Table 2 Data extraction of included studies

1

Sabha/Libya 2014

Selected health care facilities in Sebha

Anemic pregnant women (age not specified) (63.17% were between the age 21 and 40 years)

To determine the degree of anemia among pregnant women and to assess the depression, anxiety and stress among the anemic pregnant women

Cross-sectional/purposive

Structured interview

258

Depression Anxiety Stress Scales (DASS 21)

43.4% (112/258)

25% (65/258)

No significant association between depression, anxiety, stress, and hemoglobin level during pregnancy

2

Sabha/Libya 2014

Sebha City

Post-war young adults (18–35 years) (M + F)

To investigate the association of mental well‑being and depression with periodontal clinical attachment loss among young adults in postwar urban population

Cross-sectional/random sampling

Questionnaires

147

World Health Organization (WHO) Five well-being index and (ICD-10) Major depression inventory

Total 40.81% depression degree (71.6%) mild, (8.3%) moderate, (18.3%) major, (1.6%) severe

Prevalence: Depression is more prevalent in females (73.3%); however, severity is greater in male gender

3

Cross Libya (2016–2017)

Krankenhaus Nordwest Hospital, Frankfurt, Germany

Libyan patient (war-injured) Mostly adolescent (11–51 years) (all male, except 11 years old female)

to report structural preparation for management of war injuriesand to analyze demographics, injury mechanisms, symptoms, diagnostics, injury patterns and therapies at Neurological and trauma surgical Department

Retrospective study

Secondary data/hospital record

78

Neurological physical examinations

36% (28/78) psychiatric symptoms, mostly attributed to their injury by gunshots and explosions

There was a lot of stigmata attached to psychological and psychiatric evaluation, that’s why patients refused a complete assessment of a possible PTSD, Depression

4

Across Libya 7 cities (Misurata, Sabha, Zawea, Sirt, Al Bida, Benghazi, Tripoli) (2008–2009)

Nine Libyan universities/colleges

Undergraduate students (65% 20–24 years) (both sex)

To assess the frequencies of self-reported students’ eight health complaints and two stressors (educational related and general overall). And to examine the associations between the health complaints and students’ socio-demographics features, health behaviors and quality of life

Cross-sectional

Questionnaires

1300

General Student Health Survey (GSHS)

57.6% (749/1300)

Prevalence: 56.85% (738/1300) Difficulty in concentration, 49.9% (649/1300) sleep disorder/insomnia. It has been concluded that female and income insufficiency are key risk factors

5

Across Libya (11/2019–1/2021)

Izmir University of Economics Medical Park Hospital, (Turkish Hospital)

Libyan patients (orthopedic war injures) (19–56 years)

(male)

To investigate the rates of depression, anxiety, and PTSD among patients who were injured during the Libyan Civil War and were receiving medical support far away from their home country and correlation between the psychological status and severity of the trauma

Retrospective study

Secondary data/hospital record

81

Beck Depression Inventory (BDI), BeckAnxiety Inventory (BAI), and Clinician-Administered PTSD Scale (CAPS)

86.4%

85.2%

82.7%

Depression, anxiety, and PTSD are common in patients injured in wars. Injury severity does not seem to affect depression, anxiety, or PTSD in these patients

6

Tripoli (2019)

University of Tripoli

Volunteers (19–51 years) (both sex)

To examine the effects of psychoeducation and stress management techniques on posttraumatic stress disorder (PTSD) symptoms in Libya

Cross-sectional

Questionnaires

41

PTSD Checklist Civilian Version (PCL)

39% Preintervention, 15% 2 weeks post-interventions

This study concluded that in mass-trauma events such as war and natural disasters, PTSD education can reduce the PTSD symptoms of those affected

7

Across Libya 30 cities and towns (2020)

(In person and online)

Lived in Libya for at least 5 years (18–80 years) (both sex)

To study the Impact of lockdown due to the COVID-19 pandemic on mental health among the Libyan population

Cross-sectional/convenience sampling

Survey

31,557

Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Impact of Event Scale-Revised (IES-R)

(19.8%) 6245 PTSD

(13.6%)4280 severe depressive symptoms

(5.6%) 1767 severe anxiety symptoms

There was a significant association between depressive symptoms, anxiety symptoms, and PTSD in most of the study variables. Young age, being female, unmarried, educated, or victims of domestic violence or abuse, work suspension during the pandemic, and high association with having increased workload, financial issues, suicidal thoughts, or a family member with or hospitalized due to COVID-19

