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Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review

Published online by Cambridge University Press:  20 November 2024

Anne Stevenson*
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
Engida Girma
Affiliation:
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
Benon Kabale Kitafuna
Affiliation:
Community Mental Health Initiative NGO, Mulago Hospital Complex, Kampala, Uganda
Boniface Harerimana
Affiliation:
Lawson Health Research Institute, London, Ontario, Canada
Karestan C. Koenen
Affiliation:
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Soraya Seedat
Affiliation:
South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
*
Corresponding author: Anne Stevenson; Email: astevens@broadinstitute.org
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Abstract

Background

There is a strong link between trauma exposure and serious mental health conditions (SMHCs), such as schizophrenia and bipolar disorder. The majority of research in the field has focused on childhood trauma as a risk factor for developing an SMHC and on samples from high-income countries. There is less research on having an SMHC as a risk factor for exposure to traumatic events, and particularly on populations in low- and middle-income countries (LMICs).

This scoping review aimed to synthesize the nature and extent of research on traumatic events that adults with SMHCs face in LMICs. It was conducted across five databases: PubMed, Embase, PsycINFO, Web of Science Core Collection and Africa-Wide Information/NiPad in December 2023 and by hand searching citation lists.

Findings

The database search returned 4,111 articles. After removing duplicates and following a rigorous screening process, 51 articles met criteria for inclusion. There was one case study, one mixed methods study, 12 qualitative studies and 37 quantitative studies. Ten countries were represented, with the most studies from India (n = 19), Ethiopia (n = 9) and China (n = 6). Schizophrenia was the most studied type of SMHC. Of the trauma exposures, more than 76% were on interpersonal violence, such as sexual and physical violence. Of the studies on interpersonal violence, more than 23% were on physical restraint (e.g., shackling) in the community or in hospital settings. There were no studies on man-made or natural disasters.

Implications

Much of our data in this population are informed by a small subset of countries and by certain types of interpersonal violence. Future research should aim to expand to additional countries in LMICs. Additional qualitative research would likely identify and contextualize other trauma types among adults with SMHCs in LMICs.

Topics structure

Type
Review
Creative Commons
Creative Common License - CCCreative Common License - BY
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.
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Impact statement

The impact of this scoping review, a type of analysis that looks at all the research on a specific topic, shows much of our data on adults with preexisting serious mental health conditions (SMHCs) who are then exposed to trauma in low- and middle-income countries (LMICs) come from a small subset of countries and certain types of interpersonal violence.

History of the topic: Trauma exposure and SMHCs, such as schizophrenia and bipolar disorder, have been shown to be interconnected. Most of the research in this area has focused on childhood trauma as a risk factor for developing an SMHC, and the bulk of this work has come from studies in high-income countries in North America and Western Europe. While it is often stated that people with SMHCs are more vulnerable to experiencing traumatic events than the general public, there is less research on having an SMHC as a risk factor for exposure to traumatic events, and particularly on populations in LMICs, which have been underrepresented in research to date. This scoping review aims to fill this gap and to synthesize what trauma types adults with SMHCs face in LMICs.

Main takeaways: After a thorough search, we found that studies on this topic came from only 10 countries (out of more than 130 LMICs) and two-thirds of these were from India, Ethiopia and China. The vast majority of these studies were about interpersonal violence, such as sexual violence, intimate partner violence and physical violence, and more than one-fifth of these were on physical restraint, such as chaining. There were no studies on man-made or natural disasters. The findings support that adulthood trauma exposure among people with SMHCs is an existing issue in LMICs and is a call to action to eradicate violent practices in both community and healthcare settings.

Introduction

There is an established link between trauma exposure and serious mental health conditions (SMHCs), such as schizophrenia, schizoaffective disorder and bipolar disorder (Grubaugh et al., Reference Grubaugh, Zinzow, Paul, Egede and Frueh2011; Mauritz et al., Reference Mauritz, Goossens, Draijer and van Achterberg2013). Many studies have shown that trauma exposure, often defined as exposure to actual or threatened death, serious injury or sexual violence (American Psychiatric Association, 2013), poses a significant risk for the development of SMHCs (Read et al., Reference Read, van Os, Morrison and Ross2005; Varese et al., Reference Varese, Smeets, Drukker, Lieverse, Lataster, Viechtbauer, Read, van Os and Bentall2012; Woolway et al., Reference Woolway, Smart, Lynham, Lloyd, Owen, Jones, Walters and Legge2022). Most of the research on trauma and SMHCs has focused on childhood adversity and in samples from high-income countries in Europe, North America and Australasia (Read et al., Reference Read, van Os, Morrison and Ross2005; Varese et al., Reference Varese, Smeets, Drukker, Lieverse, Lataster, Viechtbauer, Read, van Os and Bentall2012; Woolway et al., Reference Woolway, Smart, Lynham, Lloyd, Owen, Jones, Walters and Legge2022).

Multiple models have been proposed to explain why exposure to trauma, and particularly childhood adversity, may increase the risk for developing an SMHC, including the stress-vulnerability model (Zubin and Spring, Reference Zubin and Spring1977). This model posits that some people have a biological vulnerability to SMHCs. While individuals may be able to withstand a certain amount of stress, once a certain threshold of stress is reached or a stressor is particularly intense, people become more susceptible to developing SMHCs.

Likewise, researchers have also argued that people with SMHCs may be more vulnerable to exposure to trauma than those without such conditions. Population studies have found people with SMHCs report more victimization than the general public (Maniglio, Reference Maniglio2009; de Vries et al., Reference de Vries, van Busschbach, van der Stouwe, Aleman, van Dijk, Lysaker, Arends, Nijman and Pijnenborg2019). One theory for this is that people with SMHCs may have cognitive impairments that impact their decision-making and problem-solving abilities, restricting their ability to navigate potentially dangerous situations (de Vries et al., Reference de Vries, van Busschbach, van der Stouwe, Aleman, van Dijk, Lysaker, Arends, Nijman and Pijnenborg2019). People with SMHCs may also be exposed to trauma through settings due to their mental health conditions, such as inpatient and outpatient healthcare centers. Patients with SMHCs have reported high rates of trauma exposure in psychiatric settings, including physical and sexual assault by staff, police and other patients (Frueh et al., Reference Frueh, Knapp, Cusack, Grubaugh, Sauvageot, Cousins, Yim, Robins, Monnier and Hiers2005; Lundberg et al., Reference Lundberg, Johansson, Okello, Allebeck and Thorson2012a).

Like the childhood adversity literature, the research on having an SMHC as a risk factor for trauma exposure in adulthood has also primarily been from samples in high-income countries (Maniglio, Reference Maniglio2009; de Vries et al., Reference de Vries, van Busschbach, van der Stouwe, Aleman, van Dijk, Lysaker, Arends, Nijman and Pijnenborg2019). Deepening research in LMICs may shed light on the possibility of unique traumas in this population. Furthermore, identifying and codifying trauma exposure in this population may raise awareness about such incidents and lead to healthcare and human rights policy changes for people with SMHCs (Guan et al., Reference Guan, Liu, Wu, Chen, Wang, Ma, Wang, Good, Ma, Yu and Good2015; Hidayat et al., Reference Hidayat, Oster, Muir-Cochrane and Lawn2023).

This scoping review aims to fill this gap by synthesizing the literature on trauma that adults with a diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder or depression with psychotic features are exposed to in LMICs, which have been less represented in research to date.

We framed this exploratory study around Peters et al.’s population, concept, context framework for scoping reviews (Peters et al., Reference Peters, Marnie, Tricco, Pollock, Munn, Alexander, McInerney, Godfrey and Khalil2021). Our primary research question aimed to establish the evidence base on adult trauma exposure experienced by people with SMHCs in LMICs. In other words, what is the extent, range, and nature of research about adults with SMHCs (population) being exposed to a traumatic event in adulthood (concept) in an LMIC (context)?

Our secondary research question was to ascertain whether there were any trends in the data; for example, whether there were trauma types or demographics that were more commonly studied than others. We expected most trauma exposures would be types of interpersonal violence (use of physical, sexual or psychological force against another person or small group of people) (Mercy et al., Reference Mercy, Hillis, Butchart, Bellis, Ward, Fang and Rosenberg2017) and human rights violations, such as solitary confinement for multiple years.

Methods

We followed the JBI updated guidelines for the conduct of scoping reviews (Peters et al., Reference Peters, Marnie, Tricco, Pollock, Munn, Alexander, McInerney, Godfrey and Khalil2021). As part of the review, we developed an extensive search query, retrieved all articles, conducted multiple phases of screening, extracted the data and synthesized the results. We outline each step below.

