13 psychological disorder. One study from Sri Lanka showed a prevalence of about 64% in a general population, with a wide variety of disorders seemingly related to war trauma,24 which is a prevalence rate frequently found in refugee populations.25 The prevalence of disorders due to trauma is rather variable, and has been assessed in two ways: one approach has been to examine prevalence in the general population, whilst the other has been to examine prevalence in "high risk" groups. For example, the Epidemiological Catchment Area(ECA) Survey estimated the lifetime prevalence of PTSD at about 1.3% in the general population, and at 3.5% in persons exposed to civilian or military violence, whilst a rate of 20% was found for veterans wounded in Vietnam.26 Another community based epidemiological study estimated the lifetime and six-month prevalence rates at 1.3 and 0.44% respectively.27 Those with PTSD had greater job instability, a family history of psychiatric disorder, parental poverty, and child abuse. The National Vietnam Veterans Readjustment Study reported lifetime prevalence rates of 30.9% for males and 17.5% for females, whilst, for those exposed to high war zone stress, the current prevalence rates were 38.5% and 17.5% for men and women respectively. Thus, work on the health consequences of trauma and organised violence indicates very strong associations between trauma and psychological disorder, and an indication that there is a "dose -response" effect: the more severe the trauma the more likely that there is an associated psychological disorder. This hypothesis would therefore predict much higher rates of disorder in torture survivors than in people who merely experience an isolated incident of trauma, such as a motor traffic accident. However, this view is modified by a recent study which demonstrated that PTSD was more strongly predicted by the subjective appraisal of trauma than the type of injury received.28 Furthermore, the applicability of PTSD to torture has also been modified by recent work, which indicates that PTSD is merely one of several diagnoses applicable to torture. 29 In Africa, clinical or epidemiological studies of the health consequences of organised violence are rare, although there is a large literature making comment upon such effects, especially the effects upon children.30 There are a few clinical studies, which generally support the conclusions of the Western work.31 Recent Zimbabwean work has suggested that disorders due to violence may be high in vulnerable populations, such as refugees, and the most recent work indicates very high rates of these disorders in areas that suffered during the Liberation War of the 1970's.32 24 See Somasundaram & Sivayokan.(1994), War trauma in a civilian population, BRIT.J.PSYCHIAT., 165, 524-527. 25 See Reeler & Immerman.(1994), An initial investigation into psychological disorders in Mozambican refugees: Prevalence and clinical features, CENTRAL AFRICAN JOURNAL OF MEDICINE, 40, 309-315 26 See Helzer,Robins & McEvoy.(1987), Post-traumatic stress disorder in the general population: Findings of the Epidemiologic Catchment Area Survey, N.E.J.MED., 317, 1630-1634. 27 See Davidson et al.(1991), Post-traumatic stress disorders in the community: An epidemiological study, PSYCHOL.MED., 21, 713-721. 28 See Feinstein & Dolan.(1992), Predictors of post-traumatic stress disorder: A examination of the stress criterion, PSYCHOL.MED., 21, 85-91. 29 See Turner & Gorst-Unsworth (1990), Psychological sequelae of torture, a descriptive model, BRIT.J.PSYCHIAT., 157, 475-480. See Dawes.(1994), The Emotional Impact of Political Violence, in A.DAWES, & D,DONALD, (eds), “Childhood and Adversity”, Cape Town: David Phillip. See Michelson.(1994), Township violence, levels of distress, and post-traumatic stress disorder, among displacees from Natal, PSYCHOL. IN SOCIETY, 18, 47-56; Straker.(1993), Exploring the effects of interacting with survivors of trauma, J.SOC.DEV. IN AFRICA., 8, 33-47. 30 31 32 See Reeler.(1995), Trauma in Mozambican refugees: Findings from a training programme for refugee workers, TORTURE, 5, 18-21; Reeler & Immerman.(1994), An initial investigation into psychological disorders in Mozambican refugees: Prevalence and clinical features, CENTRAL AFRICAN JOURNAL OF MEDICINE, 40, 309-315; Reeler & Mupinda.(1996), An Investigation into the Sequelae of Torture and Organised Violence in Zimbabwean war veterans, LEGAL FORUM, 8, 12-27; Reeler & Mupinda.(1995), Report of a pilot project to assist survivors of torture and organised violence in Mount Darwin District, Zimbabwe, April-July 1995, Harare: AMANI.