8

Tripoli/ Libya (2017–2018)

(227) IDPs in private residency, (242) IDPs in camp residency

Internally displaced persons (IDP’s) in Tripoli, Libya (above 18 years) (both sex)

To assess the prevalence of mental disorders among IDPs in Tripoli, Libya the burden of mental disorders on the quality of life, and assess its correlation with demographic, social and economic factors, while emphasizing on type of residency, utilization of health services and general health condition

Cross-sectional

Questionnaires

469

(DASS 42), Quality of Life Scale (SF-36) both Arabic version

Total 61.8%, depression degree mild (10.1%) moderate (19.2%), severe (14%), extremely severe (18.5%)

Total 58.6% anxiety degree mild (6.7%), moderate (19%), severe (14.3), extremely severe (18.6%)

Camp resident IDPs had higher mental disorders and lower score of quality-of-life domains than private resident IDPs

9

Across Libya20 cities (5–6/2020)

Online

Libyan population during COVID-19 lockdownmean age (27.2) (both sex)

To provide an overview of the psychological status and behavioral consequences of the lockdown during the COVID-19 pandemic in Libya

Cross-sectional

Survey

8084

(GAD-7)

(14.2%)

The study demonstrates a concerning high level of clinically significant anxiety during lockdown among the Libyan population during Libya’s lockdown period

10

Across Libya (05/2020)

Online

Surgical staff and residentsworking in Libyan hospitalsMean age (32.8 ± 7.1). (both sex)

To provide an overview of the mental health status among surgeons during COVID-19

Cross-sectional

Survey

309

(PHQ-9) (GAD-7)

(11.7%) 36/309

(15.2%)47/309

Surgeons working in Libya are at greater risk of mental illness owing to the civil war, financial crisis, lack of training, shortage of personal protective equipment, and risk of COVID-19 infection

11

Misurata, Libya (2022)

Three major health facilities in Misurata, Libya (Misurata Central Hospital, Algoshi Health Center, Algheran Health Center)

Postnatal mothers at first-, fourth- and sixth month post-delivery (15–43) (Female)

To find out the status of postpartum depression (PPD) and the associated factors among postnatal mothers at first-,fourth- and sixth month

Cross-Sectional

Questionnaires

100

Edinburg postnatal Depression Scale (EPDS)

60% depression, 22% borderline depression

The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have an appropriate attention by physicians and gynecologists

12

Across Libya (12–2018/2/2019)

Emergency departments of nine main tertiary hospitals in Libya

Emergency physicians after civil war serving in Libyan hospitals for at least 3 months. Mean age (31.2 ± 4.5 years) (both sex)

To identify the prevalence of depression and anxiety among physicians working in the emergency departments of nine tertiary care centers in Libya

Cross-sectional

Survey/paper-based questionnaire

108

Hospital Anxiety and Depression Scale (HADS)

(45.4%) 49/108

(45.4%) 49/108

The high prevalence rate of anxiety and depression is of concern, and the high rate of physical and verbal abuse highlights the range of abuse endured by doctors in Libya. Therefore, screening for anxiety and depression at regular intervals is needed to avoid the deterioration of mental health, which can increase the risk of suicide and dropping out, and decrease the level of healthcare for patients

13

Tripoli, Libya (7–10/2014)

12 primary and secondary schools during the scholastic year 2013–2014

Libyan primary and secondary schoolteachers Mean age (38.7 ± 8.5 years) (both sex)

To estimate the dependability, prevalence, and severity of Depression, Anxiety and Stress (DAS) among primary and secondary school teachers, and to observe any possible association between the levels of these symptoms and the socio-demographic characteristics

Cross-sectional

Questionnaire

200

(DASS-21)

(44.5%)

(56%)

The findings indicate the predominance of (DAS) in tutors. It also shows that Libyan schoolteachers experienced more symptoms than other survey countries; their quality of work possibly be affected by these events

14

Across Libya (7–8/2020)

Online In more than 20 cities in Libya

Libyan Population Mean age (28.9 ± 8.5 years) (both sex)

To determine the prevalence of insomnia, depressive and anxiety symptoms, and their associated factors among Libyan populations during the COVID-19 pandemic and the civil war

Cross-sectional

Online survey

10,296

(GAD-7), (PHQ-2), Insomnia Severity Index (ISI)

