Abstract
BackgroundLarge disasters affect people who live both near and far from the areas in which they occur. The mental health impact is expected to be similar to a ripple effect, where the risk of mental health consequences generally decreases with increasing distance from the disaster center. However, we have not been able to identify studies of the ripple effect of man-made disaster on mental health in low-income countries.ObjectivesThe objective was to examine the hypothesis of a ripple effect on the mental health consequences in populations exposed to man-made disasters in a developing country context, through a comparison of two different populations living in different proximities from the center of disaster in Mollucas.MethodsCross-sectional longitudinal data were collected from 510 Internally Displaced Persons (IDPs) living in Ambon, who were directly exposed to the violence, and non-IDPs living in remote villages in Mollucas, Indonesia, who had never been directly exposed to violence in Mollucas. Data were collected during home visits and statistical comparisons were conducted by using chi square tests, t-test and logistic regression.ResultsThere was significantly more psychological distress "caseness" in IDPs than non-IDPs. The mental health consequences of the violent conflict in Ambon supported the ripple effect hypothesis as displacement status appears to be a strong risk factor for distress, both as a main effect and interaction effect. Significantly higher percentages of IDPs experienced traumatic events than non-IDPs in all six event types reported.ConclusionsThis study indicates that the conflict had an impact on mental health and economic conditions far beyond the area where the actual violent events took place, in a diminishing pattern in line with the hypothesis of a ripple effect.
Highlights
Large disasters affect people who live both near and far from the areas in which they occur
Cross-sectional longitudinal data were collected from 510 Internally Displaced Persons (IDPs) living in Ambon, who were directly exposed to the violence, and non-IDPs living in remote villages in Mollucas, Indonesia, who had never been directly exposed to violence in Mollucas
This study indicates that the conflict had an impact on mental health and economic conditions far beyond the area where the actual violent events took place, in a diminishing pattern in line with the hypothesis of a ripple effect
Summary
Large disasters affect people who live both near and far from the areas in which they occur. We have not been able to identify studies of the ripple effect of man-made disaster on mental health in low-income countries. A number of factors have been identified as having an impact on the mental health of populations affected by disasters [1,2,3]. The geographical distance from the centre of the disaster is one of the factors that is likely to influence such an impact. This has been described as the ripple effect of a disaster, and posits that mental health problems spread outward from the center of disaster in a diminishing ripple pattern [4,5,6]. A meta-analysis of mental health of displaced persons indicated that internally displaced persons and those who fled due to unresolved conflict were most affected and had the worst mental health outcomes compared to the refugees lived in developed countries [14]
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