Search strategy: We developed our search strategy to run in five databases: PubMed, Embase, PsycINFO, Web of Science Core Collection and Africa-Wide Information/NiPad. We started with PubMed and used a combination of medical subject headings (MeSH), some of which were “exploded” to retrieve any citations that fell under its subheadings, title and abstract (tiab) fields, and keyword (kw) fields. We used Boolean operators to develop a search query based on more than 300 terms and phrases connected to SMHCs, traumatic events and LMICs.

For SMHCs, we included words that were often associated with this term, such as “schizophrenia,” “serious mental illness” and “psychotic disorder.”

For trauma exposure, we pulled terms from two commonly used measures that assess potentially traumatic events: the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition (LEC-5) (Weathers et al., Reference Weathers, Blake, Schnurr, Kaloupek, Marx and Keane2013) and the posttraumatic stress disorder module of the World Mental Health Survey version of the World Health Organization Composite International Diagnostic Interview (CIDI) (Kessler and Üstün, Reference Kessler and Üstün2004), which is based on the International Classification of Diseases (ICD). We then expanded the terms from the LEC-5 and the CIDI to include specific examples of the type of trauma in question. For example, for “natural disasters,” we listed this term and also listed typhoons, landslides, tsunamis, etc. A priori, on the basis of qualitative studies with people with SMHCs in LMICs and commentaries by leaders in the field (Alem, Reference Alem2000; Ametaj et al., Reference Ametaj, Hook, Cheng, Serba, Koenen, Fekadu and Ng2021), we included events that may be more common in LMICs than in high-income countries, although they can happen anywhere, including human rights violations, mob justice, chaining and restraining. Additionally, we included the term “idiom(s) of distress” to potentially retrieve articles that might have focused on expressions of trauma not typically captured in “Western” terminology.

For LMICs, we included the name of every country that was classified as an LMIC by the World Bank as of November 2023 (World Bank, 2023) (i.e., Afghanistan) as well as unrecognized countries or disputed territories that were not on the World Bank list but still met criteria as an LMIC (i.e., Somaliland). We also added overarching categories that are sometimes used to describe these groupings, such as “South Asia,” “developing country,” and “Global South.”

We then adapted the search string to Embase, PsycINFO, Web of Science, and Africa-Wide Information/NiPad using their controlled subject vocabulary. See Supplemental File 1 for the full search strings for each database.

Inclusion and exclusion criteria: Our inclusion and exclusion criteria were as follows:

Inclusion:

  • Adults aged ≥18 years.

  • People with a diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder or depression with psychotic features.

  • Trauma exposure must have occurred after the psychiatric diagnosis.

  • Study population was in an LMIC.

  • Observational studies only.

  • Empirical studies in peer-reviewed journals, including case studies, qualitative studies and quantitative studies.

  • There were no restrictions on the language in which the article was written.

  • There were no restrictions on the date the article was published.

Exclusion:

  • Studies with data collected in high-income countries.

  • Studies where it was not clear when the trauma occurred and the diagnosis of the mental health condition occurred.

  • Studies where the trauma only occurred in childhood, adolescence or youth.

  • Children (people aged <18 years).

  • Intervention studies (i.e., randomized control trials).

  • Conference papers and abstracts, commentaries, letters, news articles, scoping reviews, systematic reviews, meta-analyses and gray literature.

  • Biological process studies such as biomarkers, genetic studies, biospecimens and circuitry.

  • Animal studies.

There were a few caveats to these criteria. If we could not distinguish whether an article included participants with depression vs. depression with psychotic features, we kept the article in. If an article was about “psychiatric conditions,” but we could not split out data from the disorders that met our eligibility criteria (i.e., schizophrenia) from the overall grouping, we excluded the article. If an article included participants under 17.9 years and we could separate out data for participants ≥18, we included the article and only reported on data pertaining to adults. If we could not split out participants under 17.9 from ≥18 (for example, if the age range was 15–49), the article met all our other eligibility criteria and the mean age of participants was ≥18, we included the article.

Reviewing retrieved articles

We ran our search on December 20, 2023, downloaded the citations from the retrieved articles and imported them into Covidence (www.covidence.org [Veritas Health Innovation Ltd, 2024]). Following the removal of duplicate articles in Covidence, we followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., Reference Tricco, Lillie, Zarin, O’Brien, Colquhoun, Levac, Moher, Peters, Horsley, Weeks and Hempel2018) process and created a flowchart to capture each stage (see Figure 1).

We screened the remaining articles in two stages. First, two reviewers (AS and EG) independently screened the titles and abstracts for eligibility according to the inclusion/exclusion criteria. The same reviewers then independently screened the full text of the remaining articles to assess eligibility. At both stages, for articles that were in conflict, the two reviewers discussed the articles and came to a consensus on whether they met eligibility. Following confirmation that an article met the criteria, we hand-searched its reference list to identify additional articles that should be reviewed (Dundar and Fleeman, Reference Dundar, Fleeman, Boland, Dickson and Cherry2017).

We then moved all articles into the data extraction pool. We created a Google Sheet to extract a range of fields from each article: article information (i.e., first author and title), study design, sample size, sex/gender of participants (% female), mean age, racial/ethnic composition, participant psychiatric diagnosis, method of assessment for the psychiatric condition, type of trauma exposure, tool used to assess trauma exposure, and country and municipality where the participants were recruited. AS extracted data for each article, and another reviewer independently extracted data from the same article. They then cross-checked each other’s work to ensure accuracy. We held group discussions when there were divergent decisions and came to a consensus on the final answer.

Search procedure validation

In order to validate our search procedure and to confirm that we did not exclude any articles in the screening stages that should have been included, we used a machine learning tool, ASReview version 1.6.2 (https://asreview.nl/ [van de Schoot et al., Reference van de Schoot, de Bruin, Schram, Zahedi, de Boer, Weijdema, Kramer, Huijts, Hoogerwerf, Ferdinands, Harkema, Willemsen, Ma, Fang, Hindriks, Tummers and Oberski2021]) to additionally re-check the excluded articles. ASReview is an open-source software that utilizes active-learning to screen large amounts of data primarily for scoping and systematic reviews. For this process, we uploaded all the articles from the original screening phase (following the removal of the duplicates). We then selected one article that met inclusion criteria and one that did not train the software on which articles should be included/excluded. We screened 407 articles in total, labeling each one as “relevant” (likely met inclusion criteria) and “irrelevant” (did not meet inclusion criteria). From the articles we labeled as relevant, we cross-checked these against our final list of included articles and reread the full text of any articles we had originally excluded to determine whether they met inclusion criteria.

Synthesis plan

The synthesis plan was a narrative summary following guidelines from (Cumpston et al., 2022) in which we focused primarily on the types of studies included, countries where the data collection took place and types of trauma reported. We presented the charting results as text in a table and graphical summaries of the research data.

We did not conduct a formal publication bias analysis as this is not typically done in scoping reviews (Peters et al., Reference Peters, Marnie, Tricco, Pollock, Munn, Alexander, McInerney, Godfrey and Khalil2021).

Protocol deposit

The protocol for this study is available through Open Science Framework and can be found here: https://doi.org/10.17605/OSF.IO/JRSQP.

Results

We ran our search in PubMed, Embase, PsycINFO, Web of Science Core Collection and Africa-Wide Information/NiPad, which retrieved 4,111 articles. After uploading all search results into Covidence, we removed 1,744 duplicates and were left with 2,367 articles for title and abstract screening. AS and EG double screened all titles and abstracts and removed 2,290 irrelevant studies. Their agreement rate was 97.5%. We then reviewed the full text of 77 articles. Forty-six studies met the criteria for inclusion. For the hand-searching process, AS identified 39 citations for articles to screen; after going through the full screening process for these articles, AS found four that met eligibility. In addition, AS discovered an additional article that met the criteria during a separate literature review. AS added these five articles to the pool for extraction. Using ASReview, AS tagged 57 articles as relevant, of which 46 were already in our included pool. Upon rereading the additional 11, they still did not meet our inclusion criteria; thus, the software did not identify any erroneously excluded articles.

We were left with 51 articles that met the criteria. (See Figure 1 for the PRISMA flow diagram that captures the search and selection process.)

We then extracted data from all the remaining articles into a Google document (see Table 1 for the articles that met eligibility and the data we extracted from each). There was 1 case study, 1 mixed-methods study (both qualitative and quantitative measures), 12 qualitative studies and 37 quantitative studies. Of the quantitative studies, the majority were cross-sectional. There were nine studies reporting on mortality, all of which were cohort studies, some of which followed patients for years and some which used national or regional health records to determine mortality rates. The number of participants in the studies ranged from 1 to 72,021,918. The percentage of female participants ranged from 0% to 100%. For studies that provided a mean age of participants (n = 42), the average age ranged from 26.7 to 51.9 years. The most represented countries were India (n = 19), Ethiopia (n = 9) and China (n = 6), which made up two-thirds of the studies. Additional countries represented in the studies were Indonesia (n = 5), Nigeria (n = 3), Uganda (n = 3), Brazil (n = 2), Egypt (n = 2), Ghana (n = 1) and South Africa (n = 1). The most studied mental health condition was schizophrenia. The most studied traumatic event was interpersonal violence (76.5%–84.3%)Footnote 1 including intimate partner violence and sexual and physical victimization types. Of the types of interpersonal violence, more than one-fifth were about physical restraint, which ranged from shackling people by their ankles to a tree to chemical restraint in a hospital (23.3%–34.9%)Footnote 1. There were no studies on man-made or natural disasters.

