Abstract
Background: The cross-cultural validity of the construct of post-traumatic stress disorder (PTSD) has been a life-long debate in the field of trauma. Its validation in a setting such as India—a nation prone to considerably traumatic events such as conflict, natural disasters, and sexual violence against women—warrants exploration. Objective: To describe how PTSD and post-traumatic stress symptoms (PTSS) are conceptualized in the Indian context by systematically examining the evidence of studies that investigate PTSD and PTSS in India. Methods: A systematic search in PubMed, Web of Science, and Science Direct yielded a total of 56 studies that discussed one or multiple aspects of PTSD and PTSS in India. Data relating to types of events, populations, diagnostic tools, manifestations, and interventions were extracted and analyzed. Results: Eleven of 29 Indian states and 2/7 union territories were represented in the 56 included studies, with most studies (n = 21) originating from Tamil Nadu. Natural Disasters (n = 28), War/Conflict (n = 10), and Medical conditions (n = 7) were the top three most commonly investigated traumatic events. The majority of studies focused on entire communities (n = 16), while children and adolescents made up the second largest group (n = 14). Less attention was paid explicitly to male (n = 3) or female (n = 4) victims. Twenty-five different methods for screening for PTSD were identified, with the most common being the impact of events scale (n = 14). The majority of studies reported the screening and clinical diagnosis of PTSD by professional health care providers (n = 24). Abuse scored the highest average prevalence of PTSD at 52.3%, while the lowest was 16.4% due to man-made accidents. Overall, there was a lack of assessment on trauma-specific interventions, though psychosocial support was the most commonly mentioned intervention. Conclusions: Results indicate diversity in approaches for identifying, measuring, and treating PTSD and PTSS in the Indian population and how sociocultural norms influence its manifestation in this population. Future research calls for the development of culturally sensitive approaches to identifying and addressing PTSD and PTSS in India.
Highlights
Post-traumatic stress disorder (PTSD) is among the most controversial disorders to be described by the Diagnostic and Statistical Manual of Mental Disorders (DSM), with regards to the boundaries of its classification, its diagnostic criteria, its main assumptions, and its clinical implications (1)
Eligible studies included primary data sets published in peer-reviewed scientific journals, studies that were conducted in India, and studies that concern the topic of psychological trauma and PTSD and were written in English
This review puts into focus the complexity in understanding PTSD and post-traumatic stress symptoms (PTSS) from an Indian perspective
Summary
Post-traumatic stress disorder (PTSD) is among the most controversial disorders to be described by the Diagnostic and Statistical Manual of Mental Disorders (DSM), with regards to the boundaries of its classification, its diagnostic criteria, its main assumptions, and its clinical implications (1). From a relativist’s perspective, where the notion holds that all human behaviors are culturally patterned, the cross-cultural validity of the concept of PTSD has been questioned for many years (3–5) As it stands, the application and categorization of a PTSD diagnosis is based on agreed upon notions of how a person is supposed to react to traumatic events. The application and categorization of a PTSD diagnosis is based on agreed upon notions of how a person is supposed to react to traumatic events These agreed upon notions, and manifestations of PTSD, are in turn shaped by cultural norms, coping strategies, and availability of support (3). Its validation in a setting such as India—a nation prone to considerably traumatic events such as conflict, natural disasters, and sexual violence against women—warrants exploration
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