(46.2%) 4756

(19%) 1952

Confronted with the COVID-19 outbreak, the Libyan population exhibited high levels of psychological stress manifested in the form of depressive and anxiety symptoms, while one-third of the Libyan population suffered from clinical insomnia

15

Across Libya (4–5/2020)

12 Cities (Tripoli, Al-Zawia, Misrata, Sebha, Gharyan, Albayda, Benghazi, Al-Khums, Tarhuna, Alzintan, Tobruk, and Sabratha)

Medical students from 15 Libyan medical schools Mean age (23.30 ± 2.61 years) (both sex)

To determine the psychological status of medical students during the COVID-19 outbreak and civil war in Libya

Cross-sectional

Survey/questionnaire

2430

(GAD-7), (PHQ-9)

Total (21.6%) 525 moderate to severe depression, below cutoff score for diagnosis (35.2%) 855 mild depression

(64.5%) 1568, anxiety degree: mild (37.5%), moderate (16%), severe (11%)

The finding highlighted that medical students in Libya are at risk for depression, especially under the current stressful environment of the civil war and the COVID-19 outbreak

16

Across Libya (April 2020)

15 hospitals from nine major Cities in Libya

Healthcare workers including doctors and nurses working in Libyan hospitals. Mean age (33.3 ± 7.4 years) (both sex)

To assess the psychological status of healthcare workers during the COVID-19 outbreak, which has compounded Libya's existing civil war-related problems. Furthermore, examine several factors, such as violence and abuse among doctors, and their associations with depressive and anxiety symptoms

Cross-sectional

Survey

745

(HADS)

(56.3%) 420

(46.7%) 348

The study presented important findings regarding depressive symptoms, anxiety symptoms, and abuse among physicians working during the COVID-19 outbreak and civil war in Libya. It also demonstrated several factors that can be associated with depressive and anxiety symptoms

17

Across Libya (2015)

9 Libyan higher education institutes, 6 universities (Tripoli, Benghazi, Omar El-Muktar, Sebha, Sirt and Misrata University) and 3 colleges (higher medical technology institute, higher industrial technology institute and higher computer technology institute)

Higher education students (Undergraduate students) from different high institutes and different disciplines Age (17–34 years) (both sex)

To determine the rates of anxiety and depression among higher education students in Libya, and to provide basic data required by the university health program for planning related to the health need for students

Cross-sectional/random sampling

Questionnaire

1300

American College Health Association Survey (ACHA)

4.3%

8.8%

This study findings suggest that social and cultural factors seem to play a major role in determining the state of health, especially mental health (limitation of this study, there was no assessment of depression and anxiety symptoms, it depended on participants indicating if they were previously diagnosed with anxiety or depression, however many fears being stigmatized)

18

Across Libya (2021)

Libyan hospitals

Frontline physicians working in Civil Wars Under COVID-19 pandemic conditions Mean age (31.66 ± 5.97) (both sex)

To examine the prevalence of anxiety, depression, and burnout among emergency physicians on the frontline of the COVID-19 pandemic

Cross-sectional

Questionnaire

154

(HADS)

73.4%

65.6%

This study demonstrated higher than expected levels of anxiety, depression, and burnout among 154 emergencies. doctors from Libya who worked during the COVID-19 pandemic and civil war crisis

19

Gharyan, Libya (2021)

Gharyan-polyclinic in Libya

Diabetic patients visiting Gharyan-polyclinic in Libya during COVID-19 pandemicAge (≥ 18 years)

To estimate the prevalence of generalized anxiety disorder (GAD) in adult patients with diabetes mellitus (T1DM or T2DM) during COVID-19 pandemic

Cross-sectional/random sampling

Diagnostically interviewed through outpatient visits and through phone calls

115

(GAD-7)

Total 28.69%, anxiety degrees (20.86%) mild, (6.08%) moderate, (1.73%) severe

GAD is present in 28% of the patients who participated in the study. Additional epidemiological studies are needed to determine the prevalence of anxiety in the broader population of persons with diabetes

20

Across, Libya (2018)

AI-Khadra Hospital in Tripoli, Libya

Libyan mothers of autistic children in the Centers of Special Education for Autism Children and Neurodevelopment Clinic of AI-Khadra Hospital in Tripoli Mothers’ mean age (37.9 ± 7.7 years) Children (male) Mean age (7.1 ± 3.1)