Table 1. Articles and their characteristics included in the scoping review

Acronyms: BP = bipolar disorder; DSM = Diagnostic and Statistical Manual of Mental Disorders; ICD = International Classification of Diseases; IPV = intimate partner violence; MINI = Mini International Neuropsychiatric Interview; N/A = not applicable; OPCRIT = Operational Criteria Checklist for Psychotic Illness; PSE = Present State Examination; SCID = Structured Clinical Interview for DSM-IV; SCZ = schizophrenia; SMI = severe mental illness or serious mental illness; SZA = schizoaffective disorder; WHO = World Health Organization.

Note: the terminology in the table reflects the language the researchers used in their articles, such as SMI.

Figure 1. PRISMA flow chart of the search and selection process for the scoping review.

Discussion

This scoping review aimed to synthesize the existing literature on trauma exposure experienced by adults with preexisting SMHCs in LMICs. By including multiple types of studies, we captured a breadth of trauma types and SMHCs that inform the different ways we conceptualize trauma exposure across mental health diagnoses in LMIC settings. The range of sample sizes, sexes represented, age of participants and variation in diagnoses also illustrates the diversity of studies in the field, which may make the findings more reflective of real-world experiences of patients with SMHCs.

Of the 51 included articles, India, Ethiopia and China made up more than 66% of the studies; thus, even though there was a broad range of types of studies and demographics, our understanding of the field derives from a small subset of countries. For example, eight of the nine mortality studies were from India, Ethiopia and China, providing data on traumas that led to death in these populations. Furthermore, with only 10 countries represented in total, there were no data from the more than 120 other LMICs. Though the additional articles outside of India, Ethiopia and China included studies from Southeast Asia, South America and Africa, these regions and the countries within them have diverse populations, geographies and cultures. As such, the studies included may not reflect the full scope of types and frequencies of traumas that people with SMHCs face within and across such heterogeneous LMICs.

Interpersonal violence, which accounted for the majority of studies, emerged as a significant category of traumatic events. Such studies support the notion that people with SMHCs are at additional risk for victimization given their mental health conditions. For example, having an SMHC is associated with social and physical isolation and potential cognitive impairments and/or symptoms (i.e., positive and negative symptoms), which increase the likelihood of being targeted by a perpetrator (de Vries et al., Reference de Vries, van Busschbach, van der Stouwe, Aleman, van Dijk, Lysaker, Arends, Nijman and Pijnenborg2019). Alternatively, in many studies family members said they had tied up their loved ones in order to protect them from harm in the community and had no other options given the lack of treatment options and accessible and affordable health care (Asher et al., Reference Asher, Fekadu, Teferra, De Silva, Pathare and Hanlon2017).

One type of interpersonal violence, “chaining” and “restraining,” represented a significant percentage of events. However, the type of restraint differed widely. While some participants were kept in wooden cages in their community for years, some were in solitary isolation as inpatients for a short period. In both high-income countries (the United States) and in LMICs (Ethiopia and China), people with SMHCs have described restraint as traumatizing (Frueh et al., Reference Frueh, Knapp, Cusack, Grubaugh, Sauvageot, Cousins, Yim, Robins, Monnier and Hiers2005; Zhu et al., Reference Zhu, Xiang, Zhou, Gou, Himelhoch, Ungvari, Chiu, Lai and Wang2014; Ametaj et al., Reference Ametaj, Hook, Cheng, Serba, Koenen, Fekadu and Ng2021). In Uganda, the United Nations Office of the High Commissioner for Human Rights has described the use of physical, mechanical and chemical restraints and isolation/seclusion in psychiatric facilities in conflict with the Convention on the Rights of Persons with Disabilities’ Article 15 (“Freedom from torture and cruel, inhuman or degrading treatment or punishment” for all people) (OHCHR, 2016).

Even in nonpsychiatric contexts, there is evidence that physical restraint can lead to physical and psychological harm, including PTSD (Franks et al., Reference Franks, Alcock, Lam, Haines, Arora and Ramanan2021). The concept of restraint can be controversial, however, because it can be deemed necessary by hospital staff for a patient’s safety depending on an institution’s clinical guidelines. Restraint is also not captured by measures that are often used to assess trauma exposure such as the LEC and the CIDI. Such standardized measures can sometimes fail to capture a wider range of exposures as well as the subjective nature of what is considered traumatic. This may have affected how participants reported traumatic events in these countries.

This is particularly relevant in non-Western settings. Some researchers maintain that the acknowledgment of traumatic events and subsequent traumatic stress is not simply a response to objective experiences, but is shaped by the culture in which one exists and is understood through what is considered traumatic in their setting (Chentsova-Dutton and Maercker, Reference Chentsova-Dutton and Maercker2019). The value of including qualitative research is that it can augment quantitative reports by offering insights into personal trauma experiences and contextual factors in these settings.

Surprisingly, there were no studies about man-made or natural disasters, such as war, fires and landslides. There is literature about vulnerable populations being left behind in dangerous situations because they are incapable of fleeing, such as the elderly in conflict zones (Murthy and Lakshminarayana, Reference Murthy and Lakshminarayana2006) or during environmental crises like Hurricane Katrina (Dosa et al., Reference Dosa, Feng, Hyer, Brown, Thomas and Mor2010). However, none of these trauma types were elicited in this search. It is possible that this is because it is harder to conduct research during events like wars (Cohen and Arieli, Reference Cohen and Arieli2011), and this absence partially reflects a survival bias. That is, people with SMHCs who died during disasters may not be represented in studies. Despite this, there were mortality studies in the scoping review that captured types of traumas that led to death, somewhat counterbalancing this potential survival bias. Such studies were conducted in more controlled environments in which populations could be followed for years or in countries where there were strong national or regional electronic medical records where accurate patient outcome data could be pulled more easily.

Limitations

There are some limitations that should be noted here. Although we tried to capture an extensive range of trauma types, we know that there are traumas that are culturally relevant in the countries we looked at that might not meet DSM-5 or ICD-11 criteria. While we tried to account for this by including “idioms of distress” and terminology about human rights violations and chaining/restraint, it is likely that there were trauma types that have not been studied by researchers in these contexts or that used different terms from ours that we did not retrieve. In addition, if an article did not include the name of the country in its title or abstract or a grouping term for the countries that met our criteria (i.e., “LMIC” or “East Africa”), we would likely have missed it. We may have missed articles that were not indexed in the American or European databases used here, as some articles from LMICs do not get included in these databases. However, we included Africa-Wide Information/NiPad in order to capture some of the articles that might have been otherwise missed. We limited inclusion to published studies in the interest of completing this scoping review in a timely manner. We acknowledge that excluding gray literature may potentially introduce publication bias. Inclusion of gray literature to address this research question should be considered in a future systematic review. Lastly, we did not include articles with potential mediators between SMHCs and trauma exposure, such as substance use or economic disadvantage. Studies with mediators would be worthwhile to look at in the future.

Conclusion

Future research on trauma types that people with SMHCs are exposed to in LMICs should expand beyond 10 countries to more than 120 additional countries that qualify as LMICs. Research on man-made and natural disasters in this population is warranted. Additional qualitative research may help identify locally relevant trauma types as well as understand people’s lived experiences.

Open peer review

To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.123.

Supplementary material

The supplementary material for this article can be found as a Word document, which is attached to this article.

Data availability

No new data were created as part of this manuscript. The authors confirm that the data supporting the findings of this study are available within the article.

Acknowledgements

We would like to thank Supriya Misra, Carol Mita, Carrie G. Wade, Lucia Fernandez, Almalina Gomes and Sofia Paredes.

Author contribution

Study conceptualization: AS; Search query development: AS with input from Carol Mita and Carrie G. Wade at Countway Library; First draft of the manuscript: AS; Revising it critically for important intellectual content: AS, EG, BK, BH, KCK and SS; Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data for the work: AS, EG, BK, BH and SS; Final approval of the version to be published: AS, EG, BK, BH, KCK and SS; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: AS, EG, BK, BH, KCK and SS.

Financial support

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Competing interest

None.

