Nigeria continues to face several insurgencies or conflicts related to ethnic, religious, political and regional divisions such as those over resources in the Niger Delta region, Christian-Muslim division in the middle part of the country, rises in the Islamist groups in the north and cases of kidnapping and banditry in the South [1] . The insurgency has intensified with improvised devices (IEDs) and suicide bombing. The Boko Haram sect of an Islamist group had played key roles in offensive attacks on Christians, churches, mosques, schools, and other public places in Nigeria. As of 2018, an estimated 14.8 million people have been affected by insurgency, 1.7 million internally displaced, 229 refugees and widespread property destruction [2] .

The Nigerian Government responded to the ongoing crisis by deploying military personnel to most parts of the country, particularly in the Northeast, to subdue conflicts. Several states have also engaged local security personnel such as vigilantes, joint task forces and hunters to protect communities from bandits [2] .

On 5^th June 2022, a mass attack involving multiple gunshots and explosions occurred in Owo community, Ondo State, Nigeria. It was reported that some groups of gunmen entered a church and began shooting sporadically. Some explosive devices were also detonated on both the inside and outside of the church building during worship. According to the Ondo State situation report on the 21^st June 2022, a total of 249 people were affected by the attack, 40 died and 92 were hospitalized in five major hospitals in the state. The Ondo State government, in collaboration with the World Health Organization and other agencies, has responded to the event by ensuring that all the affected persons receive timely medical care, and mental health and psychosocial support.

The effect of traumatic events on an individual has been a subject of study for many years. These effects may vary, including both psychological and physiological consequences. Psychologically, exposure of an individual to a traumatic event often results in increased rates of acute stress disorder, post-traumatic stress disorder (PTSD), major depression and generalized anxiety disorder. Most studies have focused on PTSD because it is a recognized and well-defined result of traumatic events [3] . Previous studies have found an increased rate of mental disorders, particularly for isolated attacks in countries not at war and continued political conflicts [4] [5] . The prevalence of PTSD ranges from 1% to 60%, depending on the target population and the measures used to establish the diagnosis [6] . A study among Pakistani emergency responders exposed to terrorist attacks showed the prevalence of PTSD to be 15%, and 11% - 16% revealed heightened levels of anxiety and depression [7] . In Northeast Nigeria, the prevalence of PTSD was 63.7% among Internally Displaced Persons (IDPs), while Agbir et al. (2016) and Sheikh et al. (2014) found 42% and 57.8% prevalence of PTSD among IDPs in the North-Central and North-Western Nigeria respectively [8] [9] .

This study was an ongoing mental and psychosocial intervention among victims of a mass attack in Owo, Ondo State, Nigeria. The study, being the first to be conducted following the attack, aims to assess the mental health status of victims, and identify factors associated with PTSD among them. The study’s findings will guide additional mental health and psychosocial support for the victims.

This study assessed the mental health status of victims of a mass casualty following multiple gunshots and explosions in a church in Owo, Ondo State, Nigeria. We found that the males were more affected, particularly those between 11 - 20 years of age, compared to the females. This finding is similar to another study among Internally Displaced Persons (IDPs) in Jos, Nigeria, where more respondents were young and male [14] . In addition, a previous study among victims of mass casualty in Kano, Nigeria, shows a similar mean age group of 33.4 ± 19.25 years to this study (32.2 ± 1.33 years) [15] . This finding relates to the fact that there was industrial action in tertiary institutions in Nigeria during the study period. Hence, most students were not in school, which may have led to a high turnout of young ones during the church service where the attack occurred. We found that the majority of the victims were from the Yoruba ethnic group, which is a typical Owo city metropolis, and their religion is Christian in keeping with the church attack.

*Others: Pastors, Red cross, Teacher.

We found that 42.6% of the respondents had provisional PTSD, while more than one-tenth had a severe anxiety disorder. The high prevalence of provision PTSD in this study is similar to those reported in Northcentral (42%) and Northwestern (57.8%) parts of Nigeria respectively [8] [9] , lower than 63.7% reported in an earlier study in Jos, Nigeria [14] and higher than 15% reported in Pakistan [7] . The low prevalence of PTSD in the Pakistan study compared to ours may be attributed to the circumstance that respondents were emergency responders who may not have had face-to-face encounters with assailants and could have had PTSD due to several exposures to attacks while performing duties compared to this study where the majority of the respondents reported to have close contact with the gunmen. This finding suggests that exposure to traumatic conflict is associated with an increased prevalence of PTSD.

