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In most low- and middle-income countries (LMICs), such as Ethiopia, people with severe mental illness (SMI)
experience high rates of stigma and human rights abuses. However, little is known about the types of events that
people with SMI in LMICs view as traumatic or how these events impact their lives. Purposeful sampling was used
to recruit 48 patients, caregivers, health care providers, and leaders from Sodom District, Ethiopia. Semi-structured,
in-depth interviews were conducted, recorded, transcribed in Amharic and translated into English. Two coders
conducted thematic analysis using NVIVO 12. Commonly occurring potentially traumatic events (PTEs) included
beatings, sexual assault, and sudden death of loved ones. In addition to PTEs that met DSM-5 requirements,
participants described other frightening experiences that caused suffering or emotional pain including being
chained, inability to afford basic needs like food, stressful marital relationships, serious illnesses, and stigma and
discrimination. Many participants attributed the onset of SMI to PTEs. In response to PTEs, participants described
experiencing PTSD symptoms including avoidance, hyperarousal, re-experiencing, and negative thoughts as well
as worsening of SMI. In rural Ethiopia many PTEs do not fit DSM-5 criteria but are still associated with PTSD
symptoms and illness onset and exacerbation.