Conflict-related Trauma Research Articles

Addressing psychosocial trauma in post-conflict peacebuilding: Emotions in narrative and arts-based approaches

Drawing on contemporary research on the nature and treatment of trauma in psychology, neuroscience and the emerging field of art therapy, this article adopts a psychosocial approach to examine the role that the arts may play in assisting individuals and societies to recover from the trauma of violent conflict and contribute to the establishment of sustainable peace. Taking a broad understanding of the arts to include a range of creative endeavours, it primarily focuses on non-verbal art forms, including but not restricted to music, painting, sculpture, drawing and dance, as well as traditional arts and crafts. It demonstrates that many art forms have the potential to make specific contributions to the amelioration of conflict-related trauma by addressing pervasive non-verbal memories that typically stand outside the remit of more conventional psychosocial practices, such as truth-telling and storytelling. They do so, it argues, by providing a means of expressing, evoking, regulating and transforming the emotions in ways that allow individuals and societies to confront and acknowledge their violent pasts, develop supportive relationships in the present and draw on their creativity to imagine a better future.

Class, Identity, Integration, and the Two-Tiered Peace Process

Abstract This article critically examines the extent to which increases in socio-economic equality between Protestants and Catholics over the post-Agreement period has corresponded to a gradual de-centering of ethnopolitical identity in social relations and political processes. I argue that, while there has been an increase in social integration and moderate growth in the political middle ground, such trends are not experienced equally across class contexts. On an everyday basis, ethnopolitical identity is most strongly felt in relatively deprived and religiously segregated communities who have experiencing very little by the way of peace dividends and suffering disproportionately and intergenerationally from conflict-related trauma and an ongoing sense of sectarian threat.

Rethinking mental healthcare for refugees

After several years of downturn in new resettlement, the United States is projected to admit 125,000 refugees in the current fiscal year. Refugee communities have known risks of developing mental health problems due to high rates of exposure to war and conflict-related trauma and chronic stressors associated with displacement and resettlement. In this commentary, we examine limitations in the current system of mental health care available to newly arriving refugee communities and make recommendations for expanding and redesigning services to better meet the needs of culturally diverse refugee communities. This includes drawing on public health and prevention frameworks to implement a continuum of services including basic services and security, trauma-informed prevention services to meet the needs of individuals, families and communities and specialized clinical care for those that need it. Across all services, we recommend robust engagement and partnership with refugee community leaders to design and deliver programs.

Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers

The prevalence of post-traumatic stress disorder (PTSD) in individuals affected by war and conflict is high, with approximately 1 in 3 refugees and asylum-seekers meeting diagnostic criteria for PTSD. PTSD in refugees and asylum-seekers is associated with significant emotion dysregulation which may arise from chronic trauma exposure and post-migration stressors and lead to impaired day-to-day functioning. There is evidence that treatments that target emotion regulation skills prior to implementing exposure-based therapies lead to improved treatment response and reduced attrition in survivors of interpersonal traumas such as sexual abuse. The current case study details the use of a novel adaptation of one such treatment – Skills Training in Affective and Interpersonal Regulation for refugees and asylum-seekers (STAIR-R). In this case study, we report on the implementation of STAIR-R in combination with Narrative Exposure Therapy (NET) with Sara, a 60-year-old Iraqi woman who presented with high levels of nightmares, avoidance and emotion dysregulation following exposure to war- and conflict-related trauma and post-migration stressors. In this case study, we explore the intersection of emotion regulation skills training (in STAIR-R) and exposure therapy (in NET), and the potential for this combined intervention to improve emotion regulation skills, enhance coping with post-migration stressors and facilitate engagement with exposure-based treatment for PTSD.

The Association of Conflict-Related Trauma with Markers of Mental Health Among Syrian Refugee Women: The Role of Social Support and Post-Traumatic Growth.