We found that most victims reported receiving counseling from healthcare professionals. The initial assessment of the victims at the treatment centers following the attack led to intensified counseling by healthcare professionals or counselors who provided mental health and psychosocial support to them.

In this study, we found a significant relationship between marital status and the level of anxiety disorder and PTSD. Respondents who were married had higher mean levels of anxiety disorder and PTSD compared to those who were not married. The findings of this study are different from those of previous studies [16] [17] which revealed greater perceived social support and lower levels of mental disorders among victims who were married compared to those not married. It is believed that marriage could serve as a mediator that provides social integration and feelings of belonging and purpose to individuals [18] . The high level of mental disorders among the married may be due to the circumstance that the event took place in church, where families are expected to visit. This is also supported by a significant number of people who reported that their spouse and children were at the venue of the attack.

We found that the mean level of PTSD increased with the rise in age significantly. It is generally known that adults aged 65 and above might have been exposed to at least one potential event during their lifetime [19] . Earlier studies based on community samples of older adults found that 70% of older men reported lifetime exposure to trauma [19] . Most of the older respondents in this study were married and were with their family members who may have sustained various injuries or died following the attack. This might have resulted in high mental health disorders among them.

In this study, respondents who were counseled by healthcare workers had a higher mean level of anxiety disorder and provisional PTSD compared to those not counseled. Following the attack, victims were assessed and categorized based on their current mental health status, and those directly affected by the attack were visited more often by the mental health and psychosocial unit of a tertiary hospital in Owo, Ondo State, Nigeria for counseling, while some were also counseled during regular medical check-ups or visits at the health facility. Victims with severe conditions or who might have lost someone during the incident were prioritized for counseling sessions. This may be the reason that a high number of respondents counseled by healthcare workers had mental health issues in this study.

The responses of the participants might have been influenced by recall bias, however, we ensured that key questions were restricted to a specific timeline of two weeks to the study period. In addition, there may be response bias given that some aspects of the questionnaire were self-reported, which may bring back unpleasant memories about the attack but, the questions were phrased simply and concisely for the participants so as to minimize such bias.

The study reveals that a high number of victims of a mass attack following multiple gunshots and explosions were having high levels of anxiety and provisional Post Traumatic Stress Disorder, particularly those that were married and in the older age group following 5 months of the attack. It was observed that those who had received mental health and psychosocial support showed high levels of mental health issues. Psychosocial support has been one of the effective tools for buffering the negative consequences of disasters among victims; however, providing such support does not always result in positive psychological consequences due to several other factors, including the level of income and family support received among victims. Future studies may look into these different factors moderating the effectiveness of supportive interactions among victims of disasters. In addition, there is a need to intensify supportive counseling among the victims including those in the older age group.

The study benefited from the technical contributions of the Ondo State Rapid Response Teams. We appreciate the relentless efforts of personnel involved in data collection and other processes of the study.

Authors AMA and DDO conceived the study. Author AMA conducted the analysis and wrote the first draft of the manuscript. All authors reviewed the first draft and approved the final manuscript.

The ethical approval for this study was obtained from Health Research Ethics Committee of the Ondo State Ministry of Health, Ondo State Nigeria. Informed consent was obtained from the respondents before the commencement of the interview.

The authors declare that they have no conflict of interest.

Adejugbagbe, A.M., Omoniyi, D.D., Fatiregun, A.A., Dosumu, M.O., Onyejiaka, N., Ajaka, B.A. and Fagbemi, S. (2024) Psychological Consequences of a Mass Attack Following Multiple Gunshots and Explosions among Victims in a State in Southwest Nigeria. Open Journal of Epidemiology, 14, 90-109. https://doi.org/10.4236/ojepi.2024.141007

Questionnaire

Psychological consequences of a mass attack following multiple gunshots and explosions among victims in a state in Southwest Nigeria

Section 1: Socio-demographic characteristics of respondents

Section 2: Psychological consequences of attack among respondents

Section 3: Symptoms levels of anxiety and depression (Anxiety and Depression Questionnaire)

Section 4: Participants’ threat experienced during and after the event

Levels of perceived social support following the mass attack