The Mental Health Costs of Armed Conflicts—A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones

Bernardo Carpiniello

International Journal of Environmental Research and Public Health, Volume 20, Issue 4 (2023) 


This paper investigates the mental health consequences of war on refugees or those living in war zones through a review of all systematic reviews and/or meta-analyses published since 2005. The author identified 22 systematic reviews and/or meta-analyses for the review, including 15 studies in adult populations and seven focused on children and adolescents. 

Main findings: 

  • Adults and children who have been exposed to armed conflict or who have been displaced have much higher rates of mental health disorders. The prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) were two to three times higher amongst people exposed to armed conflict or who have been displaced compared to those who had not been exposed. Rates of common mental disorders appear to decrease gradually in post-war periods. 
  • Women and children are the most vulnerable to developing mental health disorders following experiences of armed conflict, with incidence correlated with the degree of trauma and access to physical and emotional support. In women, the higher risk of war-related mental health consequences is related to sexual and physical violence. War-related mental health issues in minors is a complex process relating to the stage of exposure, length of conflict, and other contextual factors 
  • A series of war-related, migratory, and post-migratory stressors contribute to short- and long-term mental health issues in displaced populations. Stressors include: (1) socioeconomic factors such as unemployment or underemployment, financial restrictions/poverty, or lack of secure housing; (2) social and interpersonal factors such as family separation, change in previous social role, social isolation, discrimination, loss of social identity, lack of social support, or changes in gender role; and (3) factors related to the asylum process and immigration policies, such as mandatory detentions, extended processing times, insecure visa status, lack of access to legal services and representation. 

The authors note the limitations in the current literature including the frequent low quality of studies, the scarcity of longitudinal studies, and the scarcity of studies on a wider range of mental health disorders beyond PTSD, depression, and anxiety. Overall, however, the results reveal the high prevalence of emotional distress experienced by those exposed to armed conflict and forced displacement, including anxiety disorders, depressive disorders, and post-traumatic stress disorders, which may be attributed both to direct exposure to the distress of war and to a series of displacement-related stressors.