Abstract
Despite significant research examining mental health in conflict-affected populations we do not yet have a comprehensive epidemiological model of how mental disorders are distributed, or which factors influence the epidemiology in these populations. We aim to derive prevalence estimates specific for region, age and sex of major depression, and PTSD in the general populations of areas exposed to conflict, whilst controlling for an extensive range of covariates. A systematic review was conducted to identify epidemiological estimates of depression and PTSD in conflict-affected populations and potential predictors. We analyse data using Bayesian meta-regression techniques. We identified 83 studies and a list of 34 potential predictors. The age-standardised pooled prevalence of PTSD was 12.9% (95% UI 6.9-22.9), and major depression 7.6% (95% UI 5.1-10.9) - markedly lower than estimated in previous research but over two-times higher than the mean prevalence estimated by the Global Burden of Disease Study [3.7% (95% UI 3.0-4.5) and 3.5% (95% UI 2.9-4.2) for anxiety disorders and MDD, respectively]. The age-patterns reveal sharp prevalence inclines in the childhood years. A number of ecological variables demonstrated associations with prevalence of both disorders. Symptom scales were shown to significantly overestimate prevalence of both disorders. Finding suggests higher prevalence of both disorders in females. This study provides, for the first time, age-specific estimates of PTSD and depression prevalence adjusted for an extensive range of covariates and is a significant advancement on our current understanding of the epidemiology in conflict-affected populations.
Highlights
This paper aims to derive a comprehensive epidemiological profile of major depression and post-traumatic stress disorder (PTSD) in general populations exposed to conflict by: (1) conducting a systematic review to identify studies investigating the epidemiology of major depression and PTSD in conflict-affected populations across different age groups; (2) identifying significant predictors of the prevalence of major depression and PTSD in conflict-affected populations; and (3) making use of the above data and GBD Bayesian meta-regression techniques to model the prevalence of major depression and PTSD by age, sex and region
We identified a total of 83 studies; 66 studies providing 128 prevalence estimates for PTSD and 33 studies providing 69 prevalence estimates for major depression
Twenty separate conflict or post-conflict countries were represented for major depression and 27 conflict or post-conflict countries for PTSD
Summary
Depression is the only other mental disorder featuring prominently in the literature, in this context Despite these advances we do not yet have a comprehensive epidemiological profile (including prevalence, distribution and risk factors) of PTSD or depression in conflict-affected populations, which is essential for the development of effective mental health policy and programmes addressing the mental health needs of these populations. In order to meet the challenges of post-conflict reconstruction, comprehensive and context-specific epidemiological models of mental disorders are crucial for both conflict-affected countries and the broader international health and humanitarian community. They provide the core data required for estimating disease prevalence, i.e. the number of cases of a given disease within conflict-affected populations at a particular point in time. We aim to derive prevalence estimates specific for region, age and sex of major depression, and PTSD in the general populations of areas exposed to conflict, whilst controlling for an extensive range of covariates
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