Open Access Research article

Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey

Ian Soosay1*, Derrick Silove2, Catherine Bateman-Steel2, Zachary Steel2, Paul Bebbington3, Peter B Jones4, Tien Chey2, Lorraine Ivancic2 and Claire Marnane2

Author Affiliations

1 Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

2 Psychiatry Research & Teaching Unit, University of New South Wales, Liverpool Hospital, Cnr Forbes & Campbell Streets, Liverpool, Australia

3 UCL, Mental Health Sciences Unit, Riding House Street, London, UK

4 Department of Psychiatry, University of Cambridge, Hills Road, Cambridge, UK

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BMC Psychiatry 2012, 12:229  doi:10.1186/1471-244X-12-229

Published: 18 December 2012



Studies in developed countries indicate that psychotic-like symptoms are prevalent in the community and are related to trauma exposure and PTSD. No comparable studies have been undertaken in low-income, post-conflict countries. This study aimed to assess the prevalence of psychotic-like symptoms in conflict-affected Timor Leste and to examine whether symptoms were associated with trauma and PTSD.


The Psychosis Screening Questionnaire and the Harvard Trauma Questionnaire (assessing trauma exposure and PTSD) were administered in an epidemiological survey of 1245 adults (response rate 80.6%) in a rural and an urban setting in Timor Leste. We defined PSQ screen-positive cases as those people reporting at least one psychotic-like symptom (paranoia, hallucinations, strange experiences, thought interference, hypomania).


The prevalence of PSQ screen-positive cases was 12 percent and these persons were more disabled. PSQ cases were more likely to reside in the urban area, experienced higher levels of trauma exposure and a greater prevalence of PTSD. PTSD only partially mediated the relationship between trauma exposure and psychotic-like symptoms.


Psychotic-like symptoms may be prevalent in countries exposed to mass conflict. The cultural and contextual meaning of psychotic-like symptoms requires further inquiry in low-income, post-conflict settings such as Timor Leste.