ORIGINAL PAPER
Study of the effect of post-traumatic stress disorder and comorbid disorders on the daily lives of schoolchildren aged 11 to 16 in public schools in Morocco
1
Health and Nutrition Research Team of the Mother and Child Couple, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
Submission date: 2024-09-20
Final revision date: 2025-09-29
Acceptance date: 2025-10-09
Online publication date: 2026-01-16
Corresponding author
Khalid Astitene
Health and Nutrition Research Team of the Mother and Child Couple, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
Health and Nutrition Research Team of the Mother and Child Couple, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
KEYWORDS
TOPICS
ABSTRACT
Background:
Post-traumatic stress disorder (PTSD) can develop after exposure to traumatic events such as those involving actual or threatened death, serious injury, or sexual violence. This survey was conducted to assess the prevalence of PTSD among adolescents attending public schools in the city of Salé in Morocco and to study the levels of anxiety and depression – the most common disorders associated with PTSD.
Participants and procedure:
Based on a cross-sectional survey, 900 schoolchildren with an age between 11 and 16 years old were selected. The percentage of participants who agreed to take part was 89%. The validated questionnaires (socio-demographic data, list of life events, CPTS-RI, CDI and STAIY) were completed by the schoolchildren. Using SPSS statistical software, Student’s t-test, Cohen’s d test, chi-square (χ2), Cramer’s V, and Pearson’s correlation (r) were calculated. The research project began after receiving research authorization from the Ministry of National Education, and consent forms were signed by partici-pants.
Results:
The prevalence of PTSD was 31.7%. Factors such as adolescent developmental characteristics, socioeconomic status, and parental education level may contribute to the observed prevalence. A higher percentage of this disorder was observed in girls (60.7%) than in boys (39.3%) (p = .008, d = 0.75). This prevalence reflects the proportion of schoolchildren currently exhibiting PTSD symptoms. Among participants, 77.2% exhibited anxiety symptoms and 51.3% exhibited depressive symp-toms.
Conclusions:
PTSD has negative consequences for the well-being of school-age adolescents, affecting their emotional, social, and aca-demic functioning. Interventions are available to treat this disorder in affected adolescents. Adolescents with PTSD should have access to professional psychological care from trained specialists, as well as support from their families.
Post-traumatic stress disorder (PTSD) can develop after exposure to traumatic events such as those involving actual or threatened death, serious injury, or sexual violence. This survey was conducted to assess the prevalence of PTSD among adolescents attending public schools in the city of Salé in Morocco and to study the levels of anxiety and depression – the most common disorders associated with PTSD.
Participants and procedure:
Based on a cross-sectional survey, 900 schoolchildren with an age between 11 and 16 years old were selected. The percentage of participants who agreed to take part was 89%. The validated questionnaires (socio-demographic data, list of life events, CPTS-RI, CDI and STAIY) were completed by the schoolchildren. Using SPSS statistical software, Student’s t-test, Cohen’s d test, chi-square (χ2), Cramer’s V, and Pearson’s correlation (r) were calculated. The research project began after receiving research authorization from the Ministry of National Education, and consent forms were signed by partici-pants.
Results:
The prevalence of PTSD was 31.7%. Factors such as adolescent developmental characteristics, socioeconomic status, and parental education level may contribute to the observed prevalence. A higher percentage of this disorder was observed in girls (60.7%) than in boys (39.3%) (p = .008, d = 0.75). This prevalence reflects the proportion of schoolchildren currently exhibiting PTSD symptoms. Among participants, 77.2% exhibited anxiety symptoms and 51.3% exhibited depressive symp-toms.
Conclusions:
PTSD has negative consequences for the well-being of school-age adolescents, affecting their emotional, social, and aca-demic functioning. Interventions are available to treat this disorder in affected adolescents. Adolescents with PTSD should have access to professional psychological care from trained specialists, as well as support from their families.
REFERENCES (61)
1.
Ainamani, H. E., Weierstall-Pust, R., Bahati, R., Otwine, A., Tumwesigire, S., & Rukundo, G. Z. (2022). Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda. European Journal of Psychotraumatology, 13, 2007730. https://doi.org/10.1080/200081....
2.
Alkharashi, Y. M., Alrasheed, F., Alhussaini, N., Almosa, A., Alkharashi, N., & Alsalamah, M. (2022). Prevalence of post-traumatic stress disorder among all emergency workers at Saudi tertiary care center in Riyadh, Saudi Arabia. Journal of Pharmaceutical Research International, 34, 1–10. https://doi.org/10.9734/jpri/2....
