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Armed conflict exposure is associated with high PTSD prevalence among civilians in Indian-administered KashmirHigh rates of trauma and anxiety found in conflict zones

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Key Takeaway
Note high PTSD prevalence and a dose-response relationship between cumulative trauma and PTSD in conflict zones.

This systematic review synthesizes 16 quantitative studies to evaluate the prevalence of PTSD and associated risk factors among civilians in Indian-administered Kashmir. The review identifies significant PTSD prevalence across multiple populations: 15.9% to 24.5% in community-based adult samples, up to 49.8% in college students, and up to 40% in children. The authors also identify a dose-response relationship between cumulative trauma exposure and PTSD.

Specific risk factors for higher PTSD prevalence include being female, belonging to socioeconomically disadvantaged groups, being an orphan, or having direct conflict-related injuries. The review notes that the prevalence of PTSD varies due to methodological differences and the reliance on cross-sectional research. The authors also note considerable variation in study quality across the included studies.

Clinical implications suggest a need for community-based and task-shared approaches in low-resource settings. However, the findings are based on heterogeneous study designs, and the results should be interpreted with caution due to the cross-sectional nature of the primary data.

How this fits prior evidence

This systematic review addresses a gap in understanding the impact of armed conflict on mental health in specific geographic regions. While prior coverage identified structured physical exercise programs as a means to reduce PTSD symptom severity, this review provides data on the prevalence and risk factors of PTSD in a specific conflict zone. It confirms the presence of high PTSD rates in diverse populations, including children and students, and identifies specific risk factors like socioeconomic disadvantage and direct injury.

Living in a zone of armed conflict creates deep psychological scars. A review of 16 studies in Indian-administered Kashmir shows that many people in these communities struggle with post-traumatic stress disorder (PTSD). The data shows that while adult community members have PTSD rates between 15.9% and 24.5%, the numbers are much higher for others. For example, up to 49.8% of college students and up to 40% of children in these areas show signs of the condition.

Several factors make the risk even higher for certain people. Women, orphans, and those with physical injuries from the conflict are more likely to experience severe symptoms. The research also found a dose-response relationship, which means that the more trauma a person experiences, the higher their risk of developing PTSD. These individuals often face other struggles at the same time, such as depression, anxiety, and substance use.

While these findings are clear, the researchers noted that the studies they looked at varied a lot in quality and design. Because the data comes from a mix of different research methods, the exact numbers can shift depending on how the study was set up. These results highlight a major need for better community-based support and shared tasks to help people in low-resource areas cope with the lasting effects of war.

What this means for you:
People in conflict zones, especially children and women, face high rates of trauma and related mental health issues.

Common questions

How common is PTSD in these areas?

In adult community samples, the prevalence of post-traumatic stress disorder ranges from 15.9% to 24.5%. However, the rates are significantly higher among younger people, with up to 49.8% of college students and up to 40% of children showing symptoms.

Who is at the highest risk for these conditions?

Certain groups face higher risks for PTSD. These include women, orphans, and people from socioeconomically disadvantaged groups. Additionally, individuals who suffered direct physical injuries related to the conflict are more likely to experience these symptoms.

Are there other mental health issues involved?

Yes, the research shows that people experiencing these conditions often face other issues at the same time. These include depression, anxiety, and substance use disorders. The study also found that more cumulative trauma leads to a higher risk of PTSD.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
PurposeProlonged 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.MethodsA 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.ResultsReported 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.ConclusionThis 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.Systematic Review Registrationhttps://osf.io/3ztxq.
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