War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks
Section snippets
Looking beyond the direct effects model
Recent interest in examining the ways in which war exposure and daily stressors might both contribute to mental health status has its roots in three sets of research findings: (1) the consistently large amount of unexplained variance in mental health outcomes when war exposure is used as the sole predictor of psychological distress (i.e., concern over the limited explanatory power of the direct effects model); (2) research with refugees in developed nations showing that that post-migration or
Why are daily stressors so stressful?
Having established the important contribution that daily stressors make to mental health and psychosocial functioning in conflict and post-conflict settings, it may be fruitful ask why daily stressors are so impactful. We suggest four reasons. First, daily stressors represent proximal or immediate stressors, whereas war exposure is often more of a distal experience, particular in post-conflict settings or situations of low intensity warfare where violence is episodic rather than constant.
Are daily stressors really daily? Unpacking the construct
In seeking to broaden the focus of research beyond the effects of direct war exposure, we suggested that research on major life events and daily hassles might offer a useful framework. On closer inspection, however, there are some reasonable objections that might be raised to this parallel. First, daily hassles are generally conceptualized as just that: hassles that occur on a daily basis. However, some of the phenomena we have considered in the category of daily stressors do not necessarily
Implications for intervention: a sequenced, integrated model
The findings from the literature we have reviewed in this paper suggest the potential utility of an integrated approach to intervention that addresses, in a sequential manner, both daily stressors (low intensity and potentially traumatic) and war exposure. They also suggest the utility of an empirically-informed set of guidelines for the allocation of mental health resources and the development of interventions aimed at improving mental health and psychosocial wellbeing in conflict and
Conclusion
In this paper, we have sought to bridge the longstanding and unhelpful division between advocates of trauma-focused and psychosocial approaches to understanding and addressing mental health needs in conflict and post-conflict settings. We have suggested that among the various factors underlying this split in the field is a fundamental difference in perception regarding what factors most critically affect mental health in the wake of organized violence. Until recently, there was a paucity of
References (87)
- et al.
Psychological responses to war and atrocity: the limitations of current concepts
Social Science & Medicine
(1995) A broader view of trauma: a biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and growth
Clinical Psychology Review
(2004)The effects of torture and political repression in a sample of Chilean families
Social Science & Medicine Special Issue: Political violence and health in the Third World
(1989)- et al.
The impact of war on the physical and mental health of the family: the Lebanese experience
Social Science & Medicine
(1993) Children in political violence
Social Science & Medicine
(1989)- et al.
Holmes-Rahe life changes scale
Journal of Psychosomatic Research
(1967) - et al.
A three-year follow-up of Cambodian young people traumatized as children
The American Academy of Child and Adolescent Psychiatry
(1989) - et al.
The psychiatric effects of massive trauma on Cambodian children: I. The children
Journal of the American Academy of Child and Adolescent Psychiatry
(1986) Long-term effects of organized violence on young Middle Eastern refugees' mental health
Social Science & Medicine
(2008)- et al.
Major depressive and post-traumatic stress disorder comorbidity in female victims of intimate partner violence
Journal of Affective Disorders
(2001)
Post-traumatic stress disorder: a reaction to state-supported child abuse and neglect
Child Abuse and Neglect
A critique of seven assumptions behind psychological trauma programmes in war-affected countries
Social Science & Medicine
Post-traumatic stress disorder reactions in children of war: a longitudinal study
Child Abuse and Neglect
Psychological symptomatology among Palestinian children living with political violence
Child and Adolescent Mental Health
Children traumatized by Central American Warfare
The psychosocial aspects of children exposed to war: practice and policy initiatives
Journal of Child Psychology and Psychiatry
Behavioral and cognitive treatments of survivors of torture
Building an evidence base on mental health interventions for children affected by armed conflict
Intervention
Mental health interventions for refugee children in resettlement: white paper II
Mental health in postwar Afghanistan
Journal of the American Medical Association
An alternative approach to cross-cultural function assessment
Social Psychiatry and Psychiatric Epidemiology
Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events?
American Psychologist
A world turned upside down
Cultures of trauma: anthropological views of posttraumatic stress disorder in international health
Culture, Medicine, and Psychiatry
Internally displaced Colombians: the recovery of victims of violence within a psychosocial framework
Beyond individual war trauma: domestic violence against children in Afghanistan and Sri Lanka
Journal of Marital and Family Therapy
The health and social impact of ash wednesday bushfires: Survey of the 12 months following the bushfires of February 1983
Understanding the psychological consequences of adversity
Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination
Journal of Consulting and Clinical Psychology
An anthropology of structural violence
Current Anthropology
Treating the trauma of rape
The Sierra Leonean refugee experience: traumatic events and psychiatric sequelae
Journal of Nervous and Mental Disease
The human ecology of early risk
Psychological sequelae of torture and organized violence suffered by refugees from Iraq: trauma-related factors compared with social factors in exile
British Journal of Psychiatry
The neurobiology of stress and development
Annual Review of Psychology
Sierra Leonean refugees in Guinea: addressing the mental health effects of massive community violence
IASC guidelines on mental health and psychosocial support in emergency settings
Somali and Oromos refugees: correlates of torture and trauma history
American Journal of Public Health
Daily hassles mediate the relationship between major life events and psychiatric symptomatology: longitudinal findings from an adolescent sample
Journal of Clinical and Consulting Psychology
Public mental health, traumatic stress and human rights violations in low-income countries
Public mental health and culture: disasters as a challenge to western mental health care models, the self, and PTSD
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