Recurrent violence in post-conflict communities linked to increased mental disorders

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1. A seven-fold increase in post-traumatic stress disorder (PTSD) and a three-fold increase in severe stress were found at follow-up as compared to baseline following a period of internal conflict. 

2. PTSD was linked to cumulative human rights trauma and ongoing family and community tensions, whereas poverty was associated with severe distress including symptoms of depression. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Communities experiencing recurrence of internal conflict after initial mass conflict could have upsurge in post-traumatic stress syndrome (PTSD) and stress disorder. These substantial increases in rates of mental disorders were highly associated with poverty, ongoing community tensions, and persisting feelings of injustice. These findings call for more appropriately tailored clinical services for people with severe, persisting psychological reactions in post-conflict settings.

This study’s strengths included a large sample size as well as high participant response and retention rates. It is limited in that the sample only included participants from two country locations. Its longitudinal design demonstrates the significance of social stabilization in prevention and recovery from the consequences of conflict. The incorporation of high-quality epidemiological methods relevant to social conditions, personally meaningful experience, and local historical context contribute to the advancement in studies of mental health in conflict-affected populations.

Click to read the study in The Lancet

Relevant Reading: Common mental disorders in postconflict settings

In-Depth [longitudinal study]: This study assessed changes in mental health symptoms of participants in Timor-Leste over a 6-year period after intervals of conflict. 1022 participants were evaluated for baseline data on PTSD and severe stress in 2004 and again in 2010. Researchers used the Harvard Trauma Questionnaire for assessment of 16 symptoms for PTSD and the Kessler-10 questionnaire for measurement of depression and anxiety. Data examining whether poverty, persisting feelings of injustice, and ongoing community conflict contributed to mental illness were also analyzed. The prevalence of severe distress increased, from 57 of 1022 (5.6%) in 2004, to 162 of 1022 (15.9) in 2010. The prevalence of PTSD also increased from 23 of 1022 (2.3%) in 2004, to 171 of 1022 (16.7%) in 2010. Having PTSD at follow up was associated with experience of human rights trauma, being a woman, ongoing family or community conflict, as well as preoccupations with injustice for two or three historical periods.

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