Mental health and resilience following violent incidents in Nigeria (MaRVIN)
Embargo Date
2028-01-20
OA Version
Citation
Abstract
BACKGROUND: Nigeria's protracted conflicts—including Boko Haram insurgency, farmer-herder violence, banditry, separatist conflicts, and resource-related violence—have exposed millions of persons to trauma, displacement, and economic devastation. Despite evidence suggesting extremely high mental health burden in conflict-affected populations globally, no validated mental health screening instruments existed for Nigerian conflict contexts, and no nationally representative data documented PTSD, depression, and anxiety prevalence or access to mental health services across Nigeria's diverse conflict zones. This critical gap in both measurement tools and epidemiological evidence prevented evidence-based mental health policy development and humanitarian program planning. OBJECTIVES: This three-manuscript dissertation aimed to: (1) culturally adapt and validate the PCL-5, PHQ-9, and GAD-7 for use in violence-affected Nigerian populations; (2) estimate weighted prevalence of probable PTSD, depression, and anxiety and identify key predictors across five conflict-affected states; and (3) examine the interaction between cumulative trauma exposure and daily stressors in predicting mental health outcomes, testing whether traditional cumulative stress models remain valid at extreme trauma exposure levels. Methods: The MaRVIN project employed a two-phase design. Phase 1 (validation study) enrolled 205 adults from Abuja IDP camps for psychometric evaluation including expert review (n=3 psychiatrists), cognitive interviewing (n=30), reliability analysis, factor analysis, and criterion validity assessment against CAPS-5 and MINI clinical interviews. Phase 2 (population survey) implemented multistage cluster sampling across five states representing five of Nigeria's six geopolitical zones (Benue, Borno, Enugu, Rivers, Sokoto), enrolling 1,371 adults. Data collection employed 60 trained field epidemiologists using ODK mobile data capture. Analysis used survey-weighted methods accounting for complex sampling design, with modified Poisson regression estimating prevalence ratios for predictors. RESULTS: In Phase 1, internal consistency coefficients were PCL-5 α=0.915, PHQ-9 α=0.906, and GAD-7 α=0.864. ROC analyses identified cut-points PCL-5≥38 (AUC=0.706), PHQ-9≥10 (AUC=0.697), and GAD-7≥8 (AUC=0.576). Exploratory factor analysis of the PCL-5 yielded four factors explaining 57.1% of variance: intrusion, a novel behavioral-cognitive cluster, avoidance, and hyperarousal. In Phase 2, weighted prevalence estimates were PTSD 20.8% (95% CI: 18.4–23.2), depression 23.2% (20.6–25.7), and anxiety 24.3% (21.6–26.9); 40% met criteria for two or more conditions. Persons in the poorest wealth quintile had PTSD prevalence ratio 2.08 (95% CI: 1.26–3.42) versus the wealthiest quintile. Widowed persons had depression prevalence ratio 2.00 (95% CI: 1.16–3.40) versus never-married persons. Each additional daily socioeconomic stressor was associated with a 3–4% increase in prevalence of all three conditions. Interaction models indicated variation in the association between daily stressors and mental health outcomes across trauma strata, with weaker marginal effects of additional stressors among respondents with the highest trauma exposure. SIGNIFICANCE: This dissertation provides validated mental health screening instruments for conflict-affected Nigerian populations and multi-state mental health prevalence estimates across diverse conflict zones. It also contributes to global PTSD research by identifying a unique symptom dimension that may reflect culturally specific trauma responses. Findings from Study 2 indicate that about one in four conflict-affected Nigerian adults meets criteria for clinically significant symptoms, with high comorbidity and clear socioeconomic gradients. The work shows that poverty and ongoing daily stressors function as key determinants of mental health outcomes, suggesting that livelihood and social protection programs can be conceptualized as mental health interventions. High comorbidity (40% with ≥2 conditions) supports integrated, transdiagnostic mental health services rather than disorder-specific vertical programs. Geographic heterogeneity in prevalence (PTSD ranging 7.7% to 29.2% across states) indicates that conflict-related mental health burden cannot be inferred from national averages and that state-level data should guide resource allocation. The validated instruments enable systematic mental health monitoring in humanitarian programs and primary care and address a measurement gap for evidence-based mental health system development in Nigerian conflict settings. Interaction analyses indicate a saturation effect at higher trauma levels, with smaller marginal effects of additional daily stressors among respondents with the highest trauma exposure. This pattern suggests that interventions targeting daily stressors may have larger marginal impact among persons with low to moderate trauma exposure, whereas persons with very high trauma exposure may require strategies that more directly address trauma-related mechanisms.This applied public health research directly informs: (1) Nigeria's National Mental Health Act 2021 and the National Mental Health Policy 2023 and their implementation by providing evidence population needs; (2) humanitarian mental health program design through validated screening tools and prevalence benchmarks; (3) task-sharing intervention development by establishing that non-specialist health workers can implement validated screening; and (4) mental health policy advocacy through robust population-based evidence demonstrating that mental health burden in Nigerian communities affected by conflict is comparable to that documented in other humanitarian emergencies globally. The research exemplifies DrPH training's emphasis on translational science—producing not only publications but actionable tools and evidence that strengthen health systems and inform policy decisions for vulnerable populations.
Description
2026
License
Attribution 4.0 International