Trauma in the Kashmir Valley and the mediating effect of stressors of daily life on symptoms of posttraumatic stress disorder, depression and anxiety

Tambri Housen,Showkat Shah,Alice Richardson,Annick Lenglet,Giovanni Pintaldi,Shabnum Ara,Helal Sha

doi:10.1186/s13031-019-0245-6

Abstract

BackgroundThe negative psychological impact of living in a setting of protracted conflict has been well studied, however there is a recognized need to understand the role that non-conflict related factors have on mediating exposure to trauma and signs of psychological distress.MethodsWe used data from the 2015 Kashmir Mental Health Survey and conducted mediation analysis to assess the extent to which daily stressors mediated the effect of traumatic experiences on poor mental health outcomes. Outcomes of interest were probable diagnosis of anxiety, depression, or PTSD; measured using the pre-validated Hopkins Symptoms Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ).ResultsTotal effect mediated were statistically significant but the proportions of effect mediated were found to be small in practical terms. Financial stress mediated 6.8% [95% Confidence Interval (CI) 6∙0–8∙4], 6.7% [CI 6.2–7∙7] and 3.6% [CI 3∙4–4∙0] of the effect of experiencing multiple traumaticogenic events on symptoms of anxiety, depression and PTSD, respectively. Family stress mediated 11.3% [CI 10.3–13.8], 10.3% [CI 9.5–11.9] and 6.1% [CI 5.7–6.7] of the effect of experiencing multiple traumatogenic events on symptoms of anxiety, depression and PTSD, respectively. Poor physical health mediated 10.0% [CI 9.1–12∙0], 7.2% [CI 6.6–8.2] and 4.0% [CI 3.8,4.4] of the effect of experiencing more than seven traumatic events on symptoms of anxiety, depression and PTSD, respectively.ConclusionOur findings highlight that not only do we need to move beyond a trauma-focussed approach to addressing psychological distress in populations affected by protracted conflict but we must also move beyond focussing on daily stressors as explanatory mediators.

Highlights

The negative psychological impact of living in a setting of protracted conflict has been well studied, there is a recognized need to understand the role that non-conflict related factors have on mediating exposure to trauma and signs of psychological distress
Drawing on Kubiak (2005) [7] they argued that the chronicity of daily stressors has the potential to deplete coping mechanisms, directly affecting the capacity to cope with traumatogenic events, and increasing the likelihood of these events leading to symptoms of mental distress
This study explored whether daily stressors mediated the association between exposure to traumatogenic events and mental health in a setting of protracted political conflict

Summary

Introduction

The negative psychological impact of living in a setting of protracted conflict has been well studied, there is a recognized need to understand the role that non-conflict related factors have on mediating exposure to trauma and signs of psychological distress. There has been a move away from a trauma-focussed view of psychological well-being in populations affected by political conflict and towards a more holistic psychosocial understanding of risk factors for adverse mental health outcomes [1,2,3,4,5]. UNCHR estimate 1000 people were detained under the Armed Forces Special Powers Act (AFSPA, 1990) and the Jammu and Kashmir Public Safety Act (PSA, 1978) between March 2016 and August 2017, including minors [13]. These Acts, unique to the state of Jammu and Kashmir, create structures that promote impunity and injustice. In Kashmir other confounders include widespread poverty, uncertainty, grief, oppression and fear in addition to high unemployment with limited development of employment generating sectors [18]

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