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Review
. 2021 Oct 15;7(6):e194.
doi: 10.1192/bjo.2021.1013.

Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review

Umanga de Silva  1 , Naomi Glover  1 , Cornelius Katona  2
Affiliations
Review

Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review

Umanga de Silva et al. BJPsych Open. .

Abstract

Background: Refugees and asylum seekers often report having experienced numerous complex traumas. It is important to understand the prevalence of complex post-traumatic stress disorder (CPTSD), which can follow complex traumas.

Aims: This systematic review aims to summarise the available literature reporting the prevalence in refugees and asylum seekers of three operationalised definitions of CPTSD: the ICD-11 diagnostic criteria, the ICD-10 criteria (for enduring personality change after catastrophic experience) and the DSM-IV criteria (for disorders of extreme stress not otherwise specified).

Method: Six electronic databases were searched for studies reporting the prevalence of CPTSD in adult refugee and/or asylum-seeking samples. Owing to heterogeneity between the studies, a narrative synthesis approach was used to summarise studies. Methodological quality was assessed using the Joanna Briggs Critical Appraisal Checklist for Prevalence Studies. This systematic review has been registered with PROSPERO (registration number CRD42020188422, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=188422).

Results: Systematic searches identified 15 eligible studies, with 10 examining treatment-seeking samples and five using population samples. CPTSD prevalence in treatment-seeking samples was between 16 and 38%. Prevalence in population samples ranged from 2.2 to 9.3% in four studies, with the fifth reporting a much higher estimate (50.9%).

Conclusions: This review highlights both the high prevalence of CPTSD in treatment samples and the lack of research aiming to establish prevalence of CPTSD in refugee and asylum-seeking populations. Understanding the prevalence of these disabling disorders has implications for policy and healthcare services for the appropriate promotion, planning and provision of suitable treatment and interventions for this highly traumatised population.

Keywords: Complex post-traumatic stress disorder; complex trauma; forced displacement; refugees; systematic review.

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Conflict of interest statement

C.K. is a member of the editorial board of BJPsych Open.

ICMJE forms are in the supplementary material, available online at http://dx.doi.org/10.1192/bjo.2021.1013.

Figures

Fig. 1
Fig. 1
Overlaps and differences among definitions of enduring personality change after catastrophic events (EPCACE), disorder of extreme stress not otherwise specified (DESNOS), complex post-traumatic stress disorder (PTSD) and ICD-11 PTSD. AD, affective dysregulation; NSC, negative self-concept.
Fig. 2
Fig. 2
PRISMA flowchart depicting study selection based on searches conducted on 25 March 2020 and 8 January 2021. PTSD, post-traumatic stress disorder.
Fig. 3
Fig. 3
Prevalence of complex post-traumatic stress disorder (PTSD), enduring personality change after catastrophic events (EPCACE) and disorder of extreme stress not otherwise specified (DESNOS) in treatment-seeking and population samples.
Fig. 4
Fig. 4
Prevalence of the most frequently measured additional diagnoses of DSM-5 post-traumatic stress disorder (PTSD) and ICD-11 PTSD compared with complex PTSD in treatment-seeking and population samples.
See this image and copyright information in PMC

References

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