Table 1. Identified studies.
| Country | Studies | Population-level trauma exposure | National or regional | Regional, specified | If regional, how/why region was selected | Year of data collection | Inclusion criteria | Response rate | N with PTSD data | PTSD measure and scoring | Time frame | PTSD prevalence (95% CI) | Women with PTSD data | PTSD %; sex difference | Age: M (years) (SD/CI); range | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DRC | Johnson et al., 2010 [124] | Violence and armed conflict for decades | Regional | Subregions of the North and South Kivu provinces and the Ituri district | High levels of violence during the war in Rwanda that crossed over the border into the DRC | Mar 2010 | Adults (18+) | 98.9% | 989 | PSS-I in Kiswahili; DSM-IV criteria Lay administered |
1 month | 50.1% (43.8%–56.3%) | 593 | 60.0% | Men: 44.4% (35.4%–53.4%) Women: 54.0% (46.6%–61.5%). p = 0.08 |
Mean = 40.1 (95% CI 38.2–42.0 years) |
| Ethiopia | Asnakew et al., 2019 [83] | Deadly garbage landfill landslide | Regional | Area of the Koshe landslide, Addis Ababa, Ethiopia, 2018 | Area experienced trauma due to landslide | May and June 2018 | Participants (15+ years old) | 98.2% | 830 | PCL-C in Amharic | 1 month | 37.3% (34.1% to 40.8%) | 491 | 59.2% | Men: 31.3% (26.4%–36.5%) Women: 41.5% (37.1%–46.0%) p = 0.003 |
Mean = 33 years (SD = 12) |
| Kenya | Jenkins et al., 2015 [125] | Election violence in August 2007 and 2013 | Regional | The Maseno area in Kisumu county, Nyanza Province in western Kenya | Endemic for malaria. In addition, Nyanza province experienced serious election violence in August 2007 | 6 months in 2013 | None reported | 96.4% | 1,146 | TSQ in English, Kiswahili, and Dholuo Cutoff of 6 Restricted to those who experienced trauma after age 16 |
1 week | 10.6% (8.8%–12.5%) | 545 | 47.6% | Men: 6.7% (4.8%–9.0%) Women: 14.9% (12.0%–18.1%) p < 0.001 |
<30 years = 281; 30–60 years = 448; >60 years = 171 |
| Liberia | Galea et al., 2010 [84] | Armed violence and conflict from 1989 to 2003 | Regional | Rural areas of Nimba County | History of civil conflict in Nimba County | Nov and Dec 2008 | Analyses restricted to those aged 19+ | 98.0% | 1,376 | HTQ in Liberian English Self-reported |
1 week | 48.3% (45.7%–50.9%) | 631 | 45.9% | Not reported | <35 y = 574 (41.7%); >35 = 802 (58.3%) |
| Johnson et al., 2008 [67] | National | N/A | N/A | May 2008 | Adults (18+), give accurate information about household | 98.2% | 1,661 | PSS-I in Liberian English; DSM-IV criteria Lay administered |
1 month | 44.0% (38.0%–49.0%) | 876 | 52.7% | Men: 46% (38%–54%) Women: 42% (38%–46%) p = 0.17 |
Mean = 41 (95% CI 40–42 years) | ||
| Vinck et al., 2013 [68] | National | N/A | N/A | Nov and Dec 2010 | Adults (18+) | 93.4% | 4,496 | PCL-C (language not reported) Cutoff of 44 Information on PCL-C assessors is not provided |
1 month | 12.6% (11.5%–13.9%) | 2,272 | 50.5% | Men: 6.3% (5.3%–7.4%) Women: 18.8% (17.2%–20.5%) p < 0.0001 |
Mean = 37.4 (SE = 0.26) | ||
| Nigeria | Gureje et al., 2006 [98] | None reported | Regional | Yoruba-speaking areas: Lagos, Ogun, Osun, Oyo, Ondo, Ekiti, Kogi, and Kwara | Not reported | Feb and Nov 2002 | Adults (18+), fluent in Yoruba | 79.9% | 4,984 | WMH Survey version of the CIDI in Yoruba Lay administered |
