Complex Post-Traumatic Stress Disorder in Refugees, Asylum Seekers, and Internally Displaced People: A Systematic Review and Meta-Analysis

Forcibly displaced populations, including refugees, asylum seekers, and internally displaced persons, are frequently exposed to severe, prolonged and repeated trauma from which escape is difficult or impossible. Such exposures increase the risk for complex post-traumatic stress disorder (CPTSD), defined by core PTSD symptoms alongside disturbances in self-organization (DSO), including affective dysregulation, negative self-concept, and relational difficulties. However, the prevalence of CPTSD in forcibly displaced populations has not yet been quantitatively synthesised. This systematic review and meta-analysis searched five databases from inception to January 2026. A random-effects meta-analysis was conducted to estimate pooled CPTSD prevalence, with pre-specified subgroup analyses, meta-regression, and sensitivity analyses. Twenty studies met inclusion criteria, representing 17 independent samples (n = 12,504). The pooled prevalence of CPTSD was 20.9% (95% CI [12.6%, 32.6%]), substantially exceeding general-population estimates. Between-study heterogeneity was substantial (I²=98.3%), with recruitment context emerging as the primary identifiable driver: prevalence in treatment-seeking samples (55.2%) was nearly five-fold higher than in community-based samples (10.6%). Asylum seekers exhibited markedly higher prevalence than refugees. Across four studies, post-migration living difficulties, including legal insecurity, poverty, and marginalisation, were more strongly associated with DSO symptoms than with core PTSD symptoms, suggesting that ongoing structural adversity actively perpetuates complex trauma psychopathology beyond pre-migration trauma alone. Our findings affirm the clinical utility of CPTSD assessment in forcibly displaced populations and underscore the need for routine screening, structural interventions targeting post-migration stressors, and scalable task-sharing models of psychosocial support.