Table 3.

GRADEpro

Summary of findings
Psychological violence on mental health
Population: Females from varying samples Setting: Primarily observational studies. Exposure: Psychological violence Outcome: PTSD, depression and anxiety
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with [comparison]	Risk with [intervention]
PTSD (Hedges g) Assessed with: multiple validated scales	0.90 (0.77; 1.04 95% CI)		-	8393 (45 observational studies)	⨁⨁◯◯ LOW a,b,c
PTSD (odds ratio) Assessed with: varying types of measures	Study population		OR 2.23 (1.37 to 3.64)	15,796 (13 observational studies)	⨁◯◯◯ VERY LOW c,d,e	The World Mental Health Survey has examined the 12-month prevalence of cross-country PTSD. The prevalence varied significantly by country income, with lower-low middle-income countries demonstrating a prevalence of 1.5% compared with 3.6% in high-income countries [88]. This variation is translated for the anticipated absolute effect comparing study population with low and high prevalence variations for PTSD.
	10 per 1000	22 per 1000 (14 to 35)
	Low
	15 per 1000	33 per 1000 (20 to 53)
	High
	36 per 1000	77 per 1000 (49 to 120)
Depression (Hedges g) Assessed with: multiple validated scales	0.69 (0.58; 0.81 95% CI)		-	112,487 (56 observational studies)	⨁⨁◯◯ LOW b,d
Depression (odds ratio) Assessed with: various types of measures	Study population		OR 2.13 (1.54 to 2.95)	74,147 (30 observational studies)	⨁⨁◯◯ LOW e,f	Kessler and Bromet [89] have reviewed the 12-month prevalence estimate of Major Depressive Disorder in 18 World Mental Health Surveys. The prevalence estimates ranges from 2.2 to 10.4% across the 18 countries. This variation is translated for the anticipated absolute effect comparing study population with low and high prevalence variations for depression.
	10 per 1000	21 per 1000 (15 to 29)
	Low
	22 per 1000	46 per 1000 (33 to 62)
	High
	104 per 1000	198 per 1000 (152 to 255)
Anxiety (Hedges g) Assessed with: multiple validated scales	0.58 (0.4; 0.76 95%CI)		-	7339 (20 observational studies)	⨁⨁◯◯ LOW b,g
Anxiety (odds ratio) Assessed with: various types of measures	Study population		OR 2.20 (1.75 to 2.77)	37,814 (8 observational studies)	⨁⨁◯◯ LOW e,h	Baxter, Scott, Vos, and Whiteford [90] applied a meta-regression of prevalence studies of anxiety disorders from 44 countries. The estimated adjusted prevalence varied from 7.6 to 17.7% within the past 12 months across countries. This variation is translated for the anticipated absolute effect comparing study population with low and high Prevalence variations for anxiety.
	10 per 1000	22 per 1000 (17 to 27)
	Low
	76 per 1000	153 per 1000 (126 to 186)
	High
	177 per 1,000	321 per 1000 (273 to 373)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI confidence interval, OR odds ratio

GRADE Working Group grades of evidence

High certainty: We are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect

Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Explanations

^a. I² statistic of 94%

^b. E.g., gender bias, convenience samples, design

^c. Large range in confidence interval—imprecise results

^d. I² statistic of 95%

^e. Design, measures, sampling

^f. I² Statistic of 97%

^g. I² Statistic of 91%

^h. I² Statistic of 62%