3.
Alzaghoul, A. F., McKinlay, A. R., & Archer, M. (2022). Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: Systematic review. BJPsych Open, 8, e153. https://doi.org/10.1192/bjo.20....
4.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revi-sion). APA Publishing.
5.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed., text revi-sion). APA Publishing.
6.
Amin, R., Nadeem, E., Iqbal, K., Asadullah, M. A., & Hussain, B. (2020). Support for Students Exposed to Trauma (SSET) program: an approach for building resilience and social support among flood impacted children. School Mental Health, 12, 493–506. https://doi.org/10.1007/s12310....
7.
Anderson, T. L., Valiauga, R., Tallo, C., Hong, C. B., Manoranjithan, S., Domingo, C., Paudel, M., Untaroiu, A., Barr, S., & Goldhaber, K. (2025). Contributing factors to the rise in adolescent anxiety and associated mental health disorders: a narrative review of current literature. Journal of Child and Adolescent Psychiatric Nursing, 38, e70009. https://doi.org/10.1111/jcap.7....
8.
Assmann, N., Fassbinder, E., Schaich, A., Lee, C. W., Boterhoven de Haan, K., Rijkeboer, M., & Arntz, A. (2021). Differential effects of comorbid psychiatric disorders on treatment outcome in posttraumatic stress disorder from childhood trauma. Journal of Clinical Medicine, 10, 3708. https://doi.org/10.3390/jcm101....
9.
Astitene, K., Aguenaou, H., Lahlou, L., & Barkat, A. (2020). Prevalence of post-traumatic stress disorder among school-age adolescents. International Neuropsychiatric Disease Journal, 14, 40–49. https://doi.org/10.9734/INDJ/2....
10.
Astitene, K., & Barkat, A. (2021). Prevalence of post-traumatic stress disorder among adolescents in school and its impact on their well-being: a cross-sectional study. Pan African Medical Journal, 39, 54. https://doi.org/10.11604/pamj.....
11.
Astitene, K., & Barkat, A. (2022). The prevalence and impact of post-traumatic stress disorder among Moroccan adolescents enrolled in public high schools in Salé: a cross-sectional study. Archives of Psychiatry Research, 58, 81–90. https://doi.org/10.20471/may.2....
12.
Basedow, L. A., Wiedmann, M. F., Roessner, V., & Golub, Y. (2022). Coping motives mediate the relationship be-tween PTSD and MDMA use in adolescents with substance use disorders. Addiction Science & Clinical Practice, 17, 46. https://doi.org/10.1186/s13722....
13.
Borst, B., Jovanovic, T., House, S. L., Bruce, S. E., Harnett, N. G., Roeckner, A. R., Ely, T. D., Lebois, L. A. M., Young, D., Beaudoin, F. L., An, X., Neylan, T. C., Clifford, G. D., Linnstaedt, S. D., Germine, L. T., Bollen, K. A., Rauch, S. L., Haran, J. P., Storrow, A. B., Lewandowski, C., … van Rooij, S. J. H. (2024). Sex differences in re-sponse inhibition-related neural predictors of posttraumatic stress disorder in civilians with recent trauma. Biological Psychiatry, 9, 668–680. https://doi.org/10.1016/j.bpsc....
14.
Boudabous, J., Kerkeni, A., Kraiem, M., Ayadi, H., & Moalla, Y. (2023). Post-traumatic stress disorder in adoles-cents during the COVID-19 pandemic: a cross-sectional Tunisian study. Middle East Current Psychiatry, 30, 101. https://doi.org/10.1186/s43045....
15.
Brewin, C. R., Atwoli, L., Bisson, J. I., Galea, S., Koenen, K., & Lewis-Fernández, R. (2025). Post-traumatic stress disorder: Evolving conceptualization and evidence, and future research directions. World Psychiatry, 24, 52–80. https://doi.org/10.1002/wps.21....
16.
Brown, P. J., Read, J. P., & Kahler, C. W. (2003). Comorbid posttraumatic stress disorder and substance use disor-ders: Treatment outcomes and the role of coping. In P. Ouimette & P. J. Brown (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (pp. 171–188). American Psychological Asso-ciation. https://doi.org/10.1037/10460-....
