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      Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review

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          Abstract

          Abstract

          Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.

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          Most cited references104

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          Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010

          Harvey Whiteford, Louisa Degenhardt, Jürgen Rehm … (2013)
          The Lancet, 382(9904), 1575-1586
          Article 0 comments Cited 898 times – based on 0 reviews     Review now
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            New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

            Fiona J. Charlson, Mark van Ommeren, Abraham Flaxman … (2019)
            Summary Background Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population. Methods In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously. Findings We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8–25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3–16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9–5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0–6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations. Interpretation The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden. Funding WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.
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              Syndemics and the biosocial conception of health.

              Merrill Singer, Nicola Bulled, Bayla Ostrach … (2017)
              The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Glob Ment Health (Camb)
                Journal ID (iso-abbrev): Glob Ment Health (Camb)
                Journal ID (publisher-id): GMH
                Title: Cambridge Prisms: Global Mental Health
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Electronic): 2054-4251
                Publication date (Electronic, collection): 2023
                Publication date (Electronic): 12 December 2022
                Volume: 10
                Electronic Location Identifier: e5
                Affiliations
                [ 1 ]Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA, USA
                [ 2 ]Department of Psychology, University of Cape Town , Cape Town, South Africa
                [ 3 ]Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health , New York, NY, USA
                [ 4 ]Department of Psychology, Colin Powell School of Civic and Global Leadership, The City College of New York , 160 Convent Avenue, New York, NY, USA
                [ 5 ]Department of Epidemiology, Columbia University Mailman School of Public Health , New York, NY, USA
                Stanford University School of Medicine , United States
                King's College London , United Kingdom of Great Britain and Northern Ireland
                Harvard University T H Chan School of Public Health , United States
                Department of Global Health and Social Medicine, Harvard Medical School , United States
                Johns Hopkins University Bloomberg School of Public Health , United States
                London School of Hygiene & Tropical Medicine , United Kingdom of Great Britain and Northern Ireland
                Stanford University School of Medicine , United States
                Department of Global Health and Social Medicine, Harvard Medical School , United States
                London School of Hygiene & Tropical Medicine , United Kingdom of Great Britain and Northern Ireland
                Johns Hopkins University Bloomberg School of Public Health , United States
                Author notes
                Author for correspondence: Debra Kaysen, Email: dkaysen@ 123456stanford.edu

                Reviewer declares none.

                Reviewer declares none.

                Reviewer declares none.

                Author information
                https://orcid.org/0000-0001-7961-2787
                https://orcid.org/0000-0002-5278-4551
                https://orcid.org/0000-0002-6097-6211
                https://orcid.org/0000-0002-4631-4764
                https://orcid.org/0000-0003-2521-6329
                https://orcid.org/0000-0002-6598-3840
                Article
                Publisher Item ID: S2054425122000632
                DOI: 10.1017/gmh.2022.63
                PMC ID: 9947613
                SO-VID: e814f217-0881-4bb2-80ee-b878d7e5ff7c
                Copyright © © The Author(s) 2022
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                Date received : 02 September 2022
                Date revision received : 22 November 2022
                Date accepted : 05 December 2022
                Page count
                References: 108, Pages: 9
                Funding
                Funded by: National Institute of Mental Health, doi http://dx.doi.org/10.13039/100000025;
                Award ID: T32MH019938
                Funded by: National Institute on Alcohol Abuse and Alcoholism, doi http://dx.doi.org/10.13039/100000027;
                Award ID: K01AA026523
                Funded by: National Institute on Minority Health and Health Disparities, doi http://dx.doi.org/10.13039/100006545;
                Award ID: R01MD011574
                Categories
                Subject: Review
                Subject: Interventions
                Subject: Individual Care
                Subject: Etiology

                Keywords: posttraumatic stress disorder,ptsd,substance use,alcohol,global mental health,low-income countries,review,alcohol use disorder,comorbidity
                Data availability:
                Keywords: posttraumatic stress disorder, ptsd, substance use, alcohol, global mental health, low-income countries, review, alcohol use disorder, comorbidity

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