Post-conflict struggles as networks of problems: A network analysis of trauma, daily stressors and psychological distress among Sri Lankan war survivors

Abstract

A growing body of literature indicates that the mental distress experienced by survivors of war is a function of both experienced trauma and stressful life events. However, the majority of these studies are limited in that they 1) employ models of psychological distress that emphasize underlying latent constructs and do not allow researchers to examine the unique associations between particular symptoms and various stressors; and 2) use one or more measures that were not developed for that particular context and thus may exclude key traumas, stressful life events and symptoms of psychopathology. The current study addresses both these limitations by 1) using a novel conceptual model, network analysis, which assumes that symptoms covary with each other not because they stem from a latent construct, but rather because they represent meaningful relationships between the symptoms; and 2) employing a locally developed measure of experienced trauma, stressful life problems and symptoms of psychopathology. Over the course of 2009 to 2011, 337 survivors of the Sri Lankan civil war were administered the Penn-RESIST-Peradeniya War Problems Questionnaire (PRPWPQ). Network analysis revealed that symptoms of psychopathology, problems pertaining to lack of basic needs, and social problems were central to the network relative to experienced trauma and other types of problems. After controlling for shared associations, social problems in particular were the most central, significantly more so than traumatic events and family problems. Several particular traumatic events, stressful life events and symptoms of psychopathology that were central to the network were also identified. Discussion emphasizes the utility of such network models to researchers and practitioners determining how to spend limited resources in the most impactful way possible.

Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees

“…In line with a large body of evidence, both within the Syrian refugee setting (Alfadhli & Drury, 2018;Panter-Brick et al, 2018;Sim, Bowes, & Gardner, 2019;Sim, Fazel, Bowes, & Gardner, 2018;Wells et al, 2018, Wells, Steel, Abo-Hilal, Hassan, & Lawsin, 2016aWells et al, 2016b) and other refugee contexts (Barber et al, 2014;Eggerman & Panter-Brick, 2010;Jayawickreme et al, 2017;Li et al, 2016;Miller & Rasmussen, 2010;Ryan et al, 2008), our findings highlight that Syrians perceive economic, institutional and psychosocial stressors related to ongoing displacement as the main sources of emotional distress. The interaction of these stressors creates a build-up of "pressure ‫,"ضغط‬ resulting in mental health difficulties.…”

“…These structural conditions in displacement settings contribute to heightened social and mental health problems (Jayawickreme et al, 2017;Killikelly, Bauer, & Maercker, 2018;Li, Liddell, & Nickerson, 2016;Miller & Rasmussen, 2010;Ryan, Dooley, & Benson, 2008;Silove, 2011). In Lebanon, the vast majority of information regarding the mental health of Syrian refugees come from epidemiological studies which report a high prevalence of mental health disorders (Karam et al, 2014;Kazour et al, 2017;Naja, Aoun, El Khoury, Abdallah, & Haddad, 2016;Souaiby, Kazour, Zoghbi & Richa, 2016).…”

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

“…Again, after a year from a traumatic injury, “re-experiencing” persisted as a core symptom [31], whereas “emotional cue reactivity” is the most important node in a sample of refugees [33]. Lastly, Jayawickreme et al [37] found that war social problems were more important than the traumatic event in a sample of war survivors.…”

“…Findings also illustrate potential pathways between traumatic events and symptoms [37]. However, the heterogeneity of the results may be due to differences in the type of traumatic experiences or in the size and type of samples included in the studies, making it difficult to integrate the results and imposing caution on the generalizability of the results.…”

Internalizing Symptoms and Social Support Among Kenyan Adolescents: A Network Analysis

“…Importantly, this interacting group of symptoms is what constitutes depression. This has made network analysis an especially appealing tool for studies aiming to understand comorbidity (e.g., INTERNALIZING SYMPTOMS AND SOCIAL SUPPORT NETWORK Heeren, Jones, & McNally, 2018) and protective factors for specific symptoms (e.g., Jayawickreme et al, 2017).…”