Post-traumatic stress, depression, and anxiety during the 2021 Myanmar conflict: a nationwide population-based survey

Xiaoyan Fan; Ke Ning; Tiffany Sw Ma; Yadanar Aung; Hein Min Tun; Phyu Phyu Thin Zaw; Francis P Flores; Mathew Sc Chow; Candi Mc Leung; Phyllis Lun; Wing Chung Chang; Gabriel M Leung; Michael Y Ni

doi:10.1016/j.lansea.2024.100396

Post-traumatic stress, depression, and anxiety during the 2021 Myanmar conflict: a nationwide population-based survey

Lancet Reg Health Southeast Asia. 2024 Apr 8:26:100396. doi: 10.1016/j.lansea.2024.100396. eCollection 2024 Jul.

Authors

Xiaoyan Fan¹, Ke Ning¹, Tiffany Sw Ma¹, Yadanar Aung², Hein Min Tun^{3

4

5

6}, Phyu Phyu Thin Zaw¹, Francis P Flores¹, Mathew Sc Chow¹, Candi Mc Leung¹, Phyllis Lun¹, Wing Chung Chang^{7

8}, Gabriel M Leung^{1

9}, Michael Y Ni^{1

8

10}

Affiliations

¹ School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
² Institute for Population and Social Research, Mahidol University, Bangkok, Thailand.
³ The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁴ Microbiota I-Center (MagIC), The Chinese University of Hong Kong, Hong Kong SAR, China.
⁵ Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁶ HKU-Pasteur Research Pole, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁷ Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁸ The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
⁹ Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong SAR, China.
¹⁰ Urban Systems Institute, The University of Hong Kong, Hong Kong SAR, China.

Abstract

Background: The UN warns that Myanmar faces the 'triple crises' of mass conflict, uncontrolled COVID-19, and economic collapse. Therefore, we aimed to assess the population mental health burden, healthcare needs, and the associated risk factors in Myanmar.

Methods: We established a nationwide random sample and recruited 1038 adults via random digit dialling from July 3-Aug 9, 2021, during the ongoing conflict since Feb 1, 2021, and surge in SARS-CoV-2 infections. Probable post-traumatic stress disorder (PTSD) was assessed using the PTSD Checklist-Civilian Version. Probable depression and anxiety were assessed using the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder-2. We calculated population attributable fractions for probable mental disorders using multivariable logistic regression models. Based on the mental health burden and healthcare-seeking patterns, we projected the need for mental health services.

Findings: During the 'triple crises', a third of adults in Myanmar (34.9%, 95% CI 32.0-37.7) reported a probable mental disorder. Prevalence of probable PTSD, depression, and anxiety were 8.1% (6.6-9.7), 14.3% (12.0-16.6), and 22.2% (19.7-24.7), respectively. We estimated that up to 79.9% (43.8-97.9) of probable PTSD was attributable to political stress. This corresponds to 2.1 million (1.1-3.2 million) fewer adults with probable PTSD if political stress was removed from the population. The mental health burden could translate into roughly 5.9 million adults seeking mental health services.

Interpretation: The mental health burden in Myanmar is substantial, and population mental health might only be restored when the three crises have ended. An accelerated peace process is critical to protecting Myanmar's population mental health.

Funding: This research was supported the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 17606122) and the Michele Tansella Award.

Keywords: Anxiety; COVID-19; Conflict; Depression; Economic crisis; Epidemiology; Myanmar; Population mental health; Post-traumatic stress disorder.