The Frequency of Neuropsychiatric Sequelae Following Traumatic Brain Injury in the Global South: A Systematic Review and Meta-Analysis

BACKGROUND: Recent research has shown that countries in the 'global south' are often characterized by demographic and socio–economic factors that are likely to contribute to the increased incidence of non–intentional injuries, such as traumatic brain injury (TBI). This systematic review and meta-analysis aimed to assess the prevalence of neuropsychiatric sequelae following a TBI specifically among the Western Asian, South Asian, and African regions of the global south.METHOD: A systematic literature review until August 20, 2021, was conducted for publications that measured some form of psychiatric or cognitive impairment following TBI from the 83 countries that constitute the aforementioned regions. Article identification began with a screening of major English and Arabic databases, like PsycINFO, Scopus, PubMed/MEDLINE, and ProQuest (English), Al–Manhal (Arabic), and Google Scholar for any remaining grey literature. Following evaluation of the articles using the Joanna Briggs Institute guidelines, the random–effects model was used to estimate the prevalence of the following specific conditions, i.e., depression, anxiety, post–traumatic stress disorders (PTSD), TBI–related sleep disturbance, Obsessive–compulsive disorder (OCD), and cognitive impairment. This systematic review has been registered under PROSPERO (registration ID. CRD42021270604).FINDINGS: Out of 56 unduplicated original studies identified by the initial search, 27 studies from 10 of the 83 identified countries were considered eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in a total sample of 1882 was 35·35% (95% CI=24·64–46·87%), of anxiety in a total sample of 1211 was 28·64% (95% CI=17·99–40·65%), of PTSD in a total sample of 426 was 19·94% (95% CI=2·35–46·37%), of OCD in a total sample of 313 was 19·48% (95% CI=0·23–58·06%), of TBI–related sleep disturbance in a total sample of 562 was 26·67% (95% CI=15·63–39·44%) and of cognitive impairment in a total sample of 941 was 49·10% (95% CI=31·26–67·07%).INTERPRETATION: To date, this is the first critical review that has examined the spectrum of post–TBI neuropsychiatric sequelae in the populations of West Asia, South Asia, and Africa. Existing studies addressing these secondary conditions lack homogenous data that could be grouped and analyzed in terms of self–report measures and standardized diagnostic procedures, rendering conclusive and comparable prevalence rates to be premature. However, results from the present study could be utilized to guide future rehabilitation efforts, policy-making, and research into 'culturally sensitive' and disease–specific outcome measures and normative data collection across the mosaic of ethnicities and cultures in the global south.FUNDING:none