Abstract
BackgroundMental disorders are likely to be elevated in the Libyan population during the post-conflict period. We estimated cases of severe PTSD and depression and related health service requirements using modelling from existing epidemiological data and current recommended mental health service targets in low and middle income countries (LMIC’s).MethodsPost-conflict prevalence estimates were derived from models based on a previously conducted systematic review and meta-regression analysis of mental health among populations living in conflict. Political terror ratings and intensity of exposure to traumatic events were used in predictive models. Prevalence of severe cases was applied to chosen populations along with uncertainty ranges. Six populations deemed to be affected by the conflict were chosen for modelling: Misrata (population of 444,812), Benghazi (pop. 674,094), Zintan (pop. 40,000), displaced people within Tripoli/Zlitan (pop. 49,000), displaced people within Misrata (pop. 25,000) and Ras Jdir camps (pop. 3,700). Proposed targets for service coverage, resource utilisation and full-time equivalent staffing for management of severe cases of major depression and post-traumatic stress disorder (PTSD) are based on a published model for LMIC’s.FindingsSevere PTSD prevalence in populations exposed to a high level of political terror and traumatic events was estimated at 12.4% (95%CI 8.5–16.7) and was 19.8% (95%CI 14.0–26.3) for severe depression. Across all six populations (total population 1,236,600), the conflict could be associated with 123,200 (71,600–182,400) cases of severe PTSD and 228,100 (134,000–344,200) cases of severe depression; 50% of PTSD cases were estimated to co-occur with severe depression. Based upon service coverage targets, approximately 154 full-time equivalent staff would be required to respond to these cases sufficiently which is substantially below the current level of resource estimates for these regions.DiscussionThis is the first attempt to predict the mental health burden and consequent service response needs of such a conflict, and is crucially timed for Libya.
Highlights
International attention has focused on the civil conflict in Libya following anti-government protests starting in February 2011 which led to the fall of the regime led by Muammar Gaddafi
Key stratifying variables include: the level of ‘‘political terror’’ as defined by the political terror scale (PTS) a country level measure of political violence compiled from human rights reports; [12] a potentially traumatic event (PTE) adversity ratio derived from the level of exposure to potentially traumatic events (PTE)’s recorded within the samples included in the systematic review; time since conflict, with closer proximity to the traumatic events resulting in higher rates of mental disorder; and whether populations were displaced due to the conflict. [11]
This paper aims to: 1. derive best-estimates for depression and post-traumatic stress disorder (PTSD) prevalence in conflict-affected Libyan populations based on the factors known to influence the prevalence of these disorders; 2. estimate the number of severe cases and comorbidity between these disorders for given populations; 3. describe the mental health service requirements that would be needed in Libya to meet the needs of this population during the post-conflict period and compare this with the current service capacity in Libya
Summary
International attention has focused on the civil conflict in Libya following anti-government protests starting in February 2011 which led to the fall of the regime led by Muammar Gaddafi. [10] Steel and colleagues have published a recent systematic review and meta-regression of depression and PTSD prevalence in conflict affected populations [11]. Evidence indicates that exposure to conflict-related potentially traumatic events (PTE) will lead to an elevation in the prevalence of mental disorders, including depression and post-traumatic stress disorder (PTSD), among exposed sections of the Libyan population. This metaregression enables the estimation of projected mental disorder prevalence for conflict-exposed populations stratified according to risk exposure variables. We estimated cases of severe PTSD and depression and related health service requirements using modelling from existing epidemiological data and current recommended mental health service targets in low and middle income countries (LMIC’s)
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