17.
Christoffersen, M. N., & Thorup, A. A. E. (2024). Post-traumatic stress disorder in school-age children: a nationwide prospective birth cohort study. Journal of Child & Adolescent Trauma, 17, 139–157. https://doi.org/10.1007/s40653....
18.
Chossegros, L., Hours, M., Charnay, P., Bernard, M., Fort, E., Boisson, D., Sancho, P. O., Yao, S. N., & Laumon, B. (2011). Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident. Accident Analysis & Prevention, 43, 471–477. https://doi.org/10.1016/j.aap.....
19.
Clarke, A. T., Grassetti, S. N., Brumley, L., Ross, K. Y., Erdly, C., Richter, S., Brown, E. R., & Pole, M. (2023). Inte-grating trauma-informed services in out-of-school time programs to mitigate the impact of community gun violence on youth mental health. Journal of Prevention & Intervention in the Community, 51, 332–351. https://doi.org/10.1080/108523....
20.
Costello, E., Erkanli, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress, 15, 99–112. https://doi.org/10.1023/A:1014....
21.
Craig, C. D., & Sprang, G. (2014). Gender differences in trauma treatment: Do boys and girls respond to evidence-based interventions in the same way? Violence and Victims, 29, 927–939. https://doi.org/10.1891/0886-6....
22.
Deering, C. G. (2000). A cognitive developmental approach to understanding how children cope with disasters. Journal of Child and Adolescent Psychiatric Nursing, 13, 7–16. https://doi.org/10.1111/j.1744....
23.
DeVries, G. J, & Olff, M. (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress, 22, 259–267. https://doi.org/10.1002/jts.20....
24.
Du, J., Diao, H., Zhou, X., Zhang, C., Chen, Y., Gao, Y., & Wang, Y. (2022). Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. Medical Review, 2, 219–243. https://doi.org/10.1515/mr-202....
25.
Dyregrov, A., & Yule, W. A. (2006). A review of PTSD in children. Child and Adolescent Mental Health, 11, 176–184. https://doi.org/10.1111/j.1475....
26.
Elia, J. (2023). Acute and posttraumatic stress disorders (ASD and PTSD) in children and adolescents. MSD Manuals.
27.
Elklit, A., & Petersen, T. (2008). Exposure to traumatic events among adolescents in four nations. Torture, 18, 2–11.
28.
Fernandez, L., Aulagnier, M., Bonnet, A., Guinard, A., Pedinielli, J. L., & Préau, M. (2005). Module VI: Outils psy-chométriques [Module VI: Psychometric tools]. In P. Verger, M. Aulagnier, V. Schwoebel, & T. Lang (Eds.), Démarches épidémiologiques après une catastrophe [Epidemiological procedures following a disaster] (pp. 201–204). La Documentation Française.
29.
Fox, V., Dalman, C., Dal, H., Hollander, A. C., Kirkbride, J. B., & Pitman, A. (2021). Suicide risk in people with post-traumatic stress disorder: a cohort study of 3.1 million people in Sweden. Journal of Affective Disorders, 15, 609–616. https://doi.org/10.1016/j.jad.....
30.
Halaly, S., Auf, A. I., Mohammed, M. A. A., Mouhammed, A. A., Albasheer, R. A., Alrahman, W. A. A., & Osman, A. H. (2024). Assessing the prevalence of post-traumatic stress disorder and its risk factors among adult inter-nally displaced persons in Sudan. Journal of Advances in Medicine and Medical Research, 36, 337–347. https://doi.org/10.9734/jammr/....
31.
Hicks, E. M., Niarchou, M., Goleva, S., Kabir, D., Johnson, J., Johnston, K. J. A., Ciarcia, J., Pathak, G. A., Smoller, J. W., Davis, L. K., Nievergelt, C. M., Koenen, K. C., Huckins, L. M., & Choi, K. W. (2024). Comorbidity profiles of posttraumatic stress disorder across the medical phenome. Biological Psychiatry Global Open Science, 4, 100337. https://doi.org/10.1016/j.bpsg....
32.
Hodges, M., Godbout, N., Briere, J., Lanktree, C., Gilbert, A., & Kletzka, N. (2013). Cumulative trauma and symp-tom complexity in children: a path analysis. Child Abuse & Neglect, 37, 891–898. https://doi.org/10.1016/j.chia....
33.
