What Are Effective Psychological Treatments for PTSD in Sub-Saharan Africa?

What you need to know

• Post-traumatic stress disorder (PTSD) is a serious mental health condition that can develop after exposure to traumatic events
• PTSD rates are likely elevated in sub-Saharan Africa due to high exposure to traumatic events, but little research has been done on effective treatments in this region
• This systematic review aims to evaluate the efficacy of different psychological interventions for PTSD in sub-Saharan African populations
• Findings could help guide clinicians in selecting appropriate PTSD treatments for patients in this region

Background on PTSD

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. People with PTSD may have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares, feel sadness, fear or anger, and feel detached or estranged from other people.

PTSD affects about 3.9% of the general population globally. However, rates are much higher (up to 15.5%) in populations affected by conflict. During the COVID-19 pandemic, extremely high PTSD rates of 44-55% were reported among healthcare workers in some African countries.

If left untreated, PTSD can significantly impact a person’s quality of life. It is associated with:

• Increased risk of other mental health issues like depression and anxiety
• Higher rates of substance abuse
• Greater risk of suicide
• Increased risk of cardiovascular disease
• Premature aging and mortality

Given these serious consequences, it’s important that PTSD is identified and treated promptly. However, in many low-resource settings in sub-Saharan Africa, PTSD often goes undiagnosed and untreated.

Challenges in Treating PTSD in Sub-Saharan Africa

There are several reasons why PTSD is undertreated in sub-Saharan Africa:

• Limited mental health resources and funding: In many countries, only a small percentage of the health budget goes toward mental health services. Most of this funding goes to inpatient care rather than community-based services.

• Shortage of mental health professionals: There is an average of only 1.4 mental health workers per 100,000 people in Africa, compared to the global average of 9 per 100,000.

• Stigma around mental health: Negative attitudes from healthcare workers, community members, and individuals themselves can prevent people from seeking help.

• Cultural beliefs: Some patients may have spiritual or cultural beliefs about mental health that differ from conventional psychiatric approaches. They may prefer to consult traditional healers.

• Lack of awareness: Many people do not recognize PTSD as a medical condition that can be treated.

• Comorbid conditions: The presence of other issues like depression or substance abuse can make it harder to diagnose PTSD.

• Limited access to care: Many people, especially in rural areas, have difficulty physically accessing mental health services.

Psychological Interventions for PTSD

Several types of psychological therapies have shown efficacy in treating PTSD symptoms:

• Cognitive-behavioral therapy (CBT): This approach helps patients identify and change negative thought patterns and behaviors related to their trauma. CBT can be trauma-focused (directly addressing the traumatic memory) or non-trauma focused.

• Eye movement desensitization and reprocessing (EMDR): This therapy involves recalling traumatic memories while doing specific eye movements. It aims to change how traumatic memories are stored in the brain.

• Other therapies: These may include psychodynamic therapy, hypnotherapy, supportive counseling, and present-centered therapy.

These interventions can be delivered individually or in group settings. Some studies in sub-Saharan Africa have found certain interventions to be effective:

• Thought field therapy reduced PTSD symptoms by 32% in Rwandan genocide survivors, with effects lasting at least 2 years.

• A “testimony” intervention, where participants verbally recount their most traumatic event, reduced PTSD symptoms for at least 11 months in a Mozambican sample.

• Trauma-focused CBT was superior to treatment-as-usual for orphaned children with trauma-related symptoms in Zambia when delivered by trained lay counselors.

However, the efficacy of these interventions may vary across different African populations due to cultural differences and variations in trauma exposure. More research is needed to determine which interventions work best in different contexts.

Goals of This Systematic Review

This systematic review aims to comprehensively evaluate the evidence on psychological interventions for PTSD in sub-Saharan Africa. The key goals are to:

1. Summarize the available evidence on the efficacy of different psychological therapies for PTSD in this region

2. Determine which types of interventions have been found to be most effective

3. Describe the specific contexts and populations in which different interventions have shown efficacy

4. Guide clinicians in selecting appropriate PTSD treatments for patients in sub-Saharan African settings

Methods

The researchers will conduct a systematic search of major medical databases (PubMed, PsychInfo, EMBASE, Cochrane) for relevant studies published between 1980 and November 2021. They will include randomized controlled trials of psychological interventions for PTSD in adult populations in sub-Saharan Africa.

Key aspects of the methodology include:

• Inclusion of studies using validated diagnostic tools to assess PTSD
• Comparison of intervention groups to control groups (e.g. waitlist, treatment as usual)
• Assessment of outcomes like PTSD symptom reduction, dropout rates, comorbid conditions, functioning, and quality of life
• Evaluation of both short-term and long-term outcomes (up to 12+ months post-intervention)
• Analysis of factors like intervention type, PTSD severity, comorbidities, and type of provider (professional vs. lay health worker)

The researchers will assess the quality and risk of bias of included studies. They will conduct meta-analyses where possible to calculate pooled effect sizes. A narrative synthesis will also be provided to summarize key findings.

Potential Impact

This systematic review could have several important impacts:

• Provide much-needed evidence on effective PTSD treatments specifically for sub-Saharan African populations
• Help clinicians select appropriate interventions based on patient characteristics and local context
• Identify gaps in current research to guide future studies
• Inform policy and resource allocation for mental health services in the region
• Ultimately improve care for individuals suffering from PTSD in sub-Saharan Africa

By synthesizing the available evidence, this review aims to strengthen the foundation for evidence-based PTSD treatment in a region where mental health resources are scarce but the need is great. The findings could play a key role in expanding access to effective care and reducing the burden of PTSD in sub-Saharan Africa.

Conclusions

• This systematic review will provide a comprehensive overview of research on psychological interventions for PTSD in sub-Saharan Africa
• Findings could help guide selection of appropriate, culturally-relevant PTSD treatments in this region
• Results may highlight gaps in current research and inform future studies on PTSD treatment in African populations
• Ultimately, this work aims to improve care for individuals with PTSD in sub-Saharan Africa by strengthening the evidence base for treatment