War experiences, daily stressors and mental health five years on

Abstract

In this paper, the authors elaborate on a model proposed in 2010 that identi¢es major sources of stress a¡ecting mental health among war a¡ected populations. That model emphasised the importance of what was termed ' daily stressors' , as well as direct exposure to war related violence as predictors of mental health status The authors ¢rst summarise the original model and discuss the widespread response to the 2010 paper among researchers and practitioners working in con£ict and post con£ict settings. Then, the authors expand on the model, suggesting that, like the trauma focused model it was meant to improve upon, the proposed 2010 model still presents an overly static view of the experience of living through organised violence. A transactional version of the model is now proposed, which the authors believe more closely approximates the lived experience of war and the multiple sources of stress it entails. Implications of this transactional model, and possible directions for future research and practice, are suggested.

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

“…That there were clusters of multiple types of nodes that appeared to reinforce each other is consistent with the theoretical loss spirals in COR theory (Hobfoll, 2001). That social problems were so central to the network supports the psychosocial emphasis on daily stressors being mediators of the effects of trauma on mental health (Miller & Rasmussen, 2010; 2014; 2017). Whether this is because traumatic events set off chains of stressors or because those exposed to trauma are more likely to rate problems as more stressful and perhaps even generate problems (Neuner, 2010) is subject to some debate, and not likely solved here.…”

“…COR theory has substantial support in war-affected populations, including Sri Lanka (e.g., Mattock, 2005; Siriwardhana et al, 2013, Somasundaram & Sivayokan, 2013; Witting, Lambert, Wickrama, Thanigaseelan, & Merten, 2016). Other similar theories with empirical support include the daily stressors model, in which the effects of war-related trauma on psychological distress are mediated and moderated by frequent stressors and stressful conditions (Miller & Rasmussen, 2010; 2014; 2017). It is not our intention in the current study to somehow propose new theory via network science, only to present findings using alternative methods.…”

Civilians in World War II and DSM-IV mental disorders: results from the World Mental Health Survey Initiative

“…Experiences common to civilians in a war zone/region of terror that have been found to be associated with adverse mental health outcomes in previous studies include chronic fear of safety, deprivation of food and other basic needs [50-51], and disruption in family structures [52]. Exposure to the daily stressors associated with war may also have had a cumulative impact on mental health equal to or more important than the effects of major traumatic events [39]. The PTSD section of the CIDI interview asked about only a limited number of more specific war-related traumas.…”

“…This makes it difficult to differentiate between the risks to mental health due to the more general deprivations associated with living in a country during wartime and due to traumatic events associated directly with the conflict, such as living through battles and witnessing atrocities. Differentiating effects on mental disorders of living in a country at war and experiencing war-related traumatic events is important to identify the blend of trauma-focused and psychosocial approaches to mental health services likely to be most effective in assisting war-affected populations [38-39]. The current report presents the results of an analysis that attempted to do this by analyzing cross-sectional retrospectively reported data collected as part of the WHO World Mental Health (WMH) Surveys [40] on the long-term associations of having been a civilian in a country involved in World War II and having experienced war-related traumas with subsequent first onset and persistence of mental disorders.…”

“We would never forget who we are”: resettlement, cultural negotiation, and family relationships among Somali Bantu refugees

“…This is a major shortcoming given the role family functioning among refugees can play in both promoting resilience and contributing to adverse outcomes of youth [56, 57]. And while addressing the mental health impact of exposure to discrete traumatic events experienced by refugees is extremely important, there is also a need to provide services that have a broader focus [58]. Addressing the mental health needs of refugee youth will require practitioners to have awareness of family-level dynamics and the impact of interactions with other systems on the wellbeing of children and adolescents.…”