Global Posttrauma Symptoms: A Systematic Review of Qualitative Literature

Abstract

Exposure to potentially traumatic events is a global health problem, especially in low- and middle-income countries. Assessments for symptoms resulting from trauma exposure rely heavily on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria for post-traumatic stress disorder (PTSD), which may not be relevant in all regions of the globe. We examined posttrauma symptoms that were not limited to Western constructs of mental health (i.e., PTSD). In a systematic review, we searched nine databases to identify posttrauma symptoms arising in qualitative literature published before July 17, 2017. A total of 17,938 records were identified and 392 met inclusion criteria. The 392 studies represented data on 400 study populations from 71 different nationalities/ethnicities. The presence and frequency of posttrauma symptoms were examined across all regions. Fisher's exact tests were also conducted to compare frequencies in posttrauma symptoms across region and gender. Based on a weighted analysis across regions, a list of global posttrauma symptoms ( N = 85) was compiled into an item bank. We found that the majority of DSM-5 PTSD symptoms were mentioned across regions (with the exception of inability to recall specific aspects of the trauma and blame of self or others for the event). Across all regions, we also found a number of symptoms mentioned that were not part of PTSD and its associated features. Findings suggest that assessing posttrauma symptoms solely based on PTSD may be limiting to global populations. Research, policy, and practice implications are discussed.

Traumatic events and posttraumatic stress disorder in individuals with severe mental illness in a non-western setting: Data from rural Ethiopia.

“…However, contrary to some existing work (Michalopoulos et al, 2015;Neugebauer et al, 2009;Rasmussen et al, 2014;Smith Fawzi et al, 1997), we found that both reexperiencing and avoidance symptoms were common. Lastly, we did not find either of the following symptoms described in previous work: persistent inability to experience positive emotions and detachment from others (Michalopoulos et al, 2020). It is possible that "holding everything to myself" was a local expression of the detachment symptom, although it could also be mistrust of others (i.e., persistent negative beliefs about others).…”

National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis

“…However, the lack of reliable and valid instruments used in the populations studied is a major limitation for both research and practice. In a 2018 review of qualitative studies examining post-trauma symptoms across cultural contexts, most study participants reported symptoms consistent with Western diagnostic criteria but also reported a number of symptoms not captured in those diagnostic classifications [107], supporting the need for local contextualization of measures. Measures that are not locally contextualized and valid may result in substantial under-or overreporting of trauma exposure and PTSD symptoms.…”

A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention

“…(1) Posttraumatic stress symptoms structure and function may be affected by unique socio-cultural factors and context that shape understanding, attribution as well as responding to traumatic events (e.g., political persecution secondary to ethno-linguistic group status, torture, etc.) (Hinton & Lewis‐Fernández, 2011; Kelley, Weathers, McDevitt‐Murphy, Eakin, & Flood, 2009; Michalopoulos et al., 2020). For example, in the studied E. African groups, sexual assault is highly socially stigmatized and likely to lead community ostracism; likewise, a number of traumatic events were experienced as a function of actions of the ruling political regime attacking specific political or ethnic group(s) (Badri, Alia, Van den Borne, & Crutzen, 2013; Badri, et al., 2012; Plaut, 2017; Rasmussen, Katoni, Keller, & Wilkinson, 2011; Van Reisen & Mawere, 2017)) (see Supplemental Material for additional information).…”

“…Results are thus circumscribed to this pool of symptoms/nodes. In addition or alternatively, it may be promising to model symptoms framed in local and socio-culturally-specific concepts or idioms reflective of “symptoms” (Michalopoulos et al., 2020; Rasmussen et al., 2014). Fourth, data are cross-sectional data limiting inferences regarding directional or causal functional associations between symptoms.…”