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Review
. 2019 Feb 22;10(1):1578637.
doi: 10.1080/20008198.2019.1578637. eCollection 2019.

The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers

Thole Hilko Hoppen  1 , Nexhmedin Morina  1
Affiliations
Review

The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers

Thole Hilko Hoppen et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Elevated prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) have been reported in populations exposed to war. However, no global estimates of war survivors suffering from PTSD and/or MD in absolute numbers have been reported. Objective: We made the first attempt to estimate in absolute numbers how many adult war survivors globally may suffer PTSD and/or MD, which should inform local and global mental health programmes. Method: Drawing on the Uppsala Conflict Database, we reviewed all countries that suffered at least one war within their own territory between 1989 and 2015 (time span chosen on availability of geo-referenced data and population estimates). We then conducted a meta-analysis of current randomized epidemiological surveys on prevalence of PTSD and/or MD among war survivors. Finally, we extrapolated our results from the meta-analysis on the global population of adult war survivors by means of using general population data from the United Nations. Results: We estimate that about 1.45 billion individuals worldwide have experienced war between 1989 and 2015 and were still alive in 2015, including one billion adults. On the basis of our meta-analysis, we estimate that about 354 million adult war survivors suffer from PTSD and/or MD. Of these, about 117 million suffer from comorbid PTSD and MD. Conclusions: Based on the slim available evidence base, the global number of adult war survivors suffering PTSD and/or MD is vast. Most war survivors live in low-to-middle income countries with limited means to handle the enormous mental health burden. Since representative high quality data is lacking from most of these countries, our results contain a large margin of uncertainty and should be interpreted with caution.

Antecedentes: Se han reportado elevadas prevalencias de Trastorno de Estrés Postraumático (TEPT) y Depresión Mayor (DM) en poblaciones expuestas a la guerra. Sin embargo, no se han reportado estimaciones globales en números absoultos de los sobrevivientes a la guerra que padecen de TEPT y/o DM.Objetivo: Realizamos el primer intento de estimar en números absolutos cuántos adultos sobrevivientes a la guerra globalmente sufren de TEPT y/o DM, lo que debería informar a los programas locales y globales de salud mental.Método: Usando la Base de Datos de conflictos de Uppsala, revisamos todos los países que experimentaron al menos una guerra en su territorio entre 1989 y 2015 (intervalo de tiempo elegido según la disponibilidad de datos y estimaciones de población georeferenciados). Luego llevamos a cabo un meta-análisis de encuestas epidemiológicas randomizadas actuales sobre la prevalencia de TEPT y/o DM entre los sobrevivientes a la guerra. Finalmente, extrapolamos nuestros resultados del meta-análisis a la población global de adultos sobrevivientes a la guerra utilizando datos de población general de las Naciones Unidas.Resultados: Estimamos que alrededor de 1.45 billones de individuos alrededor del mundo han experimentado la guerra entre 1989 y 2015 y continuaban con vida en 2015, incluyendo 1 billón de adultos. En base a nuestro meta-análisis, estimamos que alrededor de 354 millones de adultos sobrevivientes a la guerra padecen de TEPT y/o DM. De ellos, alrededor de 117 millones padecen de TEPT y DM comórbidos.Conclusiones: Basado en la escasa evidencia disponible, el número global de adultos sobrevivientes a la guerra que padece de TEPT y/o DM es vasto. La mayoría de los sobrevivientes a la guerra viven en países de ingresos bajos a medios con limitados medios para manejar la enorme carga de salud mental. Dado que no se cuenta con datos representativos de alta calidad para la mayoría de estos países, nuestros resultados contienen un amplio margen de incertidumbre y deberían ser interpretados con precaución.

背景：已发现战争暴露的人群中创伤后应激障碍（PTSD）和重度抑郁症（MD）的患病率升高。但是，没有对遭受PTSD和/或MD的战争幸存者的全球数量进行估计。目标：我们首次尝试估算全球可能患有PTSD和/或MD的成年战争幸存者的绝对数量，可以为当地和全球心理健康计划提供信息。方法：借鉴乌普萨拉冲突（Uppsala Conflict）数据库，我们综述了1989年至2015年期间（时间跨度根据地理参考数据和人口估计数据的可用性）在其领土内至少遭受过一次战争的所有国家。然后，我们对战争幸存者中PTSD和/或MD患病率的随机流行病学调查进行了元分析。最后，我们通过使用联合国的一般人口数据，基于元分析结果，对成人战争幸存者的全球人口的进行推断。结果：我们估计全球约有14.5亿人在1989年至2015年期间经历过战争，并且在2015年仍然活着，其中包括10亿成年人。根据我们的元分析，我们估计约有3.54亿成年战争幸存者患有结论：基于有限的可用证据，全球患有PTSD和/或MD的成年战争幸存者的数量是巨大的。大多数战争幸存者生活在中低收入国家，应对巨大的心理健康负担的途径有限。由于大多数这些国家缺乏具有代表性的高质量数据，因此我们的结果存在很大的不确定性，应谨慎解释。.

Keywords: Posttraumatic stress disorder; civilian war survivors; major depression; meta-analysis; prevalence; war trauma; • We estimate that 1.45 billion people worldwide have experienced war between 1989 and 2015.• We estimate that 354 million adult war survivors globally suffer from PTSD and/or MD.• We estimate that 117 million adult war survivors globally suffer from a comorbidity of PTSD+MD.• Most war survivors live in low-to-middle income countries with limited means to handle the associated mental health burden..

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Forest plot depicting meta-analytic results of all representative surveys assessing PTSD in countries with a history of war between 1989 and 2015.
Figure 2.
Figure 2.
Forest plot depicting meta-analytic results of all representative surveys assessing MD in countries with a history of war between 1989 and 2015.
Figure 3.
Figure 3.
World map with countries and regions marked which have a history of at least one war between 1989 and 2015.
See this image and copyright information in PMC

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