ABSTRACT

Background: The inclusion of complex post-traumatic stress disorder (CPTSD) in ICD-11 represents a turning point for the field of traumatic stress, with accumulative evidence of this disorder in refugees and displaced populations.

Objective: The objectives of this systematic review are to examine, in refugee and displaced populations: 1) the prevalence of CPTSD; 2) factors contributing to CPTSD; and 3) and associations between CPTSD and other common mental disorders including: PTSD, depression, anxiety and somatisation.

Method: We followed the Joanna Briggs Institute Methodology for Systematic Reviews. Papers published in English language were included, with date of publication between 1987 and June 2019. We searched six relevant databases: MEDLINE, PsycINFO, Embase, Scopus, CINAHL, and PILOTS, and the grey literature. We included observational studies with prevalence data on CPTSD.

Results: 19 articles met all inclusion criteria. Quality assessment was performed on each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Based on this, 13 moderate and high-quality studies were included in our narrative synthesis. The included studies reported prevalence of CPTSD in refugees and displaced populations ranging from 2% to 86%.

Conclusions: Reasons for the wide variation in prevalence may include contextual and geographical differences, the influence of post-migration difficulties, and sample population characteristics such as treatment seeking versus general population. We found higher prevalence rates (range: 16–82%) in more studies with treatment seeking samples, followed by convenience and snowball samples (40–51%), and lower rates in more studies utilising random sampling techniques (2–86%). Consistent with the broader literature, the studies in our review supported an association for complex post-traumatic stress disorder with prolonged, repeated trauma, and post-migration living difficulties, with the latter association being specific to refugee and displaced populations. Further research on this construct in this population group, including effective treatments, is required.

摘要

背景：在 ICD-11 中纳入复杂的创伤后应激障碍 (CPTSD) 代表了创伤应激领域的一个转折点，越来越多的证据表明这种疾病在难民和流离失所人口中存在。

目的：本系统评价的目的是检查难民和流离失所人口中： 1) CPTSD 的患病率；2) 导致 CPTSD 的因素；3) 以及 CPTSD 与其他常见精神障碍之间的关联，包括：PTSD、抑郁、焦虑和躯体化。

方法：我们遵循乔安娜布里格斯研究所的系统评价方法。包括以英语发表的论文，发表日期在 1987 年至 2019 年 6 月之间。我们检索了六个相关数据库：MEDLINE、PsycINFO、Embase、Scopus、CINAHL 和 PILOTS，以及灰色文献。我们纳入了具有 CPTSD 患病率数据的观察性研究。

结果：19篇文章符合所有纳入标准。使用乔安娜布里格斯研究所报告流行数据研究的关键评估清单对每项纳入的研究进行质量评估。在此基础上，我们的叙事综合中包括了 13 项中等和高质量的研究。纳入的研究报告称，难民和流离失所人群中 CPTSD 的患病率从 2% 到 86% 不等。

结论：患病率差异很大的原因可能包括背景和地理差异、迁移后困难的影响以及样本人群特征，例如寻求治疗与一般人群。我们发现，在更多寻求治疗样本的研究中，患病率较高（范围：16-82%），其次是便利和滚雪球样本（40-51%），在更多使用随机抽样技术的研究中患病率较低（2-86%） . 与更广泛的文献一致，我们审查中的研究支持复杂的创伤后应激障碍与长期、反复的创伤和移民后生活困难之间存在关联，后者与难民和流离失所人口有关。需要在这个人群中对这种结构进行进一步的研究，包括有效的治疗方法。