# Understanding psychotrauma in Sub-Saharan Africa: a scoping review of clinical and sociocultural perspectives

## TL;DR

This paper reviews how trauma is understood and expressed in Sub-Saharan Africa, highlighting cultural differences from Western diagnostic criteria.

## Contribution

The study provides new insights into how PTSD manifests culturally in Sub-Saharan Africa, emphasizing spiritual and somatic expressions.

## Key findings

- PTSD in Sub-Saharan Africa is often attributed to spiritual causes rather than psychological dimensions.
- Cultural expressions of trauma include somatic and spiritual frameworks, differing from DSM-5 criteria.
- Mental health interventions need to incorporate traditional healing practices for better patient care.

## Abstract

Since independence, African states have faced armed conflicts and economic crises, disrupting traditional cultures and causing trauma. In Sub-Saharan Africa, psycho trauma is seen as a shared expression of distress rather than a medical condition. Understanding these cultural manifestations is crucial for evaluating Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Posttraumatic stress disorder (PTSD) criteria. This review explores how PTSD symptoms manifest differently in these communities, aiming to enhance cultural understanding and improve patient care.

We conducted a double bind scoping review following the PRISMA guidelines. A systematic search was performed across multiple databases, including ScienceDirect, Cairn.info, SAGE Journals, Google Scholar, APA PsycInfo, Springer Link, PubMed, and ProQuest, for publications from 2016 to 2024 using the keywords PTSD, Sub-Saharan Africa, war trauma, sexual violence, culture, and expression of trauma.

The search returned 268 records. We identified 15 studies, written in English and French, that met the inclusion criteria. The studies were conducted in 8 countries Burkina Faso (n = 1) Cameroon (n = 2), Democratic Republic of the Congo (n = 4), Ivory coast (2), Kenya (1), Republic of Congo n = 1), South Africa (3) and Togo (n = 1). Nine studies (60%) highlight the symptoms related to PTSD showing that the DSM-5 emphasis psychological dimensions, whereas in sub-Sahara PTSD is primarily attributed to spiritual causes. Six studies (40%) highlight the meaning of symptoms in African anthropological structures, and the challenges faced by clinical psychologists in the context where mental health is not integrated in the cultural model of healing which involves spiritual rituals, traditional healers, and religious interventions.

This scoping review underscores the necessity of a comprehensive understanding of PTSD in Sub-Saharan Africa, where trauma is predominantly expressed through somatic and spiritual frameworks. Recognizing these cultural expressions is essential for developing contextually relevant diagnostic approaches and improving culturally adapted patient care.