Abstract
Adults who experienced the 1992 and 2008 armed conflicts in the Republic of Georgia were exposed to multiple traumatic events and stressors over many years. The aim was to investigate what coping strategies are used by conflict-affected persons in Georgia and their association with mental disorders. A cross-sectional survey was conducted with 3600 adults, representing internally displaced persons (IDPs) from conflicts in the 1990s (n = 1200) and 2008 (n = 1200) and former IDPs who returned to their homes after the 2008 conflict (n = 1200). Post-traumatic stress disorder, depression, anxiety and coping strategies were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety and adapted version of the Brief Coping Inventory, respectively. Descriptive and multivariate regression analyses were used. Coping strategies such as use of humour, emotional support, active coping, acceptance and religion were significantly associated with better mental health outcomes. Coping strategies of behavioural and mental disengagement, denial, venting emotions, substance abuse and gambling were significantly associated with poorer mental health outcomes. The reported use of coping strategies varied significantly between men and women for 8 of the 15 strategies addressed. Many conflict-affected persons in Georgia are still suffering mental health problems years after the conflicts. A number of specific coping strategies appear to be associated with better mental health and should be encouraged and supported where possible.
Highlights
Populations affected by armed conflict are frequently exposed to traumatic events and daily stressors and are at a greater risk of elevated levels of mental health disorders (Miller & Rasmussen, 2009; Steel et al 2009)
More men than women were exposed to multiple traumatic events and reported higher levels of direct exposure to combat and lack of shelter ( p < 0.001)
Disengaging from the trauma has largely been shown to impede recovery (Aldwin & Revenson, 1987; Carver et al 1989). Given this and the requirement for avoidance to be present for a diagnosis of post-traumatic stress disorder (PTSD), it is no surprise that trauma focused psychological treatments have been found to be superior in efficacy to non-trauma focused ones (Bisson et al 2013) and are recommended as the first line treatment for PTSD by the National Institute for Health and Care and Excellence (National Collaborating Centre for Mental Health, 2005) and the World Health Organisation (Tol et al 2013)
Summary
Populations affected by armed conflict are frequently exposed to traumatic events and daily stressors and are at a greater risk of elevated levels of mental health disorders (Miller & Rasmussen, 2009; Steel et al 2009). A substantial body of research has examined riskfactors for poor mental health among conflict-affected civilian populations (Porter & Haslam, 2005; Steel et al 2009), but fewer studies have examined protective factors. Research on protective factors, including coping, has been identified as a priority research area for mental health and psychosocial support among conflict-affected populations (Tol et al 2011). Most current coping measures build upon the problem- and emotion-focused domains are suggested by Folkman & Lazarus (1980). Problem-focused modes are used when a person appraises a troubling situation as surmountable through action. Problem-focused coping entails an ‘attempt to solve, reconceptualise, or minimise the effects of a stressful situation,’ while emotion-focused coping includes ‘self-preoccupation, fantasy, or other conscious activities related to affect regulation’ (Parker & Endler, 1996)
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