Jannini, T. B., Longo, L., Rossi, R., Niolu, C., Siracusano, A., & Di Lorenzo, G. (2023). Complex post-traumatic stress disorder (cPTSD) and suicide risk: a multigroup mediation analysis exploring the role of post-traumatic symptomatology on hopelessness. Journal of Psychiatric Research, 165, 165–169. https://doi.org/10.1016/j.jpsy....
34.
Josse, E. (2011). Le traumatisme psychique: Chez le nourrisson, l’enfant et l’adolescent [Psychological trauma: In infants, children and adolescents]. De Boeck Superieur.
35.
Kassam-Adams, N., Garcia-Espana, J. F., Miller, V. A., & Winston, F. (2006). Parent-child agreement regarding children’s acute stress: The role of parent acute stress reactions. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1485–1493. https://doi.org/10.1097/01.chi....
36.
Kerig, P. K., & Becker, S. P. (2010). From internalizing to externalizing: Theoretical models of the processes linking PTSD to juvenile delinquency. In S. J. Egan (Ed.), Posttraumatic stress disorder (PTSD): Causes, symptoms and treatment (pp. 33–78). Nova Science Publishers.
37.
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: Un-expected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171, 864-871. https://doi.org/10.1176/appi.a....
38.
Kihas, I., Barrett, E. L., Teesson, M., Touyz, E. L., Newton, N. C., & Mills, K. L. (2024). Co-occurring experiences of traumatic events and substance use among young people. Child Abuse & Neglect, 156, 107003. https://doi.org/10.1016/j.chia....
39.
Konrad, K., Kohls, G., Baumann, S., Bernhard, A., Martinelli, A., Ackermann, K., Smaragdi, A., Gonzalez-Madruga, K., Wells, A., Rogers, J. C., Pauli, R., Clanton, R., Baker, R., Kersten, L., Prätzlich, M., Oldenhof, H., Jansen, L., Kleeven, A., Bigorra, A., Hervas, A., … Freitag, C. M. (2022). Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. Journal of Child Psychology and Psychiatry, 63, 218–228. https://doi.org/10.1111/jcpp.1....
40.
Korte, K. J., Jiang, T., Koenen, K. C., Galea, S., & Gradus, J. L. (2021). Epidemiology of trauma and PTSD in adults. In M. J. Friedman, P. P. Schnurr, & T. M. Keane (Eds.), Handbook of PTSD: Science and practice (3rd ed., pp. 61–75). The Guilford Press.
41.
Koslouski, J. B., Stark, K., & Chafouleas, S. M. (2023). Understanding and responding to the effects of trauma in the classroom: a primer for educators. Social and Emotional Learning: Research, Practice, and Policy, 1, 100004. https://doi.org/10.1016/j.sel.....
42.
Mbwayo, A. W, Mathai, M., Harder, V.S., Nicodimos, S., & Vander-Stoep, A. (2019). Trauma among Kenyan school children in urban and rural settings: PTSD prevalence and correlates. Journal of Child & Adolescent Trauma, 13, 63–73. https://doi.org/10.1007/s40653....
43.
Meiser-Stedman, R., Smith, P., Glucksman. E., Yule, W., & Dalgleish, T. (2007). Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma. Journal of Abnormal Child Psychology, 35, 191–201. https://doi.org/10.1007/s10802....
44.
Melese, M., Maru, L., & Esubalew, D. (2024). Posttraumatic stress disorder and its associated factors among peo-ple living in Dabat district, northwest Ethiopia. Frontiers in Psychiatry, 15, 1359382. https://doi.org/10.3389/fpsyt.....
45.
Nixon, R. D., Nishith, P., & Resick, P. A. (2004). The accumulative effect of trauma exposure on short-term and delayed verbal memory in a treatment-seeking sample of female rape victims. Journal of Traumatic Stress, 17, 31–35. https://doi.org/10.1023/B:JOTS....
46.
Nooner, K. B., Linares, L. O., Batinjane, J., Kramer, R. A., Silva, R., & Cloitre, M. (2012). Factors related to post-traumatic stress disorder in adolescence. Trauma, Violence & Abuse, 13, 153–166. https://doi.org/10.1177/152483....
47.
Novotney, A. (2024, March 6). Women who experience trauma are twice as likely as men to develop PTSD. Here’s why. American Psychological Association. Retrieved from https://www.apa.org/topics/wom....
