Sarma Kiran M, Carthy Sarah L, Cox Katie M
School of Psychology National University of Ireland Galway (University of Galway) Galway Ireland.
Institute of Security and Global Affairs Leiden University Leiden The Netherlands.
Campbell Syst Rev. 2022 Aug 10;18(3):e1268. doi: 10.1002/cl2.1268. eCollection 2022 Sep.
The link between mental health difficulties and terrorist behaviour has been the subject of debate for the last 50 years. Studies that report prevalence rates of mental health difficulties in terrorist samples or compare rates for those involved and not involved in terrorism, can inform this debate and the work of those responsible for countering violent extremism.
To synthesise the prevalence rates of mental health difficulties in terrorist samples (Objective 1-Prevalence) and prevalence of mental health disorders pre-dating involvement in terrorism (Objective 2-Temporality). The review also synthesises the extent to which mental health difficulties are associated with terrorist involvement compared to non-terrorist samples (Objective 3-Risk Factor).
Searches were conducted between April and June 2022, capturing research until December 2021. We contacted expert networks, hand-searched specialist journals, harvested records from published reviews, and examined references lists for included papers to identify additional studies.
Studies needed to empirically examine mental health difficulties and terrorism. To be included under Objective 1 (Prevalence) and Objective 2 (Temporality), studies had to adopt cross-sectional, cohort, or case-control design and report prevalence rates of mental health difficulties in terrorist samples, with studies under Objective 2 also needing to report prevalence of difficulties before detection or involvement in terrorism. For Objective 3 (Risk Factor) studies where there was variability in terrorist behaviour (involved vs. not involved) were included.
Captured records were screened in by two authors. Risk of bias was assessed using checklists, and random-effects meta-analysis conducted in Comprehensive Meta-Analysis software.
Fifty-six papers reporting on 73 different terrorist samples (i.e., studies) ( = 13,648) were identified. All were eligible for Objective 1. Of the 73 studies, 10 were eligible for Objective 2 (Temporality) and nine were eligible for Objective 3 (Risk Factor). For Objective 1, the life-time prevalence rate of diagnosed mental disorder in terrorist samples ( = 18) was 17.4% [95% confidence interval (CI) = 11.1%-26.3%]. When collapsing all studies reporting psychological problems, disorder, and suspected disorder into one meta-analyses ( = 37), the pooled prevalence rate was 25.5% (95% CI = 20.2%-31.6%). When isolating studies reporting data for any mental health difficulty that emerged before either engagement in terrorism or detection for terrorist offences (Objective 2: Temporality), the life-time prevalence rate was 27.8% (95% CI = 20.9%-35.9%). For Objective 3 (Risk Factor), it was not appropriate to calculate a pooled effect size due the differences in comparison samples. Odds ratios for these studies ranged from 0.68 (95% CI = 0.38-1.22) to 3.13 (95% CI = 1.87-5.23). All studies were assessed as having high-risk of bias which, in part, reflects challenges conducting terrorism research.
AUTHOR'S CONCLUSIONS: This review does not support the assertion that terrorist samples are characterised by higher rates of mental health difficulties than would be expected in the general population. Findings have implications for future research in terms of design and reporting. There are also implications for practice with regards the inclusion of mental health difficulties as indicators of risk.
在过去50年里，心理健康问题与恐怖主义行为之间的联系一直是争论的焦点。报告恐怖主义样本中心理健康问题患病率或比较参与和未参与恐怖主义活动者患病率的研究，可以为这场辩论以及负责打击暴力极端主义的人员的工作提供参考。
综合恐怖主义样本中心理健康问题的患病率（目标1——患病率）以及参与恐怖主义活动之前心理健康障碍的患病率（目标2——时间顺序）。本综述还综合了与非恐怖主义样本相比，心理健康问题与参与恐怖主义活动之间的关联程度（目标3——风险因素）。
于2022年4月至6月进行检索，涵盖截至2021年12月的研究。我们联系了专家网络，手工检索专业期刊，从已发表的综述中收集记录，并查阅纳入论文的参考文献列表以识别其他研究。
研究需要实证检验心理健康问题与恐怖主义。为纳入目标1（患病率）和目标2（时间顺序），研究必须采用横断面研究、队列研究或病例对照研究设计，并报告恐怖主义样本中心理健康问题的患病率，目标2的研究还需要报告在被发现或参与恐怖主义活动之前心理健康问题的患病率。对于目标3（风险因素）的研究，纳入了恐怖主义行为存在差异（参与与未参与）的研究。
两位作者对收集到的记录进行筛选。使用清单评估偏倚风险，并在综合荟萃分析软件中进行随机效应荟萃分析。
共识别出56篇报告73个不同恐怖主义样本（即研究）（n = 13,648）的论文。所有论文均符合目标1的标准。在73项研究中，10项符合目标2（时间顺序）的标准，9项符合目标3（风险因素）的标准。对于目标1，恐怖主义样本中已诊断精神障碍的终生患病率（n = 18）为17.4% [95%置信区间（CI）= 11.1% - 26.3%]。当将所有报告心理问题、障碍和疑似障碍的研究合并为一项荟萃分析时（n = 37），合并患病率为25.5%（95% CI = 20.2% - 31.6%）。当单独分析报告在参与恐怖主义活动或被发现犯有恐怖主义罪行之前出现的任何心理健康问题数据的研究时（目标2：时间顺序），终生患病率为27.8%（95% CI = 20.9% - 35.9%）。对于目标3（风险因素），由于比较样本存在差异，计算合并效应量不合适。这些研究的优势比范围为0.68（95% CI = 0.38 - 1.22）至3.13（95% CI = 1.87 - 5.23）。所有研究均被评估为具有高偏倚风险，这在一定程度上反映了开展恐怖主义研究的挑战。
本综述不支持恐怖主义样本中心理健康问题患病率高于一般人群预期的说法。研究结果对未来研究的设计和报告具有启示意义。对于将心理健康问题作为风险指标的实践也具有启示意义。
