Nigerian language as a contextual moderator of trauma-related PTSD and CPTSD among Liberian and Sierra Leonean refugee children in Oru Refugee Camp: A social-ecological moderation model of refugee children’s trauma

Abstract Background The closure of the Oru refugee camp in 2012 by the Nigerian government, following the withdrawal of legal and humanitarian support by the United Nations High Commission for Refugees, exposed Liberian and Sierra Leonean stateless refugee children to multiple and chronic traumatic experiences, resulting in forced relocation to an uninhabitable host community. To date, no study has examined their mental health outcomes. This study investigates how different trauma types affect complex PTSD (CPTSD), PTSD, and functional impairment, and examines whether Nigerian and parental language proficiency moderate these associations within a social ecological framework. Methods A cross-sectional study was conducted with 320 stateless refugee children aged 6–17 years (137 males, 183 females) in Nigeria. Trauma exposure and PTSD symptoms were assessed using DSM-5–based measures (CATS; CPSS-SR-5), while ICD-11 PTSD and CPTSD diagnoses were derived using the ITQ-CA. Functional impairment and school-based support were measured with standardized instruments. Data were analyzed using SPSS v22 and SmartPLS for moderation analyses. Results Based on ICD-11 criteria, 50.0% of participants met PTSD and 24.1% met CPTSD criteria. DSM-5 analyses indicated that 31.3% met full PTSD criteria, with many exhibiting subthreshold symptoms. Witnessed and physical trauma were strongly associated with PTSD severity and functional impairment, whereas emotional and sexual trauma were associated with disturbances in self-organization (DSO), indicative of CPTSD. Teacher support was associated with lower DSO symptoms; however, this effect was moderated by Nigerian language proficiency (β = −0.230, 95% CI [−0.338, −0.121]), such that support was protective only for children with higher Nigerian language proficiency. Conclusions Trauma-related psychopathology among stateless refugee children is highly prevalent and shaped by ecological and institutional conditions. School-based teacher support can protect against DSO symptoms, but its effectiveness depends on children’s linguistic access. These findings highlight the need to integrate ICD-11 CPTSD and DSM-5 PTSD frameworks and underscore the importance of linguistically inclusive, trauma-informed educational and mental health interventions in humanitarian settings.