning, and the provision of adequate health care. 9 It has been suggested, however, that wholesale disruption to individual daily experiences and social context rather than isolated changes on any individual-level risk factor for psychopathology drives population health after conflict. Studies in postconflict areas have shown that specific subgroups are at greater risk of PTSD than others, including, for example, women 8 and those who experience severe traumatic event exposure. 3– 6 Most recently, a study conducted in Liberia showed that 44% of the population had symptoms consistent with PTSD. 1, 2 Several large studies conducted in low-income countries show that the prevalence of psychopathology overall and posttraumatic stress disorder (PTSD) in particular is substantially higher in countries and among populations that have experienced conflict or mass traumatic events. There is ample evidence that there is a substantial burden of psychopathology among those engaged in war-on combatants and civilians alike. Persistent postconflict disruptions of social and physical context may explain some of the observed patterns. The demonstration of a “path of PTSD” coincident with the decades-old path of violence dramatically underscores the direct link between population burden of psychopathology and the experience of violent conflict. The geographical patterns of traumatic event experiences and of PTSD were consistent with the best available information about the path of the intranational conflict that Nimba County experienced in 1989–1990.Ĭonclusions. The prevalence of PTSD in Nimba County was high at 48.3% (95% confidence interval = 45.7, 50.9 n = 664). In addition, we conducted a historical analysis of conflict in Nimba County, Liberia, where the civil war started in 1989. We administered individual surveys to a population-based sample of 1376 adults aged 19 years or older. We assessed the geographical distribution of posttraumatic stress disorder (PTSD) in postconflict Nimba County, Liberia, nearly 2 decades after the end of primary conflict in the area, and we related this pattern to the history of conflict.

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