Footnotes

1 The ranges here (76.5%–84.3% and 23.3%–34.9%) reflect that some studies collapsed many trauma types into one field. Thus, types of interpersonal violence could not always be teased out from non-interpersonal violence, such as sexual violence vs. road traffic accidents and physical restraint could not always be teased out from non-physical restraint.

References

Afe, T. O., Emedoh, T. C., Ogunsemi, O., & Adegbohun, A. A. (2016). Intimate partner violence, psychopathology and the women with schizophrenia in an outpatient clinic south-south, Nigeria. BMC Psychiatry, 16(1), 197. https://doi.org/10.1186/s12888-016-0898-2.CrossRefGoogle Scholar
Alem, A. (2000). Human rights and psychiatric carein Africa with particular referenceto the Ethiopian situation. Acta Psychiatrica Scandinavica, 101(399), 9396. https://doi.org/10.1111/j.0902-4441.2000.007s020[dash]21.x.CrossRefGoogle Scholar
Aluh, D. O., Ayilara, O., Onu, J. U., Pedrosa, B., Santos-Dias, M., Cardoso, G., Caldas-de-Almeida, J. M., & Grigaite, U. (2022). Experiences and perceptions of coercive practices in mental health care among service users in Nigeria: A qualitative study. International Journal of Mental Health Systems, 16(1). https://doi.org/10.1186/s13033-022-00565-4.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5™, 5th ed. American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.Google Scholar
Ametaj, A. A., Hook, K., Cheng, Y. H., Serba, E. G., Koenen, K. C., Fekadu, A., & Ng, L. C. (2021). Traumatic events and posttraumatic stress disorder in individuals with severe mental illness in a non-Western setting: Data from rural Ethiopia. Psychological Trauma-Theory Research Practice and Policy, 13(6), 684693. https://doi.org/10.1037/tra0001006.CrossRefGoogle Scholar
An, F. R., Sha, S., Zhang, Q. E., Wu, P. P., & Jin, X. (2016). Physical restraint for psychiatric patients and its associations with clinical characteristics and the National Mental Health Law in China. Psychiatry Research, 241 (An F.-R.; Sha S.; Zhang Q.-E.; Wu P.-P.; Jin X.) National Clinical Research Center for Mental Disorders & Beijing Anding Hospital, Capital Medical University, China(Ungvari G.S.) The University of Notre Dame Australia/Marian Centre, Perth, Australia(Ungv), 154158. https://doi.org/10.1016/j.psychres.2016.04.101.CrossRefGoogle ScholarPubMed
Asher, L., Fekadu, A., Teferra, S., De Silva, M., Pathare, S., & Hanlon, C. (2017). “I cry every day and night, I have my son tied in chains”: Physical restraint of people with schizophrenia in community settings in Ethiopia. Globalization and Health, 13. https://doi.org/10.1186/s12992-017-0273-1.CrossRefGoogle ScholarPubMed
Bagewadi, V. I., Kumar, C. N., Thirthalli, J., Rao, G. N., Suresha, K. K., & Gangadhar, B. N. (2016). Standardized mortality ratio in patients with schizophrenia – Findings from Thirthahalli: A rural south Indian community. Indian Journal of Psychological Medicine, 38(3), 202206. https://doi.org/10.4103/0253-7176.183083.CrossRefGoogle ScholarPubMed
Belete, H. (2017a). Leveling and abuse among patients with bipolar disorder at psychiatric outpatient departments in Ethiopia. Annals of General Psychiatry, 16, 29. https://doi.org/10.1186/s12991-017-0152-4.CrossRefGoogle ScholarPubMed
Belete, H. (2017b). Use of physical restraints among patients with bipolar disorder in Ethiopian mental specialized hospital, outpatient department: Cross-sectional study. International Journal of Bipolar Disorders, 5. https://doi.org/10.1186/s40345-017-0084-6.CrossRefGoogle ScholarPubMed
Bhattacharya, A. (2022). “The day I die is the day I will find my peace”: Narratives of family, marriage, and violence among women living with serious mental illness in India. Violence Against Women, 28(3–4), 966990. https://doi.org/10.1177/10778012211012089.CrossRefGoogle ScholarPubMed
Chandra, P. S., Carey, M. P., Carey, K. B., Shalinianant, A., & Thomas, T. (2003). Sexual coercion and abuse among women with a severe mental illness in India: An exploratory investigation. Comprehensive Psychiatry, 44(3), 205212. https://doi.org/10.1016/S0010-440X(03)00004-X.CrossRefGoogle ScholarPubMed
Chandra, P. S., Deepthivarma, S., Carey, M. P., Carey, K. B., & Shalinianant, M. P. (2003). A cry from the darkness: Women with severe mental illness in India reveal their experiences with sexual coercion. Psychiatry-Interpersonal and Biological Processes, 66(4), 323334. https://doi.org/10.1521/psyc.66.4.323.25446.CrossRefGoogle ScholarPubMed
Chentsova-Dutton, Y., & Maercker, A. (2019). Cultural scripts of traumatic stress: Outline, illustrations, and research opportunities [Hypothesis and theory]. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.02528.CrossRefGoogle ScholarPubMed
Cohen, N., & Arieli, T. (2011). Field research in conflict environments: Methodological challenges and snowball sampling. Journal of Peace Research, 48(4), 423435. https://doi.org/10.1177/0022343311405698.CrossRefGoogle Scholar
Cumpston, M., Lasserson, T., Flemyng, Ella., & Page, M.J., (2022). Cochrane Handbook for Systematic Reviews of Interventions version 6.3: Chapter III: Reporting the review. https://training.cochrane.org/handbook/current/chapter-iii. Accessed March 19, 2023.Google Scholar
de Oliveira, H. N., Machado, C. J., & Guimaraes, M. D. C. (2013). Physical violence against patients with mental disorders in Brazil: Sex differences in a cross-sectional study. Revista de Psiquiatria Clinica, 40(5), 172176. https://doi.org/10.1590/S0101-60832013000500002.CrossRefGoogle Scholar
de Vries, B., van Busschbach, J. T., van der Stouwe, E. C. D., Aleman, A., van Dijk, J. J. M., Lysaker, P. H., Arends, J., Nijman, S. A., & Pijnenborg, G. H. M. (2019). Prevalence rate and risk factors of victimization in adult patients with a psychotic disorder: A systematic review and Meta-analysis. Schizophrenia Bulletin, 45(1), 114126. https://doi.org/10.1093/schbul/sby020.CrossRefGoogle ScholarPubMed
Dosa, D., Feng, Z., Hyer, K., Brown, L. M., Thomas, K., & Mor, V. (2010). Effects of hurricane Katrina on nursing facility resident mortality, hospitalization, and functional decline. Disaster Medicine and Public Health Preparedness, 4 Suppl 1(0 1), S2832. https://doi.org/10.1001/dmp.2010.11.CrossRefGoogle ScholarPubMed
Dundar, Y., & Fleeman, N. (2017). Developing my search strategy. In Boland, A., Dickson, R., & Cherry, G. (Eds.), Doing a Systematic Review (pp. 6178). Sage.Google Scholar
El Missiry, A., El Meguid, M. A., Abourayah, A., El Missiry, M., Hossam, M., Elkholy, H., & Khalil, A. H. (2019). Rates and profile of victimization in a sample of Egyptian patients with major mental illness. International Journal of Social Psychiatry, 65(3), 183193. https://doi.org/10.1177/0020764019831315.CrossRefGoogle Scholar
Fekadu, A., Medhin, G., Kebede, D., Alem, A., Cleare, A. J., Prince, M., Hanlon, C., & Shibre, T. (2015). Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia. The British Journal of Psychiatry, 206(4), 289296. https://doi.org/10.1192/bjp.bp.114.149112.CrossRefGoogle ScholarPubMed
Fekry, M. (2011). Clinical and psychodemographic profile of victimized versus nonvictimized Egyptian patients with bipolar mood disorder. Middle East Current Psychiatry, 19, 131141.CrossRefGoogle Scholar
Franks, Z. M., Alcock, J. A., Lam, T., Haines, K. J., Arora, N., & Ramanan, M. (2021). Physical restraints and post-traumatic stress disorder in survivors of critical illness. A systematic review and Meta-analysis. Annals of the American Thoracic Society, 18(4), 689697. https://doi.org/10.1513/AnnalsATS.202006-738OC.CrossRefGoogle ScholarPubMed
Frueh, C., Knapp, R. G., Cusack, K. J., Grubaugh, A. L., Sauvageot, J. A., Cousins, V. C., Yim, E., Robins, C. S., Monnier, J., & Hiers, T. G. (2005). Special section on seclusion and restraint: Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services, 56(9), 11231133. https://doi.org/10.1176/appi.ps.56.9.1123.CrossRefGoogle ScholarPubMed
