Post traumatic stress disorders in Syrian children and adolescents exposed to the conflict A systematic review and meta analysis of the prevalence and its determinants

Abstract

A decade of ongoing armed conflict in Syria has affected millions of people. One of the most significant consequences is mental health illness in children and adolescents. Exposure to traumatic events, as conflicts, can result in mental, behavioral, and emotional problems in children and adolescents. Though several studies have assessed the prevalence of post-traumatic stress disorders among children and adolescents exposed to conflicts, a systematic approach to the issue, taking into account the specific contexts and culture of Syrian children and adolescents, is still lacking. This study aims to systematically review the literature on the prevalence of post-traumatic stress disorder among Syrian children and adolescents who were exposed to the Syrian conflict since 2011. It explores factors and determinants that mediate the exposure to armed conflict and post-traumatic stress disorder. This systematic review makes use of three databases (PubMed, Scopus, and PsychINFO) and grey literature, as reports of international non-governmental organizations such as World Health Organization, United Nations International Children's Emergency Fund, and United Nations High Commissioner for Refugees, issued between March 2011 and January 2021. Two authors performed the eligibility assessment and assessed the quality of selected articles. Meta-analysis was conducted using random effects. This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42021226619). In total, 26 eligible studies provided cross-sectional data for 11.401 Syrian children and adolescents under the age of 18, surveyed in eight countries with two types of assessment methods (self-report questionnaire and personal psychiatric interview). A meta-analysis of these studies indicates prevalence rates of 36.5% (6.3%-65.3%) for post-traumatic stress disorder. Several determinants were identified. These could be conflict-related, as the death of an important family member or an important person, witnessing clashes, violence, seeing dead bodies, and being internally displaced, socioeconomic and psychosocial, as social deprivation, social withdrawal, and VIII low parental/maternal attachment. Social trust and social support were protective factors. This study shows that post-traumatic stress disorder is highly prevalent among Syrian children and adolescents exposed to the Syrian conflict, and more prevalent than in most other contexts. It emphasizes the urgent mental health needs and encourages immediate interventions to mitigate the massive suffering for the conflict-affected children and adolescents.A decade of ongoing armed conflict in Syria has affected millions of people. One of the most significant consequences is mental health illness in children and adolescents. Exposure to traumatic events, as conflicts, can result in mental, behavioral, and emotional problems in children and adolescents. Though several studies have assessed the prevalence of post-traumatic stress disorders among children and adolescents exposed to conflicts, a systematic approach to the issue, taking into account the specific contexts and culture of Syrian children and adolescents, is still lacking. This study aims to systematically review the literature on the prevalence of post-traumatic stress disorder among Syrian children and adolescents who were exposed to the Syrian conflict since 2011. It explores factors and determinants that mediate the exposure to armed conflict and post-traumatic stress disorder. This systematic review makes use of three databases (PubMed, Scopus, and PsychINFO) and grey literature, as reports of international non-governmental organizations such as World Health Organization, United Nations International Children's Emergency Fund, and United Nations High Commissioner for Refugees, issued between March 2011 and January 2021. Two authors performed the eligibility assessment and assessed the quality of selected articles. Meta-analysis was conducted using random effects. This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42021226619). In total, 26 eligible studies provided cross-sectional data for 11.401 Syrian children and adolescents under the age of 18, surveyed in eight countries with two types of assessment methods (self-report questionnaire and personal psychiatric interview). A meta-analysis of these studies indicates prevalence rates of 36.5% (6.3%-65.3%) for post-traumatic stress disorder. Several determinants were identified. These could be conflict-related, as the death of an important family member or an important person, witnessing clashes, violence, seeing dead bodies, and being internally displaced, socioeconomic and psychosocial, as social deprivation, social withdrawal, and VIII low parental/maternal attachment. Social trust and social support were protective factors. This study shows that post-traumatic stress disorder is highly prevalent among Syrian children and adolescents exposed to the Syrian conflict, and more prevalent than in most other contexts. It emphasizes the urgent mental health needs and encourages immediate interventions to mitigate the massive suffering for the conflict-affected children and adolescents.