In the Journals

One in five people have mental disorders in post-conflict settings

Based on WHO data, researchers estimated that roughly one in five people in post-conflict settings had depression, anxiety disorder, PTSD, bipolar disorder or schizophrenia.

“Epidemiological studies in conflict settings typically present varying results, making their interpretation difficult and their statistical heterogeneity is extremely high,” Fiona Charlson, PhD, from the Queensland Centre for Mental Health Research, Australia, and colleagues wrote.

To update WHO estimates of the prevalence of mental disorders in conflict-affected populations, Charlson and colleagues conducted a systematic review to search clinical databases for studies on the prevalence of depression, anxiety disorder, PTSD, bipolar disorder and schizophrenia. They also examined grey literature (ie, government reports, conference proceedings) for relevant data.

Using Bayesian meta-regression techniques adjusted for predictors of mental disorders, the researchers calculated new point prevalence estimates in settings that had experienced conflict less than 10 years before.

Overall, 129 studies published between 1980 and mid-2017 were included in analysis and 39 countries were represented in the dataset.

At any point in time Charlson and colleagues assessed conflict-affected settings, the estimated prevalence of mental disorders was 22.1% (95% uncertainty interval [UI], 18.8-25.7). Furthermore, nearly one in ten people (9.1%) in post-conflict settings had a moderate to severe mental disorder at any point in time.

The average comorbidity-adjusted, age-standardized point prevalence of mild depression, anxiety and PTSD was higher than that of moderate forms (13% [95% UI, 10.3-16.2] vs. 4% [95% UI, 2.9–5.5]), according to the results. In addition, the data showed that the average prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe PTSD) was 5.1% (95% UI, 4-6.5). These estimates show higher prevalence of severe mental disorders as well as mild to moderate disorders than previous WHO estimates, the researchers found.

“Our study shows that the impact of conflict on people’s mental health is higher than previous estimates suggest,” Charlson and colleagues wrote. “Mental health care must be prioritized in countries affected by conflict, not least for the well-established links between mental health, functioning, and country development.”

In a related comment, Cristiane S Duarte, PhD, MPH, and M. Claire Greene, PhD, MPH, from the New York State Psychiatric Institute, Columbia University, pointed out limitations in the study, such as cultural variation and scarcity of data in conflict-affected settings, that should be addressed in future research.

“The many challenges inherent to generating information capable of guiding policy in the absence of reliable data need to be balanced against the alarming need suggested by current estimates. ... Work towards producing more accurate estimates needs to continue,” they wrote. “Notwithstanding its limitations, current estimates warrant greater investment in prevention and treatment of mental disorders in conflict-affected populations.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Duarte and Greene report grants from the NIH.

Based on WHO data, researchers estimated that roughly one in five people in post-conflict settings had depression, anxiety disorder, PTSD, bipolar disorder or schizophrenia.

“Epidemiological studies in conflict settings typically present varying results, making their interpretation difficult and their statistical heterogeneity is extremely high,” Fiona Charlson, PhD, from the Queensland Centre for Mental Health Research, Australia, and colleagues wrote.

To update WHO estimates of the prevalence of mental disorders in conflict-affected populations, Charlson and colleagues conducted a systematic review to search clinical databases for studies on the prevalence of depression, anxiety disorder, PTSD, bipolar disorder and schizophrenia. They also examined grey literature (ie, government reports, conference proceedings) for relevant data.

Using Bayesian meta-regression techniques adjusted for predictors of mental disorders, the researchers calculated new point prevalence estimates in settings that had experienced conflict less than 10 years before.

Overall, 129 studies published between 1980 and mid-2017 were included in analysis and 39 countries were represented in the dataset.

At any point in time Charlson and colleagues assessed conflict-affected settings, the estimated prevalence of mental disorders was 22.1% (95% uncertainty interval [UI], 18.8-25.7). Furthermore, nearly one in ten people (9.1%) in post-conflict settings had a moderate to severe mental disorder at any point in time.

The average comorbidity-adjusted, age-standardized point prevalence of mild depression, anxiety and PTSD was higher than that of moderate forms (13% [95% UI, 10.3-16.2] vs. 4% [95% UI, 2.9–5.5]), according to the results. In addition, the data showed that the average prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe PTSD) was 5.1% (95% UI, 4-6.5). These estimates show higher prevalence of severe mental disorders as well as mild to moderate disorders than previous WHO estimates, the researchers found.

“Our study shows that the impact of conflict on people’s mental health is higher than previous estimates suggest,” Charlson and colleagues wrote. “Mental health care must be prioritized in countries affected by conflict, not least for the well-established links between mental health, functioning, and country development.”

In a related comment, Cristiane S Duarte, PhD, MPH, and M. Claire Greene, PhD, MPH, from the New York State Psychiatric Institute, Columbia University, pointed out limitations in the study, such as cultural variation and scarcity of data in conflict-affected settings, that should be addressed in future research.

“The many challenges inherent to generating information capable of guiding policy in the absence of reliable data need to be balanced against the alarming need suggested by current estimates. ... Work towards producing more accurate estimates needs to continue,” they wrote. “Notwithstanding its limitations, current estimates warrant greater investment in prevention and treatment of mental disorders in conflict-affected populations.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Duarte and Greene report grants from the NIH.