12 months | 0.0% (0.0%–0.0%) | 2,552 | 51.2% | Men: 0% (0%–0.2%) Women: 0% (0%–0.1%) p > 0.95 |
Mean = 35 (SE = 0.37) |
| Rwanda | Fodor et al., 2015 [96] | 1994 genocide that followed years of ethnic tensions and conflict | Regional | Ngoma commune in the Huye district in the South Province | Heavily affected by the genocide | Feb and Mar 2011 | Adults (18+) | 96% | 500 | PCL-C in Kinyarwanda Cutoff score of 44 Administered by trained native Rwandan college graduates in interview format |
1 month | 21.6% (18.1%–25.5%) | 349 | 75.0% | Not reported | Mean = 41.06 (14.9); 18–83 |
| Munyandamutsa et al., 2012 [70], Eytan et al., 2015 [69] | National | N/A | N/A | 3 months in 2008 | Ages 16+, Rwandan, fluent in Kinyarwanda, no mental impairment | Not reported | 962 | PTSD section of the MINI DSM-IV and ICD-10 criteria Clinician-administered |
1 month | 26.1% (23.2%–28.9%) | 567 | 58.9% | Men: 20.5% (16.6%–24.8%) Women: 30.0% (26.2%–33.9%) p = 0.001 |
Median = 33; range: 16–108 years | ||
| Pham et al., 2004 [126] | Regional | 4 communes: Ngoma (known as Butare town), Mabanza, Buyoga, and Mutura) | Diversity in region, level of urbanization, experience with the genocide, and relationship to the ICTR | Feb 2002 | Adults (18+) | 99% | 2,091 | PCL-C (language not reported); cutoff of 44 Self-reported |
1 month | 24.8% (23.0%–26.6%) | 1,074 | 51.4% | Men: 19.6% (17.2%–22.2%) Women: 29.7% (27.0%–32.5%) p < 0.001 |
Mean = 36.4 years; range 18–94 years | ||
| Rugema et al., 2015 [80] | Regional | Southern Province | Not reported | Dec 2011 to Jan 2012 | Aged 20–35 years, Rwandan | 99.8% | 913 | MINI in Kinyarwanda Clinician-administered |
1 month | 13.6% (11.4%–16.0%) | 477 | 52.0% | Men: 7.1% (4.8%–9.9%) Women: 19.5% (16.0%–23.3%) p < 0.001 |
20–24 = 275 (30.3%); 25–29 = 300 (33.0%); 30–35 = 333 (36.7%) | ||
| Sierra Leone | Betancourt et al., 2016 [97] | Civil war from 1991–2002 and EVD | Regional | Western area rural district and western area urban district | Diversity in ethnic composition and degrees of war exposure; was epicenter of EVD cases during the 2014–2015 outbreak | Jan to Apr 2015 | Adults (18+) | 98% | 1,008 | PSS-I adapted for use in Liberia in Krio Lay (trained research assistants) administered |
1 month | 6% (4%–7%) | 505 | 50.8% | Not reported | Mean = 34.2 years (95% CI 33.2–35.2) |
| Jalloh et al., 2018 [71] | Ebola | National | N/A | N/A | Jul 2015 | Head of household and another individual (aged between 15 years and 24 years) or a woman | 98% | 3,564 | IES-6 Administered by trained data collectors |
1 week | 16% (14.7%–17.1%) | 1,774 | 50% | Not reported | Median = 35 (SD = 15) | |
| South Africa | Herman et al., 2009 [75]; Williams et al., 2008 [127]; Atwoli et al., 2013 [72]; Atwoli et al., 2017 [73]; Koenen et al., 2017 [2]; Stein et al., 2008 [74]; Myer et al., 2009 [128]; Duckers et al., 2018 [129] | Apartheid until 1994. In the post-Apartheid era, high rates of nonpolitical violence and crime, child abuse, IPV, and HIV/AIDS and TB | National | N/A | N/A | Jan 2002 to June 2004 | Adult South Africans residing in households and hostels | 87.1% | 4,351 | CIDI version 3.0 in English, Afrikaans, Zulu, Xhosa, North Sotho, South Sotho, and Tswana; DSM-IV PTSD Lay administered |
