Major depressive disorder following terrorist attacks: A systematic review of prevalence, course and correlates

Background: Terrorist attacks are traumatic events that may result in a wide range of psychological disorders for people exposed. This review aimed to systematically assess the current evidence on major depressive disorder (MDD) after terrorist attacks. Methods: A systematic review was performed. Studies included assessed the impact of human-made, intentional, terrorist attacks in direct victims and/or persons in general population and evaluated MDD based on diagnostic criteria. Results: A total of 567 reports were identified, 11 of which were eligible for this review: 6 carried out with direct victims, 4 with persons in general population, and 1 with victims and general population. The reviewed literature suggests that the risk of MDD ranges between 20 and 30% in direct victims and between 4 and 10% in the general population in the first few months after terrorist attacks. Characteristics that tend to increase risk of MDD after a terrorist attack are female gender, having experienced more stressful situations before or after the attack, peritraumatic reactions during the attack, loss of psychosocial resources, and low social support. The course of MDD after terrorist attacks is less clear due to the scarcity of longitudinal studies. Conclusions: Methodological limitations in the literature of this field are considered and potentially important areas for future research such as the assessment of the course of MDD, the study of correlates of MDD or the comorbidity between MDD and other mental health problems are discussed.