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

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A Correction to this article was published on 28 July 2022

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Abstract

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 I2 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.

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Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

The review was part of the first author’s work as a postdoctoral trainee in the LEAD Global Training Program (T37).

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Authors and Affiliations

  1. International Center for Child Health and Development (ICHAD), Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA

    Nhial T. Tutlam & Fred M. Ssewamala

  2. Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA

    Jen Jen Chang & Louise H. Flick

  3. Boston College School of Social Work, Chestnut Hill, St. Louis, MA, USA

    William Byansi & Theresa S. Betancourt

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NTT, JJC, and LHF conceptualized the study. FMS and TSB guided the study design. NTT and WB conducted the data analysis. NT wrote a first draft of the paper and all authors critically revised the manuscript and all authors read and approved the final draft.

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Correspondence to Nhial T. Tutlam.

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Tutlam, N.T., Chang, J.J., Byansi, W. et al. War-Affected South Sudanese in Settings of Preflight, Flight, and Resettlement: a Systematic Review and Meta-analysis of Trauma-Associated Mental Disorders. Glob Soc Welf (2022). https://doi.org/10.1007/s40609-022-00227-w

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