The prevalence of PTSS under the influence of public health emergencies in last two decades: A systematic review and meta-analysis

Highlights

• Experience of PTSS was relatively common (17.0%) under the influence of PHEs.

• Subgroup moderators could explain 64% of the variance across studies.

• The prevalence of PTSS was higher in patients and frontline healthcare workers.

• More attentions should be paid to post-PHE trauma-related psychiatric symptoms.

Abstract

Background

Since the beginning of 21st century, several major public health emergencies (PHEs) have threatened the health of people globally. Posttraumatic stress symptoms (PTSS) was one of the most concerned mental health problems. The objective of this study is to systematically estimate the prevalence of PTSS under the influence of PHEs.

Method

We searched both English and Chinese databases. This meta-analysis used a random-effects model to estimate the prevalence of PTSS. Subgroup analyses were conducted to analyze the source of heterogeneity. Meta-regression model was used to calculate the proportion of the variance explained by subgroup moderators.

Results

Forty eligible studies (n = 15,538) were identified. The results revealed a pooled prevalence of PTSS of 17.0% (95%CI: 13.5%–21.2%), higher than that of previous epidemiological survey, with high between-studies heterogeneity (Q = 1199, I² = 96.75%, p < .001). There was variance of prevalence in different countries (4.0%–36.5%) and epidemics (12.1%–36.5%). The prevalence of PTSS showed the feature of fluctuation in the change of time (Q = 6.173, p = .290). Patients had higher prevalence (26.2%) compared to healthcare workers (HCWs) (18.5%) and community samples (12.4%) and frontline HCWs had marginally significantly higher estimated rate than general HCWs (22.2%, 95%CI:16.0%–30.1% vs. 10.4%, 95%CI: 6.4%–16.6%). The variance of prevalence screened by interview and self-reported was significant (Q = 3.393, p = .05) and studies with higher quality possessed lower prevalence (high:12.4%; moderate: 17.3%; low: 18.0%). The total variance explained by subgroup moderators was estimated 64% by meta regression model.

Limitations

Limitations include high level of heterogeneity between studies and within subgroups as well as the lack of studies with high quality and using probability sampling.

Conclusions

This study suggested that the PTSS was common under the influence of PHEs. It was crucial to further explore the psychological mechanism and effective strategies for prevention and intervention in future research with more high-quality studies.