12 months | 0.6% (0.4%–0.8%) | 2,619 | 60.2% | Men: 0.6% (0.3%–1.1%) Women: 0.6% (0.3%–1.0%) p = 0.92 |
Not reported |
| Machisa et al., 2017 [85] | Regional | Gauteng Province | Not reported | 2010 | Adult women | 79% | 501 |
HTQ in English, Zulu, Sotho, and Afrikaans Researcher administered Mean score ≥ 2.5 |
1 week | 11.6% (9%–14%) | 495 | 100.0% | Only women included | 18–29 = 30%; 30–44 = 36%; >45 = 33% | ||
| Peltzer and Pengpid, 2019 [77] | National | N/A | N/A | 2012 | Aged 15+ | 92.6% | 15,201 | 17-item DTS Information on assessors is not provided |
1 week | 2.1% (1.9%–2.3%) | 8,254 | 54.3% | Men: 2.0% (1.7%–2.4%) Women: 2.3% (2.0%–2.6%) p = 0.20 |
Mean = 36.8 (SD = 16.5) | ||
| Smit et al., 2006 [82] | Regional | Periurban settlement outside Cape Town, South Africa | High HIV prevalence | Not reported | Aged 15+ | 64.3% | 645 | HTQ in Xhosa and English; a cutoff score of 75 Self-reported |
1 week | 14.9% (12.2%–17.9%) | 357 | 55.3% | Men: 18.7% (14.0%–24.0%) Women: 13.7% (10.3%–17.7%) p = 0.10 |
Mean = 30.3 (11.9) | ||
| Topper et al., 2015 [81] | Regional | Eastern Cape Province, urban and semiurban areas of Nelson Mandela Bay and the semirural area of Kirkwood | Not reported | Not reported | Aged 18–40 years | 97.7% | 977 | MINI, version 6.0.0 in Xhosa, English, and Afrikaans; information on PCL-C assessors is not provided | 1 month | 10.8% (9.0%–13.0%) | 467 | 47.8% | Men: 11.6% (8.9%–14.7%) Women: 10.1% (7.5%–13.2%) p = 0.45 |
Not reported | ||
| South Sudan | Ayazi et al., 2012 [99]; Ayazi et al., 2014 [130] | Decades of ongoing civil war | Regional | The Greater Bahr el Ghazal region | Not reported | 2010 | Adults (18+) | 95% | 1,200 | HTQ with minor adaptations; Arabic with key terms in indigenous languages Cutoff of 2.0 Information on HTQ assessors is not provided |
2 weeks | 37.6% (34.8%–40.4%) | 506 | 44.0% | Men: 33.6% (30.0%–37.4%) Women: 42.1% (37.8%–46.5%) p = 0.003 |
18–25 = 308 (25.7%); 26–35 = 391 (32.6%); 36–50 = 395 (32.9%); >50 = 89 (7.4%) |
| Ng et al., 2017 [131] | Regional | 11 sites in 6 of South Sudan’s 10 states: (Central Equatoria, Jonglei, Upper Nile, Western Equatoria, Eastern Equatoria, and Lakes) and Abyei | Diverse in terms of ethnicity, socioeconomic status, livelihood, exposure to conflict, and security access | Dec 2014 to Apr 2015 | Adults (18+); South Sudanese | 99.5% | 1,520 | The HTQ-R in Classical Arabic, Juba Arabic, Dinka, Nuer, Shilluk, and Bari DSM-IV criteria Information on HTQ-R assessors is not provided |
1 week | 40.7% (38.2%–43.2%) | 773 | 50.9% | Men: 45.2% (41.6%–48.9%) Women: 36.2% (32.8%–39.7%) p < 0.001 |
Mean = 36.93 years (SD 13.90); range 18–86 | ||
| Roberts et al., 2009 [132] | Regional | Juba Town | High numbers of IDPs, returned IDPs and refugees | 20–30 Nov 2007 | Adults (18+) | 96.2% | 1,242 | Adapted version of the HTQ in Juba Arabic and Bari Mean PTSD scores ≥ 2.0 Trained lay administered |
