National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis
Autoři:
Lauren C. Ng aff001; Anne Stevenson aff002; Sreeja S. Kalapurakkel aff003; Charlotte Hanlon aff005; Soraya Seedat aff006; Boniface Harerimana aff007; Bonginkosi Chiliza aff008; Karestan C. Koenen aff009
Působiště autorů:
Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
aff001; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
aff002; Duke University Global Health Institute, Durham, North Carolina, United States of America
aff003; Centre for Global Mental Health, Health Service and Population Research, Department Institute of Psychiatry, Psychology and Neuroscience King’s College, London, United Kingdom
aff004; Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
aff005; Faculty of Health Sciences, Western University, London, Ontario, Canada
aff006; College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
aff007; Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
aff008; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
aff009
Vyšlo v časopise:
National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 17(5): e1003090. doi:10.1371/journal.pmed.1003090
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003090
Souhrn
Background
People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA.
Methods and findings
The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional.
There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%–32%), while the current prevalence—defined as 1 week to 1 month—was 25% (95% CI 16%–36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%–0%) to 74% (95% CI 72%–76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%–15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%–40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non–peer-reviewed studies.
Conclusions
In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.
Klíčová slova:
Adults – Africa – Mental health and psychiatry – Metaanalysis – Post-traumatic stress disorder – Research validity – Systematic reviews – War and civil unrest
Zdroje
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