Examining the relationship between coping strategies and post-traumatic stress disorder in forcibly displaced populations: A systematic review

Abstract

Forcibly displaced people, especially refugees, experience traumatic events in pre-migration and post-migration stages. Extremely distressing challenges mainly caused by war and harsh traveling conditions during involuntary mobilization may affect severely the mental health of these populations. Research identifies Post-Traumatic Stress Disorder as one negative diagnosis for refugees and with associated comorbidities, but no prevalent evidence was determined for the link between coping strategies and PTSD. This systematic review examines psychological variables involved in the selection of coping strategies among refugees with PTSD or at risk to develop PTSD. By using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA), the database search method was employed with Scopus, EBSCOhost, and PubMed. 648 records were extracted and 289 were screened. 14 were eligible and reviewed by two independent authors, using the critical appraisal tool to assess the quality of cross-sectional studies (AXIS). Main dimensions of coping strategies were identified, including problem-focused, emotion-focused, avoidant-focused, social support-seeking, and religious coping. Regarding associations, problem-focused coping was often uncorrelated with PTSD levels or linked to lower PTSD. Emotional-focused coping strategies varied considerably, despite of representing significant correlation with lower PTSD. Avoidant coping was associated to higher PTSD. To add, maladaptive strategies, such as other-blame and emotion-focused disengagement, were associated with higher levels of PTSD among forcibly displaced individuals. Mental health services, as well research replication, should provide differentiated care according to sociocultural sensitivity of these displaced persons and attending to knowledge of traumatic events they were exposed.