To assess the magnitude of psychological distress among the mothers of autistic children and find out the associations between the psychological distresses of mothers with their socio-demographic characteristics, and with their autistic children’s socio-demographic characteristics

Case series study/convenient sampling

Face-to-face interviews by trained intern doctors/questionnaire

104

General Health Questionnaire 28 (GHQ-28)

(32.7%) severe depression

69% anxiety/insomnia

The study revealed that psychological distress is a considerable problem among mothers of autistic children in Libya. It is important to draw attention of psychologists and doctors engaged in the therapy of children with ASD to the mental condition of the parents, whose good mental health is an important condition for providing optimal help to the child

21

Tripoli, Libya (2017)

24th December) school

Adolescent Libyan Females (14–18 years) (female)

To study the prevalence of clinical depression among adolescent females, through use of anonymous questionnaire showing a higher rate of response among students because they find it impersonal and confidential

Cross-sectional

Questionnaire

262

(PHQ-9)

Total 9.1%, depression degree: (7.6%) moderately severe, (1.5%) severe. below cutoff score (31.7%) mild, (13.7%) moderate

Depression has been proved a real clinical disorder of a high prevalence in Libyan society; therefore, more specific measures should be taken to detect such cases and provide them with the proper counselling

22

Tripoli, Libya (3–5/2019)

University of Tripoli

Students registered at final years of medical sciences students at University of Tripoli (23–25 years) (female)

To estimate the prevalence of depression and stress among university medical students in Libya

Cross-sectional

Questionnaire

170

Kutcher Adolescent Depression Scale (KADS), (PHQ-9), simplified self-scoring test for stress

Total by KADS (45.8%),depression degree by PHQ (44.7%) mild, (25.8%) moderate, (8.8%) moderate severe, (1.17%) severe

This study indicates a high prevalence of mild and moderate depression among medical university students in Libya

23

Tripoli, Libya (2013)

Tripoli, Libya

Libyan population Age (≥ 18 years) (both sex)

To examine the psychological and demographic predictors that were most likely to contribute to depression among Libyans (individualism; collectivism; familism; social support, self-esteem, and gender)

Cross-sectional

Questionnaires

169

(BDI-II)

Total (79.28%) depression degree in females’ sample (40%) mild, (40%) moderate, (4%) severe, male sample (45.8%) mild, (16.9%) moderate, (3%) severe

The study indicated that self-esteem and gender are main predictors of depression in Libyan population

24

Across Libya (9–2020)

Across Libya–online survey

Libyan healthcare workers, included doctors, residents, nurses, technicians, and public health workersAge (25–67) (both sex)

To measure the level of knowledge, attitude, perception, and psychological state of Libyan Healthcare workers regarding the risks of infection with COVID-19

Cross-sectional/convenience sampling

Online survey

392

(GAD-7), (PHQ-9), Insomnia Severity Index (ISI)

Total 10.5%, depression degree (21.4%) mild (10.5%) moderate/severe

30.1%, Anxiety degree (19.4%) mild, (10.7%) moderate/severe

Many Healthcare workers reported adequate overall knowledge with a negative attitude toward government and adopted appropriate practices. Psychological problems are directly related to inadequate knowledge, incorrect attitudes, and inadequate perception

25

Western Libya

Western Libya—Online

Libyan resident in Western Libya Age (18–78) years (both sex)

In western Libya, citizens live under the dual threat of armed conflict and COVID-19. The situation merits investigation to understand citizens’ sensitivity to the pandemic under a pre-existing crisis. This research aims to extend current understanding by examining how coping strategies namely, perceived coping self-efficacy and perceived social support, moderate the effects of the two crises

Cross-sectional/snowball sampling

Questionnaires

717

Crisis Coping Assessment Questionnaire (CCAQ)

28% anxiety

Citizens draws on social capital, but do not have effective personal coping mechanisms to deal with the psychological impact of conflict

26

Benghazi, Libya (2011)

Garyounis internally displaced person camp

Tawerghan people internally displaced. Mean age (30.3 ± 13.2) (both sex)

the feasibility and efficacy of 10-week peer-led group-based recovery intervention for war-related trauma implemented at the Garyounis internally displaced person camp outside of the city of Benghazi

Cross-sectional

Questionnaires

19

PTSD Check List–Civilian Version (PCL-C)

(58%)