1 week | 36.2% (33.2%–39.4%) | 630 | 50.7% | Men: 29.7% (25.4%–34.5%) Women: 42.5% (39.4%–45.7%) p < 0.01 |
Mean = 33 years | ||
| Uganda | Ertl et al., 2014 [79]; Neuner et al., 2012 [78] | Twenty-one years of war | Regional | Anaka, Awer, and Padibe Acholi regions | Varying degrees of war exposure and distance from the largest town, Gulu | Jul 2007 to Apr 2008 | Aged 12–25 | 99.9% | 1,113 | PDS in Luo Information on PDS assessors is not provided |
1 month | 15% (13%–17%) | 693 | 62.3% | Not reported | Not reported |
| Mugisha et al., 2015 [133]; Mugisha et al., 2015 [134]; Mugisha et al., 2016 [135] | Regional | Subcounties Lalogi and Koro (in Gulu district); Amuru and Atiak (in Amuru district); and Koch Goma and Alero (in Nwoya district) | Some of the most affected subdistricts by the 20-year civil war in northern Uganda that had a health center | 2 Jan 2013 to 2 June 2013 | Adults (18+), stayed in the area for more than 6 months, could fluently speak Luo | 100% | 2,361 | MINI in Luo Administered by trained psychiatric nurses |
1 month | 11.8% (10.5%–13.1%) | 1,475 | 62.5% | Men: 13.4% (11.2%–15.7%) Women: 10.9% (9.3%–12.5%) p = 0.002 |
18–24 = 555 (23.5%); 25–34 = 644 (27.3%); 35–44 = 490 (20.8%); 45–54 = 672 (28.5%) | ||
| Pham et al., 2009 [136] | Regional | 8 districts: Amuru, Gulu, Kitgum, Pader, Lira, Oyam, Amuria, and Soroti | Represent a variety of ethnic groups (Acholi, Iteso, and Langi) and exposure to the armed conflict | Mar to June 2007 | Adults (18+) | 64.5% | 2,867 | PCL-C in 3 local languages Cutoff score of 44 Non-clinician administered |
1 month | 54% (52%–56%) | 1,417 | 49.5% | Men: 40% (37.5%–42.6%) Women: 68.3% (65.8%–70.7%) p < 0.001 |
Mean = 35.4 years (SD = 14.35) | ||
| Vinck et al., 2007 [137] | Regional | Four districts: Gulu, Kitgum, Lira, and Soroti | Selected to represent a diversity of ethnic composition (Acholi, Langi, and Teso) and varying degrees of exposure to the war | Apr to May 2005 | Adults (18+) | 73% | 2,389 | PCL-C in Acholi, Lango, and Ateso Cutoff score of 44 Information on PCL-C assessors is not provided |
1 month | 74.3% (72.5%–76.0%) | 1,198 | 50.1% | Men: 64.7% (61.9%–67.4%) Women: 83.3% (81.6%–85.8%) p < 0.001 |
Mean = 37 years (SD = 13.8 years) | ||
Abbreviations: CI, confidence interval; CIDI, Composite International Diagnostic Interview [94]; DRC, Democratic Republic of Congo; DSM-IV, Diagnostic and Statistical Manual Version 4 [138]; DTS, Davidson Trauma Scale [89]; EVD, Ebola virus disease; HTQ, Harvard Trauma Questionnaire [86]; HTQ-R, Harvard Trauma Questionnaire-Revised; ICD-10, International Classification of Diseases, Tenth Revision [139]; ICTR, United Nations’ International Criminal Tribunal for Rwanda; IDP, internally displaced person; IES-6, Impact of Event Scale-6 [91]; IPV, intimate partner violence; MINI, Mini International Neuropsychiatric Interview [92]; N/A, Not applicable; PCL-C, PTSD Checklist-Civilian Version [87]; PDS, Posttraumatic Stress Diagnostic Scale [90]; PSS-I, PTSD Symptom Scale Interview [93]; PTSD, posttraumatic stress disorder; SE, standard error; TB, tuberculosis; TSQ, Trauma Screening Questionnaire [88]