BackgroundSyrian refugee women not only suffered the refuging journey but also faced the burden of being the heads of their households in a new community. We aimed to investigate the mental health status, traumatic history, social support, and post-traumatic growth (PTG) of Syrian refugee women.MethodsA cross-sectional study was conducted using a structured interviewer-administered survey between August and November 2019. Syrian refugee women who head their households and live outside camps were eligible. The survey included items investigating socio-demographic characteristics and conflict-related physical trauma history. The Refugee Health Screener-15 (RHS-15) scale was used to screen for emotional distress symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), with a score range of 0−4 and higher scores indicating emotional distress. The Multidimensional Scale of Perceived Social Support (MSPSS) was utilized to assess the perceived support from family, friends, and significant others (score range 1−7), with scores of 3−5 and 5.1−7.0 representing moderate and high support, respectively. The PTG Inventory (PTGI) scale investigated the positive transformation following trauma; the score range was 0−5, and the cutoff point of ≥3 defined moderate-to-high growth levels.ResultsOut of 140 invited refugee women, 95 were included, with a response rate of 67.9%. Their mean (SD) age was 41.30 (11.75) years, 50.5% were widowed, and 17.9% reported their husbands as missing persons. High levels of conflict-related traumatic exposure were found, including threats of personal death (94.7%), physical injury (92.6%), or both (92.6%); and a history of family member death (92.6%), missing (71.6%), or injury (53.7%). The mean (SD) RHS-15 score was above average (2.08 (0.46)), and most women (90.5%) were at high risk for depression, anxiety, and PTSD symptoms. The mean (SD) MSPSS score was 5.08 (0.71), representing moderate social support, with friends’ support being the highest (5.23 (0.85)). The mean (SD) PTGI score was 2.44 (0.48), indicating low growth, with only 12.6% of women experiencing moderate-to-high growth levels. Spiritual change and personal strength had the highest sub-scores, with moderate-to-high growth levels experienced by 97.9% and 84.2%, respectively. Most women were more optimistic and religious, had feelings of self-reliance and better difficulties adapting, and were stronger than they thought. Statistically significant correlations of MSPSS and its subscales with RHS-15 and PTGI were detected.ConclusionSignificant but unspoken mental health problems were highly prevalent among Syrian refugee women and an imminent need for psychological support to overcome traumatic exposure. The role of social support seems to be prominent and needs further investigation.

Affective working memory capacity in refugee adolescents.

High numbers of adolescents today are exposed to conflict-related trauma, with trauma-exposure being associated with adverse biopsychosocial outcomes. Here we investigated the influence of trauma-exposure and high levels of posttraumatic stress disorder (PTSD) symptoms on cognitive functioning in trauma-related compared to neutral contexts. Afghan adolescent refugees with high levels of PTSD symptomatology and non-trauma-exposed Afghan adolescent refugee controls (N = 47; 43% female; aged 13-19 years, M = 15.49, SD = 1.40) completed a visual working memory task including affective (trauma-related) and neutral distractors. Working memory capacity in the context of trauma-related distractors (and not neutral distractors) was significantly poorer in trauma-exposed refugees with high levels of PTSD when compared to non-trauma-exposed controls. The findings highlight the importance of investigating posttraumatic cognitive functioning within affective contexts and suggest that affective working memory capacity may constitute a promising target for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Relational Factors and HIV Testing Practices: Qualitative Insights from Urban Refugee Youth in Kampala, Uganda

Despite the global phenomenon of refugee urbanization, little is known of relational contexts that shape HIV testing among urban refugee youth. We explored perspectives, experiences, and preferences for social support in HIV testing among refugee youth aged 16–24 in Kampala, Uganda. We conducted five focus groups with refugee youth (n = 44) and five in-depth key informant interviews. Participant narratives signaled relational contexts shaping HIV testing included informal sources (intimate partners and family members) and formal sources (peer educators and professionals). There was heterogeneity in perspectives based on relationship dynamics. While some felt empowered to test with partners, others feared negative relationship consequences. Participant narratives reflected kinship ties that could facilitate testing with family, while others feared coercion and judgment. Peer support was widely accepted. Professional support was key for HIV testing as well as conflict-related trauma. Findings emphasize bonding and bridging social capital as salient components of enabling HIV testing environments.

The role of school culture in teacher professional development for peace education: the case of Sukma Bangsa School Pidie in post-conflict Aceh, Indonesia

ABSTRACT This paper explored the relations between the practice of school culture and teacher professional development for peace education. Using the case of Sukma Bangsa School Pidie (SBS Pidie) in post-conflict Aceh, Indonesia, and the influence of school culture on teacher professional development as the theoretical framework, this paper provides a discussion of teacher professional development for peace education that is still lacking in the literature. The findings suggest that SBS Pidie teachers who participated in this study perceived that their school leadership had developed a school culture and clarity of stance that was conducive to their learning for peace. The culture in this school is based on a clear stance of the school on peace, and the practices that contribute to teacher professional development are manifested in the school management and its environment, facilitation for learning, and relationships between teachers. The findings also suggest that in post-conflict areas, school culture needs to be able to assist teachers in overcoming their conflict-related trauma.