Gilmoor, A. R., Vallath, S., Regeer, B., & Bunders, J. F. G. (2020). “If somebody could just understand what I am going through, it would make all the difference”: Conceptualizations of trauma in homeless populations experiencing severe mental illness. Transcultural Psychiatry, 57(3), 455467. https://doi.org/10.1177/1363461520909613.CrossRefGoogle ScholarPubMed
Gowda, G. S., Lepping, P., Noorthoorn, E. O., Ali, S. F., Kumar, C. N., Raveesh, B. N., & Math, S. B. (2018). Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. Asian Journal of Psychiatry, 36, 1016. https://doi.org/10.1016/j.ajp.2018.05.024.CrossRefGoogle ScholarPubMed
Grubaugh, A. L., Zinzow, H. M., Paul, L., Egede, L. E., & Frueh, B. C. (2011). Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: A critical review. Clinical Psychology Review, 31(6), 883899. https://doi.org/10.1016/j.cpr.2011.04.003.CrossRefGoogle ScholarPubMed
Guan, L., Liu, J., Wu, X. M., Chen, D., Wang, X., Ma, N., Wang, Y., Good, B., Ma, H., Yu, X., & Good, M. J. (2015). Unlocking patients with mental disorders who were in restraints at home: A national follow-up study of china’s new public mental health initiatives [Article]. PLoS One, 10(4). https://doi.org/10.1371/journal.pone.0121425.CrossRefGoogle Scholar
Hidayat, M. T., Oster, C., Muir-Cochrane, E., & Lawn, S. (2023). Indonesia free from pasung: A policy analysis. International Journal of Mental Health Systems, 17(1), 12. https://doi.org/10.1186/s13033-023-00579-6.CrossRefGoogle ScholarPubMed
Hu, L. L., Wang, Q., Wang, Y. H., Gu, L. X., & Yu, T. G. (2022). A retrospective analysis of death among Chinese Han patients with schizophrenia from Shandong. Risk Management and Healthcare Policy, 15, 403414. https://doi.org/10.2147/RMHP.S351523.CrossRefGoogle ScholarPubMed
Jakhar, K., Bhatia, T., Saha, R., & Deshpande, S. N. (2015). A cross sectional study of prevalence and correlates of current and past risks in schizophrenia. Asian Journal of Psychiatry, 14, 3641. https://doi.org/10.1016/j.ajp.2015.01.005.CrossRefGoogle ScholarPubMed
Kessler, R. C., & Üstün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93121. https://doi.org/10.1002/mpr.168.CrossRefGoogle ScholarPubMed
Lundberg, P., Johansson, E., Okello, E., Allebeck, P., & Thorson, A. (2012a). Sexual risk behaviours and sexual abuse in persons with severe mental illness in Uganda: A qualitative study. PLoS One, 7(1), e29748. https://doi.org/10.1371/journal.pone.0029748.CrossRefGoogle ScholarPubMed
Lundberg, P., Nakasujja, N., Musisi, S., Thorson, A. E., Cantor-Graae, E., & Allebeck, P. (2015). Sexual risk behavior, sexual violence, and HIV in persons with severe mental illness in Uganda: Hospital-based cross-sectional study and National Comparison Data. American Journal of Public Health, 105(6), 11421148. https://doi.org/10.2105/AJPH.2014.302479.CrossRefGoogle ScholarPubMed
Maniglio, R. (2009). Severe mental illness and criminal victimization: A systematic review. Acta Psychiatrica Scandinavica, 119(3), 180191. https://doi.org/10.1111/j.1600-0447.2008.01300.x.CrossRefGoogle ScholarPubMed
Manjunatha, N., Kumar, C. N., Thirthalli, J., Suresha, K. K., Harisha, D. M., & Arunachala, U. (2019). Mortality in schizophrenia: A study of verbal autopsy from cohorts of two rural communities of South India. Indian Journal of Psychiatry, 61(3), 238243. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_135_19.CrossRefGoogle ScholarPubMed
Mauritz, M. W., Goossens, P. J. J., Draijer, N., & van Achterberg, T. (2013). Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European Journal of Psychotraumatology, 4(1), 19985. https://doi.org/10.3402/ejpt.v4i0.19985.CrossRefGoogle ScholarPubMed
Melo, A. P. S., Dippenaar, I. N., Johnson, S. C., Weaver, N. D., Acurcio, F. D. A., Malta, D. C., Ribeiro, A. L. P., Guerra, A. A. Jr., Wool, E. E., Naghavi, M., & Cherchiglia, M. L. (2022). All-cause and cause-specific mortality among people with severe mental illness in Brazil’s public health system, 2000-15: A retrospective study. Lancet Psychiatry, 9(10), 771781. https://doi.org/10.1016/S2215-0366(22)00237-1.CrossRefGoogle ScholarPubMed
Mercy, J., Hillis, S., Butchart, A., Bellis, M., Ward, C., Fang, X., & Rosenberg, M. (2017). Interpersonal Violence: Global Impact and Paths to Prevention (3rd ed.). The International Bank for Reconstruction and Development/The World Bank. https://doi.org/10.1596/978-1-4648-0522-6_ch5.Google ScholarPubMed
Minas, H., & Diatri, H. (2008). Pasung: Physical restraint and confinement of the mentally ill in the community [Article]. International Journal of Mental Health Systems, 2. https://doi.org/10.1186/1752-4458-2-8.CrossRefGoogle ScholarPubMed
Mojtabai, R., Varma, V. K., Malhotra, S., Mattoo, S. K., Misra, A. K., Wig, N. N., & Susser, E. (2001). Mortality and long-term course in schizophrenia with a poor 2-year course: A study in a developing country. The British Journal of Psychiatry, 178(1), 7175. https://doi.org/10.1192/bjp.178.1.71.CrossRefGoogle ScholarPubMed
Moodley, L., Ntlantsana, V., Tomita, A., & Paruk, S. (2023). The missed pandemic: Intimate partner violence in female mental-health-care-users during the COVID-19 pandemic. Psychology Health & Medicine. https://doi.org/10.1080/13548506.2023.2206143.CrossRefGoogle ScholarPubMed
Mpango, R. S., Ssembajjwe, W., Rukundo, G. Z., Amanyire, P., Birungi, C., Kalungi, A., Rutakumwa, R., Tusiime, C., Gadow, K. D., Patel, V., Nyirenda, M., & Kinyanda, E. (2023). Physical and sexual victimization of persons with severe mental illness seeking care in central and southwestern Uganda. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1167076.CrossRefGoogle ScholarPubMed
Murthy, R. S., & Lakshminarayana, R. (2006). Mental health consequences of war: A brief review of research findings. World Psychiatry, 5(1), 2530.Google Scholar
Nair, S., Satyanarayana, V. A., & Desai, G. (2020). Prevalence and clinical correlates of intimate partner violence (IPV) in women with severe mental illness (SMI). Asian Journal of Psychiatry, 52. https://doi.org/10.1016/j.ajp.2020.102131.CrossRefGoogle ScholarPubMed
Ng, L. C., Medhin, G., Hanlon, C., & Fekadu, A. (2019). Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia. Social Psychiatry and Psychiatric Epidemiology, 54(7), 835842. https://doi.org/10.1007/s00127-019-01673-2.CrossRefGoogle ScholarPubMed
OHCHR (2016) CRPD/C/UGA/CO/1: Concluding observations on the initial report of Uganda. United Nations Office of the High Commissioner for Human Rights. https://www.ohchr.org/en/documents/concluding-observations/crpdcugaco1-concluding-observations-initial-report-ugandaGoogle Scholar
Opekitan, T., Emedoh, T. C., Ogunsemi, O. O., & Adegohun, A. A. (2017). Socio-demographic characteristics, partner characteristics, socioeconomic variables, and intimate partner violence in women with schizophrenia in south-South Nigeria. Journal of Health Care for the Poor and Underserved, 28(2), 707720. https://doi.org/10.1353/hpu.2017.0069.Google Scholar
Paul, S. (2018). Are we doing enough? Stigma, discrimination and human rights violations of people living with schizophrenia in India: Implications for social work practice. Social Work in Mental Health, 16(2), 145171. https://doi.org/10.1080/15332985.2017.1361887.CrossRefGoogle Scholar
Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. (2021). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Implementation, 19(1), 310. https://doi.org/10.1097/xeb.0000000000000277.CrossRefGoogle ScholarPubMed
Ponnudurai, R., Jayakar, J., & Sathiya Sekaran, B. W. (2006). Assessment of mortality and marital status of schizophrenic patients over a period of 13 years. Indian Journal of Psychiatry, 48(2), 8487. https://doi.org/10.4103/0019-5545.31595.CrossRefGoogle Scholar
Ran, M. S., Chen, E. Y., Conwell, Y., Chan, C. L., Yip, P. S., Xiang, M. Z., & Caine, E. D. (2007). Mortality in people with schizophrenia in rural China: 10-year cohort study. The British Journal of Psychiatry, 190, 237242. https://doi.org/10.1192/bjp.bp.106.025155.CrossRefGoogle ScholarPubMed