The use of peers to lead recovery groups is not only feasible but appears to be highly efficacious in reducing PTSD symptoms in civilians exposed to war-related trauma

27

Tripoli, Libya (2015–2016)

Veterans Affairs Center for Rehabilitation and Psychotherapy

Registered Veterans at Tripoli Veterans Affairs Center Age (20–40) years (male)

To measure the prevalence of PTSD in veterans after the long-lasting war in Libya, and its correlation with neighborhood the veterans live at

Cross-sectional/random sampling

Questionnaires

773

PTSD Checklist (PCL)

Total 100% PTSD degree: (5.44%) mild, (82.66%) moderate, (11.9%) severe

There is significant difference between veterans living in different neighborhood, which can be explained due to severity of attacks differs at each site

28

Benghazi, Libya (2017–2018)

6 Primary and secondary schools located at heaviest attacked area in Benghazi

Primary and secondary school’s teachers in Benghazi. (both sex)

To identify the level of post-traumatic stress disorder and its relation to some variables, among teachers in Benghazi City

Cross-sectional

Questionnaires

176

Davidson Trauma Scale-DSM-IV)

(24.4%)

There were no statistically significant differences between males and females on the PTSD scale in the total score

29

Misrata Libya (2013/2014)

University of Misurata, Libya

Undergraduate student at University of Misurata Age (18–22) (both sex)

To measure the prevalence of PTSD among Misrata undergraduate student and identify it correlation with sex, loss of loved ones and damage of their homes during the war

Cross-sectional

Questionnaires

1301

PTSD Checklist (PCL)

Total (82.39%) PTSD degree: (13.22%) mild, (82.39%) moderate, (4.38%) severe

The study identified the prevalence of PTSD more in females, and it has positive correlation with the negative effect of war such as loss of loved one

30

Benghazi, Libya

Ten Primary School in Al-Marj and Al-Bayda

Children who attended schools during periods of civil war in Benghazi (2016) and their families who had escaped to the neighboring cities of Al-Marj and Al-Bayda. Children age (9–15) years (both sex) Parents (female)

To study the association between exposure to civil war trauma and mental health problems among displaced parents and children; and whether coping strategies and perceived social support moderated this association

Cross-sectional

Questionnaires

200 (100 children/100 parents)

Children: Children's Revised Impact of Event Scale (CRIES-8); parents: (IES-22) and (GHQ-12)

PTSD (47%) parents, (56%) children

Internally displaced parents and their children reported high rates of post-traumatic stress and mental health problems, which were significantly associated with exposure to trauma. This association was moderated by parents using support-seeking and children using problem-solving strategies

31

Tripoli Libya2011

3 Libyan National Health Services

Libyan patients attending three randomly selected Libyan National Health Services. Age (≥ 18 years) (both sex)

To estimate the prevalence, severity and associated factors of dental anxiety among adult patients attending the Libyan National Health Services

Cross-sectional

Face-to-face interview

419

Modified Dental Anxiety Scale (MDAS)

Total (91.5%), degrees: (32.5%) slight, (33.4%) fair, (16.9%) very anxious, (8.6%) extremely

The results of this study suggest that a higher proportion of the Libyans suffering from dental anxiety compared to other nationalities

32

Across Libya

Three universities in Libya (Al Asmarya University for Islamic Sciences, Alzaytonah university and Al Mergeb University)

Fourth-year English department students at three universities in Libya (no age) (no sex)

To investigate EFL the fourth-year students’ level of speaking anxiety. Also, the study investigates the main three factors (communication apprehension, fear of negative evaluation and low self-confidence) that contribute to increasing speaking anxiety among EFL learners

Cross-sectional

Questionnaires

300

Foreign Language Speaking Anxiety Scale (FLSAS)

Total: (84.33%) degrees:(48%) moderate, (36.33%) high level of anxiety

The findings of this study revealed that students experienced a moderate to high level of EFL speaking anxiety, also that the low self-confidence factor received the highest average followed by fear of negative evaluation, and communication apprehension factors

33

Misrata Libya (2013)

Internally displaced people in Misrata

Age (15–70) Sex (both)

To study the prevalence of PTSD in internally displaced person in Misrata City and its correlation with age, sex and address before displacement

Cross-sectional

Questionnaires

118

PTSD Checklist (PCL)

(66%)

The study indicated that female is more prevalent to PTSD, however in severe cases it was more prevalent in males