Prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries: a systematic review and meta-analysis

Abstract

Objectives To systematically synthesise the evidence on prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries (LMICs).Design Systematic review and meta-analysis.Data sources MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Global Health, Global Index Medicus and the grey literature were searched with no language or date restrictions. The final search was carried out on 3 May 2022.Eligibility criteria Cross-sectional, cohort or case–control studies that assessed the prevalence of PTSD in pregnant or postpartum women in LMICs were included.Data extraction and synthesis Screening, data extraction and quality assessment were conducted independently by two reviewers. Pooled prevalence estimates were calculated with 95% CIs and prediction intervals (PI) using random-effects meta-analyses. Subgroup analyses and meta-regression were conducted to explore possible sources of statistical heterogeneity.Results 39 studies were included in the systematic review of which 38 were included in meta-analysis. The pooled prevalence of clinically diagnosed perinatal PTSD was 4.2% (95% CI 2.2% to 6.8%; 95% PI 0–18%; 15 studies). The pooled prevalence of self-reported perinatal PTSD symptoms was 11.0% (95% CI 7.6% to 15.0%; 95% PI 0–36%; 23 studies). There was no evidence of differences in prevalence according to perinatal stage (antenatal versus postnatal), geographical region, type of setting or study quality.Conclusions Findings of this review suggest 1 in 10 perinatal women experiences symptoms of PTSD and 1 in 20 experiences clinically diagnosed PTSD. Statistical heterogeneity between studies persisted in subgroup analyses and results should be interpreted with caution. More research from low-income countries is needed to improve understanding of the burden of perinatal PTSD in these settings.PROSPERO registration number CRD42022325072.