Common mental disorders in postconflict settings

doi:10.1016/S0140-6736(03)13692-6

The Lancet

Volume 361, Issue 9375, 21 June 2003, Pages 2128-2130

https://doi.org/10.1016/S0140-6736(03)13692-6 Get rights and content

Summary

Research into postconflict psychiatric sequelae in low-income countries has been focused largely on symptoms rather than on full psychiatric diagnostic assessment. We assessed 3048 respondents from postconflict communities in Algeria, Cambodia, Ethiopia, and Palestine with the aim of establishing the prevalence of mood disorder, somatoform disorder, post-traumatic stress disorder (PTSD), and other anxiety disorders. PTSD and other anxiety disorders were the most frequent problems. In three countries, PTSD was the most likely disorder in individuals exposed to violence associated with armed conflict, but such violence was a common risk factor for various disorders and comorbidity combinations in different settings. In three countries, anxiety disorder was reported most in people who had not been exposed to such violence. Experience of violence associated with armed conflict was associated with higher rates of disorder that ranged from a risk ratio of 2·10 (95% CI 1·38–2·85) for anxiety in Algeria to 10·03 (5·26–16·65) for PTSD in Palestine. Postconflict mental health programmes should address a range of common disorders beyond PTSD.

References (5)

M Van Ommeren et al.
Psychiatric disorders among tortured Bhutanese refugees in Nepal
Arch Gen Psychiatry
(2001)
de JongJTVM et al.
Lifetime events and posttraumatic stress disorder in 4 post-conflict settings
JAMA
(2001)

There are more references available in the full text version of this article.

Cited by (312)

Weathering within war: Somatic health complaints among Vietnamese older adults exposed to bombing and violence as adolescents in the American war
2023, Journal of Psychosomatic Research
People living in war may experience deteriorating health via weathering (wear and tear) from long-term exposures to psychosocial and environmental stressors. Weathering embodied in somatic health complaints may illuminate the effects of war on health.
We investigate whether wartime stress exposures occurring during adolescence and early adulthood affect weathering in late adulthood via linear regression with data from the Vietnamese Health and Aging Study (VHAS). VHAS is a cross-sectional study wherein investigators surveyed 2447 adults aged 60+ in four districts of northern and central Vietnam in 2018. These same individuals ranged in age from seven to 52 in 1965, with most having been in adolescence or early adulthood at the peak of the American war in Vietnam (1965–1975). The sample used for this study (n = 2254) were participants in the first VHAS wave in 2018.
We find older Vietnamese adults exposed to higher-intensity provincial bombing suffer more numerous somatic health complaints (unstandardized β = 0.005, SE = 0.001, p = 0.001). Additionally, greater health complaints emerge among older adults whose most intense bombing exposures were at younger ages of adolescence (< age 15) as compared to those whose peak exposures were in older ages (19–25) (unstandardized β = 0.62 95%, SE = 0.19, p = 0.01).
Our findings suggest that age of exposure to armed conflict is a critical determinant of weathering across the life course.
Pathways from parent mental health to child outcomes in Liberia: Testing cross-sectional and longitudinal serial mediation models
2022, SSM - Mental Health
Children in humanitarian settings face complex adversities that impact development. The interplay of caregiver mental health, couples' relationship quality, and parenting practices can both protect against adversity and contribute to it. The purpose of the study was to examine whether caregiver depressive symptoms are associated with increased couples' distress, in turn predicting fewer positive parent-child interactions and then worse child emotional and behavioral outcomes. This study took place in four urban settlements in Monrovia, Liberia. Participants (N = 569) included parents or caregivers of children three- or four-years-old. Using structural equation modeling, the serial mediation pathway from depressive symptoms to child outcomes through couples' distress and reduced positive parent-child interactions was tested cross-sectionally and longitudinally across three time points. In the cross-sectional model, two statistically significant, but very small, indirect effects were found: 1) a serial mediation from parent depressive symptoms to child problems through increased couples' distress and reduced positive parent-child interactions and 2) a specific mediation effect through couples’ distress. The longitudinal model yielded null direct and indirect effects. These mixed results suggest that, while these processes may be related, the specific pathways linking these family indicators are not well understood, especially over time and in humanitarian settings.
The experience of people with psychosocial disabilities of living independently and being included in the community in war-affected settings: A review of the literature
2022, International Journal of Law and Psychiatry
This article explores the experience of people with psychosocial disabilities with independent living and community inclusion in war-affected settings. While the UN CRPD obliges states to protect the rights of persons with psychosocial disabilities to community living (Article 19) in contexts of war (Article 11), information is lacking about people's lived experience. We reviewed studies published between 1980 and 2020, exploring concepts central to the CRPD's Article 19. Sixteen articles met the inclusion criteria. Findings indicate that support for persons with psychosocial disabilities is lacking while also being insufficiently described; little information is available about types of mental health and psychosocial support services; and data are almost absent about access to community services available for the general population. To ensure independent living and community integration in contexts of war, we emphasize the need for comprehensive and intersectional approaches that are locally relevant, participatory, and based on human rights.
Patterns of conflict-related trauma exposure and their relation to psychopathology: A person-centered analysis in a population-based sample from eastern DRC
2021, SSM - Mental Health
Populations in war-torn regions are exposed to a wide array of traumatic events that can cause an enormous psychological burden. Individual characteristics influence the likelihood of being exposed to certain events, pointing to systematic interindividual differences in trauma exposure. However, there is a dearth of studies examining potential patterns of trauma exposure in war regions. In this cross-sectional epidemiological study, we applied a person-centered approach to identify patterns in the exposure to conflict-related traumatic events and determine their impact on commonly reported mental health problems in a population-based sample (N = 1000) from the eastern Democratic Republic of Congo. We implemented multi-stage random cluster sampling to randomly select adults from 100 villages. Of 1000 adults (M_age = 43.19 years) included in the study, 50% were female. Results showed high prevalence of PTSD (17.0%), depression (27.8%), anxiety (25.4%) and suicidality (15.1%) following exposure to conflict-related traumatic events since 2002. Latent Class Analysis identified three distinct classes of trauma exposure: Class 1 “low-trauma-exposure” (51.4%, n = 514) was characterized by the lowest probabilities of trauma exposure. Class 2 “non-physical-trauma” (39.1%, n = 391) consisted of individuals with a high probability for exposure to non-physical trauma types only. Class 3 “interpersonal-trauma” (9.5%, n = 95) had the overall highest probability of exposure to traumatic events and was the only class affected by interpersonal-trauma types. Class membership was related to gender, age and place of living. Vulnerability to mental health problems increased from low-trauma-exposure to non-physical-trauma to interpersonal-trauma class. Our findings indicate that the exposure to traumatic events in conflict-affected populations underlies distinct patterns, with interpersonal trauma as a distinguishing marker. Vulnerability to psychopathology varies with trauma patterns, revealing patterns that include both non-physical and interpersonal traumata as most detrimental for mental health. Identification of underlying trauma patterns and their effects may improve mental health care in war-affected populations.
Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka
2023, BJPsych Open
Traumatised Witnesses in International Criminal Trials: Testimony, Fair Proceedings, and Accurate Fact-Finding
2024, Traumatised Witnesses in International Criminal Trials: Testimony, Fair Proceedings, and Accurate Fact-Finding

View all citing articles on Scopus

View full text

Research LettersCommon mental disorders in postconflict settings

Summary

Psychiatric disorders among tortured Bhutanese refugees in Nepal

Arch Gen Psychiatry

Lifetime events and posttraumatic stress disorder in 4 post-conflict settings

JAMA

Research Letters
Common mental disorders in postconflict settings