War-Affected South Sudanese in Settings of Preflight, Flight, and Resettlement: a Systematic Review and Meta-analysis of Trauma-Associated Mental Disorders.

Background: South Sudanese have experienced prolonged exposure to conflict and displacement regionally and globally, with studies in different settings yielding vastly inconsistent rates of trauma-associated mental disorders. This systematic review and meta-analysis aimed to synthesize the methodological approach and quality, trauma exposure, risk and protective factors, and aggregate available data on the prevalence of trauma-associated mental disorders among South Sudanese in different settings to gain better understanding of the impact of war trauma in this population.

Methods: Guided by the new (2020) Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, we conducted a systematic review and meta-analysis of all studies published from 1981 to 2021. The main inclusion criteria were as follows: studies published in English, present prevalence rates on anxiety, depression, and/or posttraumatic stress disorder (PTSD), and number of traumatic events, and have a sample size of 30 or more. We calculated pooled prevalence, 95% confidence intervals, and statistic to test heterogeneity between studies in MedCalc statistical software.

Results: We reviewed a total of nine reports from eight unique studies with total of 6138 participants. All studies were cross-sectional in design with six designated as low quality and two as moderate quality. South Sudanese experienced on average nine war-related traumatic events. Consequently, the overall pooled rates of trauma-associated mental disorders are high: anxiety = 25.2% (95% CI: 14.0, 38.5); depression = 24.2% (8.4, 45.0); and PTSD = 34.0% (29.0, 39.1). Overall prevalence of PTSD was 40% in both preflight and flight settings; however, aggregate rate of just 14% was recorded in resettlement settings. Risk factors include female gender, advanced age, severity, and recency of traumatic events, and cultural adjustment difficulties. Protective factors include urban residency, social support, religion, higher annual household income, household possessions, and history of migration.

Conclusions: This systematic review and meta-analysis reveals that prolonged exposure to war trauma has negatively impacted the psychological wellbeing of South Sudanese in refugee camps and those still in their homeland. However, the prevalence appears to be lower among those resettled in developed countries.