Association between triage level and outcomes at Médecins Sans Frontières trauma hospital in Kunduz, Afghanistan, 2015

BackgroundFive million people die annually due to injuries; an increasing part is due to armed conflict in low-income and middle-income countries, demanding resolute emergency trauma care. In Afghanistan, a low-income...

Community-Based Interventions for the Treatment and Management of Conflict-Related Trauma in Low-Middle Income, Conflict-Affected Countries: a Realist Review

Where low- and middle-income countries have limited economic resources to provide individualized mental health services to people exposed to conflict, community-based interventions may be more appropriate. We aimed to evaluate community level interventions for improving mental health outcomes in Low- and Middle-income countries (LMIC). A realist review of community-based interventions (CBIs) to improve mental health for people in LMIC following conflict. Five databases (Cochrane, PubMed, PsychINFO, Medline, and CINAHL) and a manual search of individual papers. We found 1318 articles, of which 29 were selected. Out of the 29 primary articles, 19 showed successful results, 4 showed mixed results, 1 showed inconclusive results, and 1 showed unsuccessful results. After analyzing the results, we found 3 mechanisms that may influence the effectiveness of these CBIs: the use of lay community members as intervention deliverers, the application of transdiagnostic approaches, and customized outcome assessment tools. Community-based approaches to improve mental health in LMICs are rare and evidence for their effectiveness is limited. Interventions that have a wide scope, train lay mental health workers, and use contextually adapted outcome assessment tools show promise.

Patterns of conflict-related trauma exposure and their relation to psychopathology: A person-centered analysis in a population-based sample from eastern DRC

Populations in war-torn regions are exposed to a wide array of traumatic events that can cause an enormous psychological burden. Individual characteristics influence the likelihood of being exposed to certain events, pointing to systematic interindividual differences in trauma exposure. However, there is a dearth of studies examining potential patterns of trauma exposure in war regions. In this cross-sectional epidemiological study, we applied a person-centered approach to identify patterns in the exposure to conflict-related traumatic events and determine their impact on commonly reported mental health problems in a population-based sample (N ​= ​1000) from the eastern Democratic Republic of Congo. We implemented multi-stage random cluster sampling to randomly select adults from 100 villages. Of 1000 adults (Mage ​= ​43.19 years) included in the study, 50% were female. Results showed high prevalence of PTSD (17.0%), depression (27.8%), anxiety (25.4%) and suicidality (15.1%) following exposure to conflict-related traumatic events since 2002. Latent Class Analysis identified three distinct classes of trauma exposure: Class 1 “low-trauma-exposure” (51.4%, n ​= ​514) was characterized by the lowest probabilities of trauma exposure. Class 2 “non-physical-trauma” (39.1%, n ​= ​391) consisted of individuals with a high probability for exposure to non-physical trauma types only. Class 3 “interpersonal-trauma” (9.5%, n ​= ​95) had the overall highest probability of exposure to traumatic events and was the only class affected by interpersonal-trauma types. Class membership was related to gender, age and place of living. Vulnerability to mental health problems increased from low-trauma-exposure to non-physical-trauma to interpersonal-trauma class. Our findings indicate that the exposure to traumatic events in conflict-affected populations underlies distinct patterns, with interpersonal trauma as a distinguishing marker. Vulnerability to psychopathology varies with trauma patterns, revealing patterns that include both non-physical and interpersonal traumata as most detrimental for mental health. Identification of underlying trauma patterns and their effects may improve mental health care in war-affected populations.

Reaching the Unreached: Bridging Islam and Science to Treat the Mental Wounds of War.

Radical new paradigms are needed to equip non-professionals and leverage community faith-based infrastructure to address the individual and communal wounds of war- and conflict-related trauma. Muslims in war-torn regions like Somalia experience high rates of trauma and posttraumatic stress; yet, lack of providers, potential stigma, and lack of integration with one's faith are substantial barriers to care. In this pre-post feasibility clinical trial (NCT03761732), mosque leaders implemented a brief, group- and mosque-based intervention, Islamic Trauma Healing, targeting trauma-related psychopathology and community reconciliation for trauma survivors (N = 26) in Somaliland, Somalia. Leaders were trained in a brief 2-day training, with supervision provided remotely via WhatsApp. This six-session intervention combines empirically-supported trauma-focused psychotherapy and Islamic principles, focusing on wisdom from the lives of the Prophets and turning to Allah in dua about trauma. There were large, clinically meaningful effects for PTSD (g = 1.91), depression (g = 2.00), somatic symptoms (g = 2.73), and well-being (g = 1.77). Qualitative data from group members highlighted how well the program was aligned with their Islamic faith, built community, and need to expand the program. These results highlight the feasibility of this non-expert, easily up-scalable mental health approach in war-torn Muslim regions and refugee communities. This program has the potential to provide a low-cost, self-sustaining, Islam-based intervention addressing the psychological wounds of war consistent with the IOM's call to develop novel approaches to address unmet clinical needs.ClinicalTrials.gov Identifier: NCT03761732.

