Meta-analysis of interventions for posttraumatic stress disorder and depression in adult survivors of mass violence in low- and middle-income countries

Abstract Background Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). Methods Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. Results The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. Conclusions Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

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Further thoughts on evaluating interventions for posttraumatic stress disorder in low and middle income countries

Intervention ◽

10.1097/wtf.0000000000000033 ◽

2014 ◽

Vol 12 (2) ◽

pp. 286-289

Author(s):

William Yule

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Evaluating interventions for posttraumatic stress disorder in low and middle income countries

Intervention ◽

10.1097/wtf.0000000000000001 ◽

2014 ◽

Vol 12 (2) ◽

pp. 250-266 ◽

Cited By ~ 11

Author(s):

Adrian P. Mundt ◽

Petra Wünsche ◽

Andreas Heinz ◽

Christian Pross

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Residual posttraumatic stress disorder symptoms after provision of brief behavioral intervention in low‐ and middle‐income countries: An individual‐patient data meta‐analysis

Depression and Anxiety ◽

10.1002/da.23221 ◽

2021 ◽

Author(s):

Aemal Akhtar ◽

Phiona Koyiet ◽

Atif Rahman ◽

Alison Schafer ◽

Syed Usman Hamdani ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Behavioral Intervention ◽

Stress Disorder ◽

Individual Patient Data ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Posttraumatic Stress Disorder Symptoms ◽

Brief Behavioral Intervention

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Representation of low and middle income countries in traumatic stress journals from 2006 to 2015

South African Journal of Psychology ◽

10.1177/0081246319831605 ◽

2019 ◽

Vol 49 (4) ◽

pp. 562-574

Author(s):

Brian Robson ◽

Leanne Chang ◽

Debra Kaminer

Keyword(s):

Posttraumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Middle Income Country ◽

Trauma Survivors ◽

Middle Income ◽

Middle Income Countries ◽

Domain Specific ◽

Funding Sources ◽

Low And Middle Income

Although the majority of trauma survivors reside in low and middle income countries, these regions have historically been poorly represented in traumatic stress research. However, a recent review of geographic representation within traumatic stress journals is lacking. This study reviewed all articles published between 2006 and 2015 in six leading traumatic stress journals. When articles ( n = 2530) were categorised by region, less than one tenth (9.76%; n = 247) were representative of low and middle income countries. All articles categorised as being from a low and middle income country were then coded for the regional and country representations of samples, author affiliations, and funding sources, and for type of research methodology. The majority of primary author teams (56.28%) and funding sources (55.87%) for articles based in low and middle income countries were located in high-income countries. The majority of low and middle income country articles (71.66%) used structured symptom questionnaires of which more than two thirds (70.6%) assessed symptoms of posttraumatic stress disorder. These findings indicate that knowledge production about traumatic stress in domain-specific journals reflects a state of ongoing geographic inequality and that research published from low and middle income countries reflects predominantly etic methodologies centred on measuring posttraumatic stress disorder. The implications are discussed and recommendations are offered for developing a research base in domain-specific journals that better represents the experiences and needs of trauma survivors in low and middle income countries.

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