Post-Traumatic Stress Disorder among civilians in Indian-administered Kashmir: a systematic review

Prolonged exposure to armed conflict is associated with elevated rates of PTSD in civilian populations, such as Indian-administered Kashmir. This review aimed to systematically synthesise research on prevalence, risk factors, and correlates of PTSD among civilians in this setting and their association with armed conflict exposure.

A systematic review following PRISMA guidelines was conducted for empirical studies published up to 2025. Sixteen quantitative studies met the inclusion criteria. Due to heterogeneity in study design, sampling, and PTSD assessment, findings were synthesised narratively.

Reported PTSD prevalence varied across studies. Among community-based adult samples, prevalence ranged from 15.9% to 24.5%, with higher screening-based estimates in selected populations, including college students (up to 49.8%) and children (up to 40%) meeting a PCL-C threshold for probable PTSD. Higher prevalence was observed among women, socioeconomically disadvantaged groups, orphans, and individuals with direct conflict-related injuries. Several studies reported dose-response relationships between cumulative trauma exposure and PTSD, with PTSD symptoms commonly reported even years after exposure and comorbid with depression, anxiety, and substance misuse. Several limitations of existing literature were identified, such as considerable variation in study quality and reliance on cross-sectional research.

This review reveals substantial levels of PTSD among civilians in Indian-administered Kashmir. It highlights variability driven by methodological differences in measurement, sampling, and exposure assessment. Greater consistency in assessment and study design and more longitudinal studies are needed to strengthen psychiatric epidemiological evidence in armed conflict settings to inform psychiatric support approaches in prolonged armed conflict settings. The findings highlight how the scale of need for psychiatric care in Kashmir exceeds capacity, prompting a need to explore possible low-resource interventions options such as community-based and task-shared approaches, options which may also be applicable in other militarised, low-resource settings.

https://osf.io/3ztxq.