The prevalence of PTSS under the influence of public health emergencies in last two decades: A systematic review and meta-analysis

BACKGROUND: Since the beginning of 21st century, several major public health emergencies (PHEs) have threatened the health of people globally. Posttraumatic stress symptoms (PTSS) was one of the most concerned mental health problems. The objective of this study is to systematically estimate the prevalence of PTSS under the influence of PHEs. METHOD: We searched both English and Chinese databases. This meta-analysis used a random-effects model to estimate the prevalence of PTSS. Subgroup analyses were conducted to analyze the source of heterogeneity. Meta-regression model was used to calculate the proportion of the variance explained by subgroup moderators. RESULTS: Forty eligible studies (n = 15,538) were identified. The results revealed a pooled prevalence of PTSS of 17.0% (95%CI: 13.5%–21.2%), higher than that of previous epidemiological survey, with high between-studies heterogeneity (Q = 1199, I(2) = 96.75%, p < .001). There was variance of prevalence in different countries (4.0%–36.5%) and epidemics (12.1%–36.5%). The prevalence of PTSS showed the feature of fluctuation in the change of time (Q = 6.173, p = .290). Patients had higher prevalence (26.2%) compared to healthcare workers (HCWs) (18.5%) and community samples (12.4%) and frontline HCWs had marginally significantly higher estimated rate than general HCWs (22.2%, 95%CI:16.0%–30.1% vs. 10.4%, 95%CI: 6.4%–16.6%). The variance of prevalence screened by interview and self-reported was significant (Q = 3.393, p = .05) and studies with higher quality possessed lower prevalence (high:12.4%; moderate: 17.3%; low: 18.0%). The total variance explained by subgroup moderators was estimated 64% by meta regression model. LIMITATIONS: Limitations include high level of heterogeneity between studies and within subgroups as well as the lack of studies with high quality and using probability sampling. CONCLUSIONS: This study suggested that the PTSS was common under the influence of PHEs. It was crucial to further explore the psychological mechanism and effective strategies for prevention and intervention in future research with more high-quality studies.