Interpersonal Sensitivity as Mediator of the Relations Between War Experiences and Mental Illness in War-Affected Youth in Northern Uganda: Findings From the WAYS Study.

Kennedy Amone-P'Olak,Ask Elklit

doi:10.1037/trm0000145

Abstract

The pathways from war experiences to mental health problems are poorly understood. The current study aims to assess the role of interpersonal sensitivity in the relations between war experiences and mental health problems based on data from the War-Affected Youth Survey cohort study. The War-Affected Youth Survey is an ongoing research project of formerly abducted children in Northern Uganda assessing their war experiences and the risk and protective factors in the development of mental health problems. Mediation of the relations between war experiences and mental health problems by interpersonal sensitivity was analyzed using structural equation modeling. War experiences were related to posttraumatic stress disorder through interpersonal sensitivity accounting for 55% of the variance in their relations, to depression/anxiety through interpersonal sensitivity accounting for 89% of the variance in their relations (i.e., near complete mediation), and to psychotic symptoms through interpersonal sensitivity accounting for 53% of the variance in their relations. The direct relation between war experiences, on the one hand, and posttraumatic stress disorder and psychotic symptoms, on the other hand, attenuated but remained statistically significant. For depression/anxiety, the direct relationship ceased to be significant after including interpersonal sensitivity in the model. Interpersonal sensitivity is an important determinant of long-term mental health problems in war-affected youth. Interventions to improve mental health should target youth with high scores on interpersonal sensitivity. Cognitive–behavioral therapy to recognize and change cognitive schemas in youth prone to interpersonal sensitivity is recommended.

Highlights

Numerous studies have consistently reported a high prevalence of mental health problems in the aftermath of war (Karam & Ghosn, 2003; Machel, 2001; Priebe et al, 2010; Steel et al, 2009)
All variables measured in the mediation model were significantly correlated with each other (Table 1)
The findings of the current study demonstrate evidence for a possible mechanism with a potential to illuminate the path from war experiences to mental illness, suggesting that war experiences may lead to interpersonal sensitivity, which, in turn, may be linked to mental health problems

Summary

Introduction

Numerous studies have consistently reported a high prevalence of mental health problems in the aftermath of war (Karam & Ghosn, 2003; Machel, 2001; Priebe et al, 2010; Steel et al, 2009). A number of factors have been proposed to explain the variations in postwar mental health outcomes and adaptation. These factors include the type of war events experienced (AmoneP’Olak, Ovuga, Croudace, Jones, & Abbott, 2014; Johnson & Thompson, 2008; Kohrt et al, 2008) and coping styles (AmoneP’Olak, Garnefski, & Kraaij, 2007). Besides the type of war experiences, postwar environmental stressors have been linked to adverse social consequences such as poor emotional regulation (Amone-P’Olak et al, 2007), impaired ability to relate to others in the community, diminished trust, and interpersonal sensitivity (Amone-P’Olak, 2008; Cloitre, StovallMcClough, Zorbas, & Charuvastra, 2008). Exploration of the causal pathways through which war experiences impact on survivor’s mental health can inform strategies to mitigate adverse outcomes from a public health point of view

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