Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.

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Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

ContextThe global refugee crisis requires that researchers, policymakers, and
clinicians comprehend the magnitude of the psychological consequences of forced
displacement and the factors that moderate them. To date, no empirical synthesis
of research on these issues has been undertaken.ObjectiveTo meta-analytically establish the extent of compromised mental health
among refugees (including internally displaced persons, asylum seekers, and
stateless persons) using a worldwide study sample. Potential moderators of
mental health outcomes were examined, including enduring contextual variables
(eg, postdisplacement accommodation and economic opportunity) and refugee
characteristics.Data SourcesPublished studies (1959-2002) were obtained using broad searches of
computerized databases (PsycINFO and PILOTS), manual searches of reference
lists, and interviews with prominent authors.Study SelectionStudies were selected if they investigated a refugee group and at least
1 nonrefugee comparison group and reported 1 or more quantitative group comparison
on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4%
of identified reports), yielding 59 independent comparisons and including
67 294 participants (22 221 refugees and 45 073 nonrefugees).Data ExtractionData on study and report characteristics, study participant characteristics,
and statistical outcomes were extracted using a coding manual and subjected
to blind recoding, which indicated high reliability. Methodological quality
information was coded to assess potential sources of bias.Data SynthesisEffect size estimates for the refugee-nonrefugee comparisons were averaged
across psychopathology measures within studies and weighted by sample size.
The weighted mean effect size was 0.41 (SD, 0.02; range, −1.36 to 2.91
[SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement
conditions moderated mental health outcomes. Worse outcomes were observed
for refugees living in institutional accommodation, experiencing restricted
economic opportunity, displaced internally within their own country, repatriated
to a country they had previously fled, or whose initiating conflict was unresolved.
Refugees who were older, more educated, and female and who had higher predisplacement
socioeconomic status and rural residence also had worse outcomes. Methodological
differences between studies affected effect sizes.ConclusionsThe sociopolitical context of the refugee experience is associated with
refugee mental health. Humanitarian efforts that improve these conditions
are likely to have positive impacts.

Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis.

http://www.cpcnetwork.org/wp-content/uploads/2014/04/Miller-_-Rasmusssen-2009.pdf

War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks

BackgroundThe literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study.MethodA systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.ResultsThe prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.ConclusionsAnxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S003329171200147X

Global prevalence of anxiety disorders: a systematic review and meta-regression

Background: The suboptimal compliance to vaccinations continues to be a major public health problem.

Factors associated with

ContextLittle is known about the impact of trauma in postconflict, low-income
countries where people have survived multiple traumatic experiences.ObjectiveTo establish the prevalence rates of and risk factors for posttraumatic
stress disorder (PTSD) in 4 postconflict, low-income countries.Design, Setting, and ParticipantsEpidemiological survey conducted between 1997 and 1999 among survivors
of war or mass violence (aged ≥16 years) who were randomly selected from
community populations in Algeria (n = 653), Cambodia (n = 610), Ethiopia (n
= 1200), and Gaza (n = 585).Main Outcome MeasurePrevalence rates of PTSD, assessed using the PTSD module of the Composite
International Diagnostic Interview version 2.1 and evaluated in relation to
traumatic events, assessed using an adapted version of the Life Events and
Social History Questionnaire.ResultsThe prevalence rate of assessed PTSD was 37.4% in Algeria, 28.4% in
Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. Conflict-related trauma after
age 12 years was the only risk factor for PTSD that was present in all 4 samples.
Torture was a risk factor in all samples except Cambodia. Psychiatric history
and current illness were risk factors in Cambodia (adjusted odds ratio [OR],
3.6; 95% confidence interval [CI], 2.3-5.4 and adjusted OR,1.6; 95% CI, 1.0-2.7,
respectively) and Ethiopia (adjusted OR, 3.9; 95% CI, 2.0-7.4 and adjusted
OR, 1.8; 95% CI, 1.1-2.7, respectively). Poor quality of camp was associated
with PTSD in Algeria (adjusted OR, 1.8; 95% CI, 1.3-2.5) and in Gaza (adjusted
OR, 1.7; 95% CI, 1.1-2.8). Daily hassles were associated with PTSD in Algeria
(adjusted OR, 1.6; 95% CI, 1.1-2.4). Youth domestic stress, death or separation
in the family, and alcohol abuse in parents were associated with PTSD in Cambodia
(adjusted OR, 1.7; 95% CI, 1.1-2.6; adjusted OR, 1.7; 95% CI, 1.0-2.8; and
adjusted OR, 2.2; 95% CI, 1.1-4.4, respectively).ConclusionsUsing the same assessment methods, a wide range of rates of symptoms
of PTSD were found among 4 low-income populations who have experienced war,
conflict, or mass violence. We identified specific patterns of risk factors
per country. Our findings indicate the importance of contextual differences
in the study of traumatic stress and human rights violations.

https://jamanetwork.com/journals/jama/articlepdf/194062/JOC10164.pdf

Lifetime events and posttraumatic stress disorder in 4 postconflict settings.

As one article in a series on Global Mental Health Practice, Peter Ventevogel and colleagues provide a case study of their efforts to integrate brief, practice-oriented mental health training into the Afghanistan health care system at a time when the system was being rebuilt from scratch.

/pdf/improving-access-to-mental-health-care-and-psychosocial-bks752ljjq.pdf

Improving access to mental health care and psychosocial support within a fragile context: a case study from Afghanistan.

The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a community-oriented and culturally sensitive public health response to the psychosocial problems of refugees and victims of organized violence. This paper describes the 9-step model that TPO has developed as a blueprint for each new intervention. Beneficiaries participate in determining priorities and there is an orientation toward culturally competent training, capacity-building, and sustainability. Two cases, one related to Sudanese refugees in Uganda and the other to internally displaced persons and returnees in postwar Cambodia, show how the TPO intervention protocol is adapted to local settings. The paper provides preliminary evaluative comments on the model's performance.

Bringing order out of chaos: A culturally competent approach to managing the problems of refugees and victims of organized violence

Starting mental health services in Cambodia.

Special populations are particularly vulnerable to mental health problems in the aftermath of a disaster. Efficient delivery of mental health services, the integrated use of psychosocial services and mental health facilities, and the active intervention of trained community health care workers can offer effective management of the psychosocial problems of special populations. Women, children, adolescents, the poor, the elderly, and individuals with preexisting health problems have been identified as special populations who often suffer psychological morbidity as a result of a catastrophic disaster. Understanding the cultural, ethnic, and socioeconomic factors in a postdisaster situation is crucial to helping special populations overcome debilitating mental illness and declining quality of life. Planning the delivery of mental health services is critical and includes hazard mapping to identify vulnerable geographic and social areas, screening instruments to identify at-risk populations, and education of community leaders and health care workers. An integrated approach using psychosocial and institutionalized interventions can provide better outcomes than either approach alone. A community-based approach with trained grassroots health care workers can provide effective psychosocial support and rehabilitation services.

/pdf/management-of-trauma-in-special-populations-after-a-disaster-1z4bk41321.pdf

Willem van de Put

Papers

Lifetime events and posttraumatic stress disorder in 4 postconflict settings.

Improving access to mental health care and psychosocial support within a fragile context: a case study from Afghanistan.

Bringing order out of chaos: A culturally competent approach to managing the problems of refugees and victims of organized violence

Starting mental health services in Cambodia.

Management of trauma in special populations after a disaster.