Background

The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS.

Methods

A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted.

Results

The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I² = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I²: 87.91 to 99.62).

Limitations

Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected.

Conclusions

The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.

中文翻译：

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东地中海地区遭受暴力冲突、战争和相关侵犯人权行为的成年平民的创伤后压力：系统评价和荟萃分析

背景

东地中海地区 (EMR) 是世界上最暴力冲突的舞台，也是世界上最大的难民人口的起源地。这些冲突可能导致创伤后压力 (PTS) 的症状。迄今为止，尚未对 EMR 中平民 PTS 的比例进行全面的荟萃分析。样本特征、方法论、冲突相关和流离失所相关因素可能会影响 PTS 的发生率。

方法

在 2020 年 3 月之前，对来自 EMR 的成年平民 PTS 的研究进行了系统的文献检索，并产生了 118 个适合纳入的个体研究样本。进行了质量评估。对比例和敏感性分析进行了随机效应荟萃分析，并计算了 95% 的预测区间。进行了亚组分析以确定调节剂（例如诊断仪器、置换）。

结果

纳入的研究样本的质量各不相同。所有 118 个研究样本的比例汇总估计值为 0.31（95% CI：0.27 - 0.35）。异质性相当大（Q  = 10151.58，p < .0001；I ²  = 98.64%）。预测区间为 0.01 至 0.76。在排除九个离群研究样本后，结果保持不变。所有亚组的异质性仍然很高（I ^{2 的}范围：87.91 至 99.62）。

限制

由于异质性，无法解释合并估计。无法检测导致异质性的调节剂。

结论

来自 EMR 的平民 PTS 症状的比例差异很大。预测区间表明真实率介于 1% 和 76% 之间。未来的研究需要确定影响异质性的变量。