Mental health literacy among populations in and from war and armed conflict zones: a narrative review

Background: Mental health literacy (MHL) plays a key role in promoting mental health outcomes and help-seeking behaviors, making it a critical component of public mental health strategies. While MHL has been widely studied in general populations, little is known about the concept among individuals living in war and conflict zones and refugees displaced from these settings, despite their high burden of mental health challenges. This narrative review aims to collect, synthesize, and summarize the available literature on MHL among individuals residing in ongoing war or armed conflict zones and refugees originating from these regions. Methods: Following PRISMA guidelines, we conducted a systematic search of Medline, PsycINFO, CINAHL, and Web of Science for studies published between January 1997 and December 2024. We included studies that examined MHL using an established framework, yielding a final sample of 35 studies. Data were extracted and synthesized thematically using a narrative approach, focusing on five core areas: study characteristics, population characteristics, measures and frameworks, MHL levels and correlates, and discussions of war and conflict contexts. Findings were analyzed separately for populations residing in conflict zones and for refugees or immigrants from those zones. Results: Twenty-six studies focused on populations residing in conflict zones and nine on refugees or immigrants from such areas. Most studies employed quantitative cross-sectional designs and used standard MHL tools. Findings indicated moderate-to-high MHL levels among populations in conflict zones and low-to-moderate levels among refugee groups. Common correlates of higher MHL included younger age, female gender, higher educational attainment, and prior use of mental health services. However, most studies did not integrate war-related experiences into their analytical frameworks. Conclusions: This review highlights a critical gap in the literature: although conflict-affected populations face unique mental health challenges, existing studies often assess MHL using frameworks developed in the global north and non-conflict settings and without incorporating the context of war or displacement. There is an urgent need to reconceptualize MHL frameworks and tools to reflect the lived experiences, needs, and sociopolitical realities of individuals in crisis settings. Context-sensitive approaches are essential for informing relevant interventions and improving mental health outcomes in these vulnerable populations.