‘Ending the Silence’: Addressing the Legacy of Displacement in Northern Ireland’s ‘Troubles’

Though transitional justice measures are increasingly used to address displacement, particularly restitution programmes and truth-telling initiatives, the issue of addressing the long-term impact of displacement on individuals, communities and wider society represents significant challenges for peacebuilding processes. Based on in-depth interviews with those who suffered displacement in Northern Ireland’s ‘Troubles’, this article seeks to explore the marginalized and often silenced narratives of those displaced, shedding light on the multi-layered short- and long-term harms and consequences of displacement for individuals, families and community relations. The article’s argument is twofold: first, that experiences of displacement should be considered as a form of conflict-related harm and trauma and those displaced recognized as victims. And second, that ‘storytelling’ and other bottom-up acknowledgement projects are seen by victims and survivors as an effective vehicle to ‘break’ the silence, end the denial and advance their pursuit of recognition and acknowledgement.

Derry Girls and containment: conflict-related and transgenerational trauma in Northern Ireland

In this article, I consider role of the television show Derry Girls in providing containment for the unbearable aspects of conflict-related and transgenerational trauma in the context of Northern Ireland. Derry Girls is a situation comedy set during the political conflict of Northern Ireland in the 1990s. The show provides nostalgic, satirical and affectionate observations on the seemingly mundane and at times farcical misdemeanours of a group of young people living out their everyday lives in the backdrop of sectarianism, bigotry and political violence. First airing in 2018, 20 years after the peace agreement in Northern Ireland, Derry Girls offers a forum for experiencing a flavour of life in the height of the Troubles, evoking strong emotional reactions in audiences through laughter, consternation and tears. I consider the role of psychosocial studies in framing understanding of the show as a cultural outlet for and container of societal level trauma and collective pain.

Impact of the Healing in Harmony program on women's mental health in a rural area in South Kivu province, Democratic Republic of Congo.

To assess whether Healing in Harmony (HiH), a form of music therapy, improved women's mental health following conflict-related trauma and sexual violence in the Democratic Republic of Congo. This study used a step-wedged design and included 167 women, who completed up to two pre-tests, a post-test, and up to two follow-up interviews at 3 and 6 months after completing the program. The Hopkins Symptoms Checklist was used to measure anxiety and depression. The Harvard Trauma Questionnaire was used to measure post-traumatic stress disorder (PTSD). Generalized estimating equations with unstructured covariance were used to estimate mean change in mental health scores and relative risks (RRs) for screening positive. Prior to starting the HiH program, 73.9, 84.2, and 68.5% screened positive with median scores being 2.20, 2.70, and 2.06 for depression, anxiety, and PTSD, respectively. The RR for screening positive declined significantly (RR = 0.49 for depression, 0.61 for anxiety, and 0.54 for PTSD) and mean scores declined significantly by -0.54, -0.67, and -0.53 points, respectively, from the pre- to the post-test, declines that were sustained at the 3-month and 6-month follow-up interviews. The HiH program was associated with significant improvement in women's mental health that was sustained up to 6 months post completion of the program despite instability in the region and evidence of continued experience of conflict-related trauma during the study. These data support the value of providing psychological care in the context of ongoing humanitarian crises.

The NETfacts health system: An integrative approach to counter the mental sequelae of trauma and violence at the individual and community level

In areas of armed conflict such as Eastern DR Congo, a large proportion of the population is affected by violence. Trauma and violent acts can lead to mental health and behavioural problems which have ramifications beyond the individual into the family, community and societal systems, and are passed on across generations. Dynamics of avoidance and with it the dysfunctional communication about survivors' traumatic experience lead to the emergence of prejudices and marginalization of victims and prevent informed understandings in the aggregate. Cycles of violence emerge within communities that ‘build' on the inherited consequences of conflict-related trauma. This article outlines the NETfacts health system that provides an integrated approach to counter the consequences of violence at the individual and community level.