Rani, A., Raman, K. J., Antony, S., Thirumoorthy, A., & Basavarajappa, C. (2023). Profiles of victimized outpatients with severe mental illness in India. Indian Journal of Community Medicine, 48(6), 920925. https://doi.org/10.4103/ijcm.ijcm_915_22.CrossRefGoogle ScholarPubMed
Rani, A., Raman, K. J., Antony, S., Thirumoorthy, A., & Chethan, B. (2023). A qualitative study to understand the nature of abuse experienced by persons with severe mental illness. Violence and Gender. https://doi.org/10.1089/vio.2022.0046.CrossRefGoogle Scholar
Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112(5), 330350. https://doi.org/10.1111/j.1600-0447.2005.00634.x.CrossRefGoogle ScholarPubMed
Read, U. M., Adiibokah, E., & Nyame, S. (2009). Local suffering and the global discourse of mental health and human rights: An ethnographic study of responses to mental illness in rural Ghana. Globalization and Health, 5, 13. https://doi.org/10.1186/1744-8603-5-13.CrossRefGoogle ScholarPubMed
Reddy, P. V., Tansa, K. A., Raj, A., Jangam, K., & Muralidharan, K. (2020). Childhood abuse and intimate partner violence among women with mood disorders. Journal of Affective Disorders, 272, 335339. https://doi.org/10.1016/j.jad.2020.03.113.CrossRefGoogle ScholarPubMed
Sadath, A., Narasimha, V. M., Rao, M., Kumar, V., Muralidhar, D., Varambally, S., Gangadhar, B. N., Kori, A., & Supraja, A. (2014). Human rights violation in mental health: A case report from India. African Journal of Psychiatry, 17(3), 12. http://ezp-prod1.hul.harvard.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-36342-006&site=ehost-live&scope=siteani00711@yahoo.comGoogle Scholar
Sam, S. P., Nisha, A., & Varghese, P. J. (2019). Stressful life events and relapse in bipolar affective disorder: A cross-sectional study from a tertiary Care Center of Southern India. Indian Journal of Psychology Medicine, 41(1), 6167. https://doi.org/10.4103/IJPSYM.IJPSYM_113_18.CrossRefGoogle ScholarPubMed
Subramanian, K., Sarkar, S., Kattimani, S., Philip Rajkumar, R., & Penchilaiya, V. (2017). Role of stressful life events and kindling in bipolar disorder: Converging evidence from a mania-predominant illness course. Psychiatry Research, 258, 434437. https://doi.org/10.1016/j.psychres.2017.08.073.CrossRefGoogle ScholarPubMed
Suryani, L. K., Lesmana, C. B. J., & Tiliopoulos, N. (2011). Treating the untreated: Applying a community-based, culturally sensitive psychiatric intervention to confined and physically restrained mentally ill individuals in Bali, Indonesia [article]. European Archives of Psychiatry and Clinical Neuroscience, 261(SUPPL. 2), S140S144. https://doi.org/10.1007/s00406-011-0238-y.CrossRefGoogle ScholarPubMed
Teferra, S., Shibre, T., Fekadu, A., Medhin, G., Wakwoya, A., Alem, A., Kullgren, G., & Jacobsson, L. (2011). Five-year mortality in a cohort of people with schizophrenia in Ethiopia. BMC Psychiatry, 11, 165. https://doi.org/10.1186/1471-244x-11-165.CrossRefGoogle Scholar
Tricco, A., Lillie, E., Zarin, W., O’Brien, K., Colquhoun, H., Levac, D., Moher, D., Peters, M., Horsley, T., Weeks, L., & Hempel, S. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467473. https://doi.org/10.7326/m18-0850.CrossRefGoogle ScholarPubMed
Tsigebrhan, R., Shibre, T., Medhin, G., Fekadu, A., & Hanlon, C. (2014). Violence and violent victimization in people with severe mental illness in a rural low-income country setting: A comparative cross-sectional community study. Schizophrenia Research, 152(1), 275282. https://doi.org/10.1016/j.schres.2013.10.032.CrossRefGoogle Scholar
van de Schoot, R., de Bruin, J., Schram, R., Zahedi, P., de Boer, J., Weijdema, F., Kramer, B., Huijts, M., Hoogerwerf, M., Ferdinands, G., Harkema, A., Willemsen, J., Ma, Y., Fang, Q., Hindriks, S., Tummers, L., & Oberski, D. L. (2021). An open source machine learning framework for efficient and transparent systematic reviews. Nature Machine Intelligence, 3(2), 125133. https://doi.org/10.1038/s42256-020-00287-7.CrossRefGoogle Scholar
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os, J., & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), 661671. https://doi.org/10.1093/schbul/sbs050.CrossRefGoogle ScholarPubMed
Veritas Health Innovation Ltd. (2024) Covidence. www.covidence.orgGoogle Scholar
Vijayalakshmi, P., Reddemma, K., & Math, S. B. (2012). Gender-related differences in the human rights needs of patients with mental illness. Journal of Nursing Research, 20(2), 9098. https://doi.org/10.1097/jnr.0b013e318257b57b.CrossRefGoogle ScholarPubMed
Wang, Q. W., Wang, Q. W., Hou, C. L., Wang, S. B., Huang, Z. H., Huang, Y. H., Zhang, J. J., Zhang, J. J., & Jia, F. J. (2020). Frequency and correlates of violence against patients with schizophrenia living in rural China [Article]. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02696-9.CrossRefGoogle ScholarPubMed
Weathers, F., Blake, D., Schnurr, P., Kaloupek, D., Marx, B., & Keane, T. (2013). The Life Events Checklist for DSM-5 (LEC-5) Standard. [Measurement Instrument.]. National Center for PTSD. https://www.ptsd.va.gov/professional/assessment/documents/LEC5_Standard_Self-report.PDFGoogle Scholar
Windarwati, H. D., Keliat, B. A., Ismail, R. I., Bachtiar, A., & Erawati, E. (2021). A journey of hidden outburst of anger shackling a person with schizophrenia: The Indonesian context. Qualitative Report, 26(8), 25772597. https://doi.org/10.46743/2160-3715/2021.4728.Google Scholar
Woolway, G. E., Smart, S. E., Lynham, A. J., Lloyd, J. L., Owen, M. J., Jones, I. R., Walters, J. T. R., & Legge, S. E. (2022). Schizophrenia polygenic risk and experiences of childhood adversity: A systematic review and meta-analysis. Schizophrenia Bulletin, 48(5), 967980. https://doi.org/10.1093/schbul/sbac049.CrossRefGoogle ScholarPubMed
World Bank (2023) World Bank Country and Lending Groups. Retrieved 23 November 2023 from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groupsGoogle Scholar
Yosep, I., Mediani, H. S., Lindayani, L., & Sriati, A. (2021). How patients with schizophrenia “as a victim” cope with violence in Indonesia: A qualitative study. EGYPTIAN JOURNAL OF NEUROLOGY PSYCHIATRY AND NEUROSURGERY, 57(1). https://doi.org/10.1186/s41983-021-00327-y.CrossRefGoogle Scholar
Yosep, I., Mediani, H. S., & Sriati, A. (2021). Experiences of violence among individuals with schizophrenia in Indonesia a phenomenological study. Journal of Psychosocial Nursing and Mental Health Services, 59(11), 4146. https://doi.org/10.3928/02793695-20210528-01.CrossRefGoogle ScholarPubMed
Zerihun, T., Tesfaye, M., Deyessa, N., & Bekele, D. (2021). Intimate partner violence among reproductive-age women with chronic mental illness attending a psychiatry outpatient department: Cross-sectional facility-based study, Addis Ababa, Ethiopia. BMJ Open, 11(12), e045251. https://doi.org/10.1136/bmjopen-2020-045251.CrossRefGoogle ScholarPubMed
Zhang, Y. S., Li, K. Q., Sun, J. H., Li, W., Tong, Z. H., Yan, B. P., Ungvari, G. S., Ng, C. H., & Xiang, Y. T. (2018). Long-term outcomes of unlocking Chinese patients with severe mental illness [article]. Psychiatric Quarterly, 89(3), 757763. https://doi.org/10.1007/s11126-018-9575-6.CrossRefGoogle ScholarPubMed
Zhu, X. M., Xiang, Y. T., Zhou, J. S., Gou, L., Himelhoch, S., Ungvari, G. S., Chiu, H. F. K., Lai, K. Y. C., & Wang, X. P. (2014). Frequency of physical restraint and its associations with demographic and clinical characteristics in a Chinese psychiatric institution. Perspectives in Psychiatric Care, 50(4), 251256. https://doi.org/10.1111/ppc.12049.CrossRefGoogle Scholar
Zubin, J., & Spring, B. (1977). Vulnerability--a new view of schizophrenia. Journal of Abnormal Psychology, 86(2), 103126. https://doi.org/10.1037//0021-843x.86.2.103.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Articles and their characteristics included in the scoping review

