How is trauma-related distress experienced and expressed in populations from the Greater Middle East and North Africa? A systematic review of qualitative literature

Abstract

The Greater MENA region has high rates of political, social, and structural violence exposure, however there is a discrepancy in reported rates of PTSD in comparison with other areas of the world. This may be due to cultural variations in the conceptualization and expression of traumatic stress. More generally, there has been ongoing tension between theories of universality versus cultural variance in mental health. Quantitative evidence shows that similar symptoms emerge in the aftermath of trauma across cultures. At the same time, a growing body of evidence indicates the integral role of culture in shaping the etiology and phenomenology of mental disorders. Research exploring local narratives of individuals exposed to violence within the Greater MENA region is increasing, but no review has summarized findings of this body of research yet. This systematic review aimed to critically examine qualitative literature investigating how PTSD, CPTSD, any other forms of culturally-acknowledged trauma-related distress are experienced and expressed among people living in the Greater MENA region. Results covered CCD, culturally normalized symptoms of distress, PTSD, and CPTSD symptoms. Main symptom clusters of PTSD and CPTSD were endorsed with variations on particular symptom expressions. Studies provided sociocultural norms guiding such symptom expressions and highlighted the importance of structural factors in maintaining and perpetuating traumatic distress. The discussion section situates these findings within broader literature to deepen our understanding, and thus provide practical and research recommendations for more comprehensive and culturally-relevant understanding, diagnosis, and treatment of traumatic stress with the Greater MENA region.

Keywords

• Trauma
• CCD
• CPTSD
• DSO
• Trauma-related distress
• PTSD