Longitudinal path analysis of depressive symptoms and functioning among women of child-rearing age in postconflict Timor-Leste

This longitudinal study indicates that exposure to the traumas of mass conflict and subsequent depressive symptoms play an important role in pathways leading to functional impairment in the postconflict period...

Childhood trauma as a predictor of reoffending in a Northern Irish probation sample

BackgroundIt is well-documented that there is a high prevalence rate of childhood trauma experiences among the prison population, and studies have found a link between childhood trauma and later acts of violence. ObjectiveThe aim of the current study was to investigate whether childhood trauma (i.e., physical, sexual, emotional abuse and physical neglect) among offenders who have served a life sentence in Northern Ireland was associated with general and violent reoffending patterns. The study also explored the relationship between childhood trauma resulting from the sectarian conflict “The Troubles” in the region and its impact on reoffending. MethodThe casefiles of 100 offenders were coded for trauma experiences and official reoffending data was extracted. Logistic regression analysis was performed to explore the relationship between trauma and reoffending. ResultsThe most common form of childhood trauma were emotional abuse and/or emotional neglect (n = 43), conflict-related trauma (n = 43) and physical abuse (n = 40). Only age (OR .91) and conflict-related trauma (OR 5.57) emerged as significant predictors (p < .05) of general reoffending at any time post release. Similarly, only age (OR .92) and conflict-related trauma (OR 4.57) emerged as significant predictors (p < .05) of violent reoffending. Although it did not reach significance (p = .09), childhood physical abuse was related to an increase in the odds of violently reoffending, of a large magnitude (OR 4.09). ConclusionsConflict-related trauma significantly predicted general and violent reoffending among offenders with previous violent convictions.

An investigation of associations between experience of childhood trauma and political violence and theory of mind impairments in schizophrenia

There has been little examination of the association between trauma and cognitive deficits seen in individuals diagnosed with schizophrenia. Theory of Mind (ToM) impairments are a significant feature of schizophrenia but it remains unclear as to why these deficits are so prevalent in this population. This study aimed to explore associations between ToM deficits and specific forms of childhood adversities in a schizophrenia population. The study sample comprised of 66 adults with a confirmed diagnosis of schizophrenia, attending mental health services in Northern Ireland. Assessments were completed to ascertain if individuals had prior experience of sexual or physical abuse, emotional neglect or experience of the political violence of Northern Ireland's “Troubles”, and the Gardner Hinting Test was applied to assess ToM ability. Backwards stepwise regression analyses demonstrated that emotional neglect, specifically during early childhood (0–6 years) predicted ToM impairments in this group. Conflict-related trauma was also associated with ToM but was not an independent significant predictor of ToM deficits. This is the first study to examine links between specific forms of childhood adversity and ToM impairments in individuals diagnosed with schizophrenia. Potential underpinning psychological mechanisms are considered and implications for clinical practice are discussed.

Life after conflict-related amputation trauma: a clinical study from the Gaza Strip

BackgroundMore than 17.000 Palestinians were injured during different Israeli military incursions on the Gaza Strip from 2006 to 2014. Many suffered traumatic extremity amputations. We describe the injuries, complications, living conditions and health among a selection of traumatic amputees in the Gaza Strip.MethodsWe included 254 civilian Palestinians who had survived, but lost one or more limb(s) during military incursions from 2006 to 2016. All patients were receiving follow-up treatment at a physical rehabilitation center in Gaza at the time of inclusion. We measured and photographed anatomical location and length of extremity amputations and interviewed the amputees using standard questionnaires on self-reported health, socioeconomic status, mechanism of injury, physical status and medical history.ResultsThe amputees were young (median age 25,6 years at the time of trauma), well educated (37% above graduate level), males (92%), but also 43 children (17% ≤ 18 years). The greater part suffered major amputations (85% above wrist or ankle). Limb losses were unilateral (35% above-, 29·5% below knee), and bilateral (17%) lower extremity amputations. Pain was the most frequent long-term complaint (in joints; 34%, back; 33% or phantom pain; 40·6%). Sixty-three percent of amputees were their family’s sole breadwinner, 75·2% were unemployed and 46% had lost their home. Only one in ten (11·6%) of the destroyed homes had been rebuilt.ConclusionsThe most frequently observed amputees in our study were young, well-educated male breadwinners and almost one in five were children. Conflict-related traumatic amputations have wide-ranging, serious consequences for the amputees and their families.