48.
Pederson, C. L., Maurer, S.H., & Kaminski, P. L. (2004). Hippocampal volume and memory performance in a community-based sample of women with posttraumatic stress disorder secondary to child abuse. Journal of Traumatic Stress, 17, 37–40. https://doi.org/10.1023/B:JOTS....
49.
Phung, B. (2022). Potential challenges and future implications for trauma-informed approaches in schools. Fron-tiers in Education, 7, 1040980. https://doi.org/10.3389/feduc.....
50.
Rabie, M. A., El-Sheikh, M., ElSayed, M., Fekry, M., & Saad, M. (2015). Post-traumatic stress disorder and psychi-atric comorbidity in a sample of Egyptian adolescents after the revolution: a cross-sectional study. Middle East Current Psychiatry, 22, 91–96. https://doi.org/10.1097/01.XME....
51.
Sanger, B. D., Alarachi, A., McNeely, H. E., McKinnon, M. C., & McCabe, R. E. (2025). Brain fog and cognitive dysfunction in posttraumatic stress disorder: an evidence-based review. Psychology Research and Behavior Management, 18, 589–606. https://doi.org/10.2147/PRBM.S....
52.
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxie-ty Inventory. Consulting Psychologists Press.
53.
Stuber, J., Galea, S., Pfefferbaum, B., Vandivere, S., Moore, K., & Fairbrother, G. (2005). Behavior problems in New York City’s children after the September 11, 2001, terrorist attacks. American Journal of Orthopsychiatry, 75, 190–200. https://doi.org/10.1037/0002-9....
54.
Tamir, T. T., Tekeba, B., Mekonen, E. G., Gebrehana, D. A., & Zegeye, A. F. (2025). Shadows of trauma: an um-brella review of the prevalence and risk factors of post-traumatic stress disorder in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 19, 48. https://doi.org/10.1186/s13034....
55.
Tuicomepee, A., & Romano, J. L. (2008). Thai adolescent survivors 1 year after the 2004 tsunami: a mixed methods study. Journal of Counseling Psychology, 55, 308–318. https://doi.org/10.1037/0022-0....
56.
Vila, G., & Bertrand, C. (2003). Exposition de l’enfant au facteur traumatique et réactions parentales. Analyse des interactions et modélisation [Child exposure to the traumatic factor and parental reactions. Analysis of inter-actions and modeling]. Stress et Trauma, 3, 89–91.
57.
Walter, K. H., Levine, J. A., Madra, N. J., Beltran, J. L., Glassman, L. H., & Thomsen, C. J. (2022). Gender differences in disorders comorbid with posttraumatic stress disorder among U.S. sailors and marines. Journal of Traumatic Stress, 35, 988–998. https://doi.org/10.1002/jts.22....
58.
Wamser-Nanney, R., & Cherry K. E. (2018). Children’s trauma-related symptoms following complex trauma ex-posure: Evidence of gender differences. Child Abuse & Neglect, 77, 188–197. https://doi.org/10.1016/j.chia....
59.
Wang, S. K., Feng, M., Fang, Y., Lv, L., Sun, G. L., Yang, S. L., Guo, P., Cheng, S. F., Qian, M. C., & Chen, H. X. (2023). Psychological trauma, posttraumatic stress disorder and trauma-related depression: a mini-review. World Journal of Psychiatry, 13, 331–339. https://doi.org/10.5498/wjp.v1....
60.
Xiang, A. H., Martinez, M. P., Chow, T., Christensen, M. L., Nguyen, A., Duffy, E. Y., Dyer, W., Cummings, C., Beckman, J. A., Tran, N., Young, D. R., Nhan, L. A., Ma, W., Hale, C., Li, Y., Subramaniam, V., Kim, H., Wu, D., Chou, C. P., Liu, C. H., … Nguyen, K. (2024). Depression and anxiety among US children and young adults. JAMA Network Open, 7, e2436906. https://doi.org/10.1001/jamane....
61.
Zhao, L., Wang, H., Wang, K., Shen, C., & Tao, M. (2024). Study on the relationship between PTSD and academic control and academic emotion in primary and middle school students after flood disaster. Frontiers in Psy-chology, 15, 1429238. https://doi.org/10.3389/fpsyg.....
Copyright: © Institute of Psychology, University of Gdansk This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2353-5571 |
| ISSN: | 2353-4184 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
