Psychiatry · Medical Literature
Mental health of people living in Afghanistan: protocol for a systematic review
Abstract
Introduction Afghanistan has experienced decades of war, political instability, displacement, poverty and structural upheaval, all of which are likely to have contributed to the population’s deteriorating mental health. Individual studies and reports describe depression, anxiety, trauma-related distress and a severe lack of access to care, especially among women. However, the evidence remains fragmented. There has been no recent synthesis of evidence on mental health conditions, determinants, coping strategies, services and interventions among people living in Afghanistan. This protocol describes a systematic review of the literature on the mental health of this population. Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. The review will be conducted and reported in accordance with PRISMA 2020. MEDLINE, Embase, APA PsycINFO, Web of Science and WHO Global Index Medicus will be searched using subject headings and keywords related to Afghanistan and mental health, with searches updated before final analysis. Relevant grey literature will also be included. Eligible study designs include quantitative, qualitative and mixed-methods studies reporting mental health outcomes, determinants, coping strategies, access to mental healthcare or mental health interventions among people living in Afghanistan. No language restrictions will be applied. Title and abstract screening and full-text review will be conducted independently by two reviewers, with disagreements resolved through discussion or, if necessary, adjudicated by a third reviewer. Data will be extracted using a piloted structured template. Given the expected heterogeneity in study designs and outcome measures, quantitative findings will be reported as frequencies and qualitative data will be analysed using thematic approaches to support the synthesis. Where appropriate, findings will be grouped by po
Clinical relevance
Afghanistan's population has endured decades of armed conflict, political instability, forced displacement, and entrenched poverty, all of which are well-established drivers of depression, anxiety, PTSD, and broader psychosocial distress. Despite individual studies documenting high psychiatric morbidity—including a cross-sectional survey (N=2,698) reporting depression prevalence of 72%, anxiety of 72%, and stress of 66%—the evidence base remains fragmented, with no recent comprehensive synthesis covering mental health conditions, determinants, coping strategies, service infrastructure, and interventions among people currently residing in Afghanistan. This protocol is particularly timely given the post-2021 Taliban resurgence, which has sharply curtailed women's rights and access to care, creating an urgent need to consolidate and appraise the available evidence to inform both humanitarian response and clinical practice.
Key findings
NOTE: This is a systematic review PROTOCOL, not a completed review. No primary outcome data, effect sizes, confidence intervals, p-values, or NNT/NNH are reported in the abstract. The following describes the protocol's key methodological and contextual parameters, as reported: 1. Scope: The review will synthesise evidence on mental health conditions, determinants, coping strategies, access to care, and interventions among people living in Afghanistan—a population for which no recent comprehensive evidence synthesis exists. 2. Search strategy: Five major databases (MEDLINE, Embase, APA PsycINFO, Web of Science, WHO Global Index Medicus) plus relevant grey literature will be searched, with no language restrictions applied, and searches updated prior to final analysis. 3. Study design eligibility: Quantitative, qualitative, and mixed-methods studies are all eligible, reflecting the recognised heterogeneity in design and outcome measures across the Afghan mental health literature. 4. Dual independent screening: Title/abstract and full-text review will be conducted independently by two reviewers, with discrepancies resolved by discussion or third-party adjudication, in keeping with PRISMA 2020 standards. 5. Analytical approach: Given anticipated heterogeneity, quantitative findings will be reported as frequencies (precluding pooled meta-analysis) and qualitative data will be synthesised thematically; findings will be grouped by population subgroup where appropriate. 6. Contextual burden (from prior literature cited in this field): An estimated 85% of Afghanistan's population has experienced at least one traumatic event; Afghanistan's 2017 National Mental Health Survey (N=4,474) found 2.2% of adults reported suicidal ideation in the past 12 months and 3.4% reported a lifetime suicide attempt, with women at approximately double the risk of men—underscoring the unmet need this review addresses.
Practice implications
Clinicians and humanitarian programme planners should anticipate the completed review to serve as the most current and methodologically rigorous evidence base for designing mental health services in Afghanistan, with particular attention to high-risk subgroups (women, ethnic minorities, youth, and people with disabilities) who face compounded structural barriers to care. Given the severe shortage of mental health professionals in-country and strong cultural stigma, the review's findings on coping strategies, culturally salient idioms of distress, and community-based or task-shifted interventions (such as culturally adapted Problem Management Plus) will be directly relevant to selecting feasible and acceptable service models in this low-resource, conflict-affected context. International clinicians receiving Afghan refugees or displaced persons should remain alert to high rates of trauma-related disorders, suicidality (especially among women), and the likelihood that patients have never accessed formal psychiatric care, necessitating culturally informed, trauma-sensitive assessment and care pathways.