Prevalence and Intervention Gaps for PTSD and CPTSD Following Interpersonal Trauma in Low- and Middle-Income Countries: A Systematic Review

Abstract

Objective The psychological burden of interpersonal trauma is a significant global concern, yet a critical gap remains in identifying and treating trauma-related disorders in low- and middle-income countries (LMICs). Following the introduction of the International Classification of Diseases 11th Revision (ICD-11), understanding the distinction between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) has become essential, particularly in resource-constrained settings where chronic trauma is prevalent.Methods We conducted a systematic review following PRISMA guidelines to examine prevalence of interpersonal trauma, PTSD/CPTSD prevalence, and available interventions in LMICs. Thirty-five studies were selected following independent data extraction and quality appraisal by two reviewers based on JBI Critical Appraisal and Cochrane Risk of Bias assessments.Results The findings indicate a substantial gap between high interpersonal trauma exposure and clinical recognition. Children, adolescents, and women were identified as the most vulnerable populations, frequently exposed to domestic and gender-based violence. While PTSD prevalence rates were high across LMICs, only three studies utilized the ICD-11 criteria for CPTSD. Regarding interventions, while evidence-based models such as trauma-focused cognitive behavioral therapy and narrative exposure therapy have been implemented, evaluation research in LMICs remains limited compared to the high trauma burden.Conclusion This review highlights a diagnostic lag and research-to-practice gap in LMICs, particularly concerning the CPTSD recently introduced in ICD-11. Addressing these disparities requires prioritizing implementation science frameworks, focusing on task-shifting models, cultural tailoring of evidence-based interventions, and the integration of digital health solutions to ensure sustainable care for vulnerable survivors.