Figure 1

Figure 1. PRISMA flow chart of the search and selection process for the scoping review.

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Author comment: Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review — R0/PR1

Comments

Dear Drs. Bass and Chibanda,

We are pleased to submit an original research article, “Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: A scoping review,” for consideration by Cambridge Prisms: Global Mental Health.

This review aims to synthesize the nature and extent of research on traumatic events that adults with serious mental health conditions (SMHCs), such as schizophrenia and bipolar disorder, face in low- and middle-income countries (LMICs) and offers an important contribution to the field of trauma and mental health conditions.

There is a strong link between trauma exposure and SMHCs. The majority of research in the field has focused on childhood trauma as a risk factor for developing a SMHC and on samples from high-income countries. There is less research, however, on having a SMHC as a risk factor for exposure to traumatic events, and particularly on populations in LMICs.

After conducting a search across <b>5 databases, 51 articles met criteria for inclusion of which 66% were from India, Ethiopia, and China. More than 76% of the trauma exposures were on interpersonal violence, such as sexual and physical violence. Of the interpersonal violence studies, more than 23% were on physical restraint (e.g., shackling).</b>

<b>Main takeaways:</b> Much of our data in this population is informed by a small subset of countries and by certain types of interpersonal violence. Future research should aim to expand to additional countries in LMICs. Additional qualitative research would likely identify context-relevant types of traumas amongst this population.

As we know it <b>can be challenging to find reviewers for manuscripts, we have suggested 15 potential reviewers</b> who have extensive experience in the intersection of trauma exposure and psychosis, and many of them are from the countries which are cited in the manuscript.

As the corresponding author, I take full responsibility for the content and integrity of the manuscript, and I confirm that it is not under review at any other journal.

Kind regards,

Anne Stevenson

Stellenbosch University

<u>Potential reviewers:</u> (full names, emails, and affiliations are in the portal)

1 Taiwo Opekitan Afe afeet23@yahoo.co.uk;

2 Laura Asher Laura.Asher@nottingham.ac.uk;

3 Ursula M Read ursula.read@warwick.ac.uk;

4 Vuyokazi Ntlantsana Ntlantsanav@ukzn.ac.za;

5 Keneilwe Molebatsi Molebatsik@ub.ac.bw;

6 Habte Belete habte.belete@gmail.com;

7 Richard Stephen Mpango Richard.Mpango@lshtm.ac.uk;

8 K Janaki Raman janakitrichy@gmail.com;

9 Lynette Moodley lynette_moodley@yahoo.ca;

10 Bonga Chiliza ChilizaB@ukzn.ac.za;

11 Iyus Yosep iyuskasep_07@yahoo.com;

12 Atalay Alem atalay.alem@gmail.com;

13 Heni Dwi Windarwati henipsik.fk@ub.ac.id;

14 Anindita Bhattacharya ab4050@uw.edu;

15 Guru S. Gowda drgsgowda@gmail.com.

Recommendation: Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review — R0/PR2

Comments

In addition to the reviewer comments, please also add a methodological guideline in the methods section, for instance, Arksey and O’Malley, JBI etc.

Decision: Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review — R0/PR3

Comments

No accompanying comment.

Author comment: Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review — R1/PR4

Comments

Prof. Dixon Chibanda

Editor-in-Chief, Cambridge Prisms: Global Mental Health

Dear Professor Chibanda,

Thank you very much for the opportunity to revise and resubmit our manuscript, “Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: A scoping review.” We are very appreciative of the handling editor and the external reviewers who read the article and provided feedback on it. Please thank Professor André Janse van Rensburg and the two anonymous reviewers for their time and effort.

We believe our subsequent edits have made this a stronger manuscript. Please see our responses below and as track changes in the text of the manuscript.

We hope this scoping review will make an important contribution to the field.

Sincerely,

Anne Stevenson

Handling Editor’s Comments to Author:

Handling Editor: Janse van Rensburg, André

Comments to the Author:

In addition to the reviewer comments, please also add a methodological guideline in the methods section, for instance, Arksey and O’Malley, JBI etc. Author response: Thank you for noting this. We have added this (JBI) to the methods section.

Please also ensure your manuscript complies with the following formatting points (a copy of our author guidelines is included for reference):

- Please include the abstract in the main text document. Author response: This was included in the original submission.

- Please include an Impact Statement below the abstract (max. 300 words). This must not be a repetition of the abstract but a plain worded summary of the wider impact of the article. Author response: The impact statement was included in the original submission, but we have moved it now to the correct place below the abstract.

- Submission of graphical abstracts is encouraged for all articles to help promote their impact online. A Graphical Abstract is a single image that summarises the main findings of a paper, allowing readers to quickly gain an overview and understanding of your work. Ideally, the graphical abstract should be created independently of the figures already in the paper, but it could include a (simplified version of) an existing figure or a combination thereof. Graphical abstracts should not be too text-heavy in order to be easily viewable at thumbnail size. If you do not wish to include a graphical abstract please let me know. Author response: We made a graphical abstract and included it in the original submission as a supplementary file. If you still not see this on the backend, there is a problem with the portal upload and we can send it by email.

- Please ensure references are correctly formatted. In text citations should follow the author and year style. When an article cited has three or more authors the style ‘Smith et al. 2013’ should be used on all occasions. At the end of the article, references should first be listed alphabetically, with a full title of each article, and the first and last pages. Journal titles should be given in full. Author response: The references were formatted like this in the original submission.

- Statements of the following are required in the main text document at the end of all articles: ‘Author Contribution Statement’, ‘Financial Support’, ‘Conflict of Interest Statement’, ‘Ethics statement’ (if appropriate), ‘Data Availability Statement’. Please see the author guidelines for further information. Author response: This was included in the original submission.

- Please submit figures as separate files and please ensure all files are submitted in an editable electronic format. Author response: The figure was included in the original submission both within the text and uploaded as a separate file. We have removed the one which was inserted into the manuscript text.

Reviewer(s)' Comments to Author:

Reviewer: 1

Comments to the Author

It is excellent work. However some concerns by me are noted as follows:

1. In line 131-132 the authors wrote we included events that may be unique to the context of LMICs including human rights violations, mob justice, chaining, and restraining. In my view this phrase may sound prejudicial and a sweeping pejorative characterisation.

Author response: We absolutely recognize the reviewer’s concern and are thankful for the opportunity to correct this. We do not believe that “human rights violations, mob justice, chaining, and restraining” are “unique” to LMICs as they can happen anywhere. We chose to include these terms because they regularly came up in our reviews of commentaries by leaders in the field and in qualitative research. We also felt these terms were important based on our own experiences in LMIC settings. One of our co-authors who has lived experience of bipolar disorder in Uganda has written about his own experiences of many of these trauma types in two commentaries (Kitafuna, 2022a, 2022b), however, we did not want to cite ourselves in the paper. Many of these trauma types have also come up in our own unpublished research.

We have now updated the sentence to read:

“A priori, on the basis of qualitative studies with people with SMHCs in LMICs and commentaries by leaders in the field (Alem, 2000; Ametaj et al., 2021), we included events that may be more common in LMICs than in high-income countries, although they can happen anywhere, including human rights violations, mob justice, chaining, and restraining.”

2. The exclusion of grey literature and many Afrocentric databases may account for a strong limitation, as much research in some LMIC don’t get to be warehoused in Euro-American Databases. Author response: We agree and thank you for this comment. We tried to address some of this challenge by including the African database, Africa-Wide Information, however by not including more Afrocentric databases, we would likely have missed relevant articles. We have added this to the limitations section of discussion. See the added following text in the limitations section:

“We may have missed articles that were not indexed in the American or European databases used here, as some articles from LMICs do not get included in these databases. However, we included Africa-Wide Information/NiPad in order to capture some of the articles that might have been otherwise missed.

We limited inclusion to published studies in the interest of completing this scoping review in a timely manner. We acknowledge that excluding grey literature may potentially introduce publication bias. Inclusion of grey literature to address this research question should be considered in a future systematic review.”

3a. The authors gave a scoping review but it would have been richer if subtle references to why they are particularly vulnerable to trauma and violence in LMIC?

Author response: From our experience as co-authors from both HICs and LMICs and as people who have spent significant time in both settings, we do not believe that people with SMHCs are necessarily more vulnerable to trauma and violence in LMICs than HICs. We believe risk of harm would differ depending on the specific country and region within a country. However, the goal of our review was not to say that people from LMICs are more vulnerable than in HICs, but to synthesize the literature about the types of trauma people with pre-existing SMHCs in LMICs because this has been understudied to date in comparison with HICs.

3b. Are the experiences similar across LMIC? Future research may be needed.

Author response: Thank you for this question. With our detailed search queries of trauma types, we believe that there are many similar trauma types across all settings, such as sexual violence and intimate partner violence. However, due to heterogeneity within and across countries, we do not believe that experiences would be identical across LMICs. In the discussion, we have addressed how the absence of data from > 90% of LMICs makes it difficult to capture the true range of trauma exposures in different countries. On lines 308-313, we write (and have updated some of the wording to make this point on this stronger): “With only 10 countries represented in total, there was no data from the more than 120 other LMICs. Though the additional articles outside of India, Ethiopia, and China included studies from Southeast Asia, South America, and Africa, these regions and the countries within them have diverse populations, geographies, and cultures. As such, the studies may not reflect the full scope of types and frequencies of traumas that people with SMHCs face within and across such heterogeneous LMICs.”

We also stress the value of qualitative research in future studies in the discussion and the conclusion for this reason. On lines 341-346, we write: “Researchers maintain that the acknowledgement of traumatic events and subsequent traumatic stress is not simply a response to objective experiences, but is shaped by the culture in which one exists and is understood through what is considered traumatic in their setting (Chentsova-Dutton & Maercker, 2019). The value of including qualitative research is that it can augment quantitative reports by offering insights into personal trauma experiences and contextual factors in these settings.”

And in the conclusion, we write: “Future research on trauma types that people with SMHCs are exposed to in LMICs should expand beyond 10 countries to the more than 120 additional countries that qualify as LMICs. Research on man-made and natural disasters in this population is warranted. Additional qualitative research may help identify locally relevant trauma types as well as understand people’s lived experiences.”

4. Exact Search Strategy for each database should have been written out in supplementary should have been added. Author response: This was included in the original submission as a supplementary file. It is a very detailed 12-page document. We have reattached it to the resubmission in case it did not come through the first time. If you still not see this on the backend, there is a problem with the portal upload and we can send it by email.

Overall commendation to the authors. Thank you!

Reviewer: 2

Comments to the Author

This paper is titled "Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: A scoping review.” A comprehensive search of published literature was undertaken, and the methodology is adequately explained. The conclusions made are in line with the findings.

Introduction

1. The authors mentioned that ‘Researchers have also argued that people with SMHCs may be more vulnerable to exposure to trauma than those without such conditions’. I believe it may strengthen the introduction to expand on the theories/mechanisms underlying this vulnerability.

Author response: Thank you for this suggestion. We have added two paragraphs to the introduction as follows:

“Multiple models have been proposed to explain why exposure to trauma, and particularly childhood adversity, may increase the risk for developing a SMHC, including the stress-vulnerability model (Zubin & Spring, 1977). This model posits that some people have a biological vulnerability to SMHCs. While individuals may be able to withstand a certain amount of stress, once a certain threshold of stress is reached or a stressor is particularly intense, people become more susceptible to developing SMHCs.

Likewise, researchers have also argued that people with SMHCs may be more vulnerable to exposure to trauma than those without such conditions. Population studies have found people with SMHCs report more victimization than the general public (de Vries et al., 2019; Maniglio, 2009). One theory for this is that people with SMHCs may have cognitive impairments that impact their decision-making and problem-solving abilities, restricting their ability to navigate potentially dangerous situations (de Vries et al., 2019). People with SMHCs may also be exposed to trauma through settings due to their mental health conditions, such as inpatient and outpatient healthcare centres. Patients with SMHCs have reported high rates of trauma exposure in psychiatric settings, including physical and sexual assault by staff, police, and other patients (Frueh et al., 2005; Lundberg et al., 2012).”

2. On why it is important to conduct this review: the authors posit that ‘Investigating types of trauma in people with pre-existing SMHCs may help prevent future exposure’. Kindly expand on how the findings of the review would achieve this.

Author response: Thank you for noting this. We believe that investigating something is the first step in prevention, but there are many intermediary steps between the two. We have rewritten the sentences and have cited two national policies, one in China and one in Indonesia, where laws have been enacted to “unlock” people with SMHCs and to eradicate the practice of chaining, isolating / seclusion, and caging people with SMHCs:

“Deepening research in LMICs may shed light on the possibility of unique traumas in this population. Furthermore, identifying and codifying trauma exposure in this population may raise awareness about such incidents and lead to healthcare and human rights policy changes for people with SMHCs (Guan et al., 2015; Hidayat et al., 2023).”

Results

It might be worthwhile to present results under subheadings. For example, Identified studies; characteristics/descriptions of the included studies (design, setting, population, sample size); trauma (types, prevalence and assessment tools etc.)

Author response: Thank you for this suggestion. We agree that it might be worthwhile to present the results under subheadings. Initially, we decided not to use subheadings for the characteristics of the included studies because, given the diversity of the 51 articles, there was no systematic way to implement subheadings without repeating information already presented in the tables.

References

Alem, A. (2000). Human rights and psychiatric carein Africa with particular referenceto the Ethiopian situation. Acta Psychiatrica Scandinavica, 101(399), 93-96. https://doi.org/https://doi.org/10.1111/j.0902-4441.2000.007s020[dash]21.x

Ametaj, A. A., Hook, K., Cheng, Y. H., Serba, E. G., Koenen, K. C., Fekadu, A., & Ng, L. C. (2021). Traumatic Events and Posttraumatic Stress Disorder in Individuals With Severe Mental Illness in a Non-Western Setting: Data From Rural Ethiopia. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY, 13(6), 684-693. https://doi.org/10.1037/tra0001006

Chentsova-Dutton, Y., & Maercker, A. (2019). Cultural Scripts of Traumatic Stress: Outline, Illustrations, and Research Opportunities [Hypothesis and Theory]. Frontiers in psychology, 10. https://doi.org/10.3389/fpsyg.2019.02528

de Vries, B., van Busschbach, J. T., van der Stouwe, E. C. D., Aleman, A., van Dijk, J. J. M., Lysaker, P. H., Arends, J., Nijman, S. A., & Pijnenborg, G. H. M. (2019). Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis. Schizophr Bull, 45(1), 114-126. https://doi.org/10.1093/schbul/sby020

Frueh, C., Knapp, R. G., Cusack, K. J., Grubaugh, A. L., Sauvageot, J. A., Cousins, V. C., Yim, E., Robins, C. S., Monnier, J., & Hiers, T. G. (2005). Special Section on Seclusion and Restraint: Patients' Reports of Traumatic or Harmful Experiences Within the Psychiatric Setting. Psychiatric Services, 56(9), 1123-1133. https://doi.org/10.1176/appi.ps.56.9.1123

Guan, L., Liu, J., Wu, X. M., Chen, D., Wang, X., Ma, N., Wang, Y., Good, B., Ma, H., Yu, X., & Good, M. J. (2015). Unlocking patients with mental disorders who were in restraints at home:A National follow-up study of china’s new public mental health initiatives [Article]. PLOS ONE, 10(4). https://doi.org/10.1371/journal.pone.0121425

Hidayat, M. T., Oster, C., Muir-Cochrane, E., & Lawn, S. (2023). Indonesia free from pasung: a policy analysis. Int J Ment Health Syst, 17(1), 12. https://doi.org/10.1186/s13033-023-00579-6

Kitafuna, K. B. (2022a). A Critical Overview of Mental Health-Related Beliefs, Services and Systems in Uganda and Recent Activist and Legal Challenges. Community Ment Health J, 58(5), 829-834. https://doi.org/10.1007/s10597-022-00947-5

Kitafuna, K. B. (2022b). Personal Experience, Involvement and Activism for the Reform of Uganda’s Mental Health System. Community Ment Health J, 58(5), 824-828. https://doi.org/10.1007/s10597-022-00946-6

Lundberg, P., Johansson, E., Okello, E., Allebeck, P., & Thorson, A. (2012). Sexual risk behaviours and sexual abuse in persons with severe mental illness in Uganda: a qualitative study. PLOS ONE, 7(1), e29748. https://doi.org/10.1371/journal.pone.0029748

Maniglio, R. (2009). Severe mental illness and criminal victimization: a systematic review. Acta Psychiatr Scand, 119(3), 180-191. https://doi.org/10.1111/j.1600-0447.2008.01300.x

Zubin, J., & Spring, B. (1977). Vulnerability--a new view of schizophrenia. J Abnorm Psychol, 86(2), 103-126. https://doi.org/10.1037//0021-843x.86.2.103

Recommendation: Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review — R1/PR5

Comments

No accompanying comment.

Decision: Serious mental health conditions and exposure to adulthood trauma in low- and middle-income countries: a scoping review — R1/PR6

Comments

No accompanying comment.