Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders.

Journal: JAMA network open

Volume: 6

Issue: 6

Year of Publication: 2023

Affiliated Institutions:  Survey Research Center, University of Michigan, Ann Arbor. Universitair Psychiatrisch Centrum-Katholieke Universiteit, Campus Gasthuisberg, Leuven, Belgium. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania. Center for Reducing Health Disparities, University of California, Davis Health System, Sacramento. Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain. School of Psychology, Ulster University, Londonderry, United Kingdom. Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal. Anxiety Disorders Research Center, Buenos Aires, Argentina. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon. Institut de Psychologie, Université Paris Cité, Paris, France. Instituto Nacional de Salud, Universidad Cayetano Heredia, Lima, Peru. Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia. Department of Psychological Medicine, University of Otago, Dunedin, New Zealand. Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Abstract summary 

Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies.To estimate the association between exposure to civil violence and the subsequent onset and persistence of common mental disorders (in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) in representative surveys of civilians from countries that have experienced civil violence since World War II.This study used data from cross-sectional World Health Organization World Mental Health (WMH) surveys administered to households between February 5, 2001, and January 5, 2022, in 7 countries that experienced periods of civil violence after World War II (Argentina, Colombia, Lebanon, Nigeria, Northern Ireland, Peru, and South Africa). Data from respondents in other WMH surveys who immigrated from countries with civil violence in Africa and Latin America were also included. Representative samples comprised adults (aged ≥18 years) from eligible countries. Data analysis was performed from February 10 to 13, 2023.Exposure was defined as a self-report of having been a civilian in a war zone or region of terror. Related stressors (being displaced, witnessing atrocities, or being a combatant) were also assessed. Exposures occurred a median of 21 (IQR, 12-30) years before the interview.The main outcome was the retrospectively reported lifetime prevalence and 12-month persistence (estimated by calculating 12-month prevalence among lifetime cases) of DSM-IV anxiety, mood, and externalizing (alcohol use, illicit drug use, or intermittent explosive) disorders.This study included 18 212 respondents from 7 countries. Of these individuals, 2096 reported that they were exposed to civil violence (56.5% were men; median age, 40 [IQR, 30-52] years) and 16 116 were not exposed (45.2% were men; median age, 35 [IQR, 26-48] years). Respondents who reported being exposed to civil violence had a significantly elevated onset risk of anxiety (risk ratio [RR], 1.8 [95% CI, 1.5-2.1]), mood (RR, 1.5 [95% CI, 1.3-1.7]), and externalizing (RR, 1.6 [95% CI, 1.3-1.9]) disorders. Combatants additionally had a significantly elevated onset risk of anxiety disorders (RR, 2.0 [95% CI, 1.3-3.1]) and refugees had an increased onset risk of mood (RR, 1.5 [95% CI, 1.1-2.0]) and externalizing (RR, 1.6 [95% CI, 1.0-2.4]) disorders. Elevated disorder onset risks persisted for more than 2 decades if conflicts persisted but not after either termination of hostilities or emigration. Persistence (ie, 12-month prevalence among respondents with lifetime prevalence of the disorder), in comparison, was generally not associated with exposure.In this survey study of exposure to civil violence, exposure was associated with an elevated risk of mental disorders among civilians for many years after initial exposure. These findings suggest that policy makers should recognize these associations when projecting future mental disorder treatment needs in countries experiencing civil violence and among affected migrants.

Authors & Co-authors:  Axinn William G WG Bruffaerts Ronny R Kessler Timothy L TL Frounfelker Rochelle R Aguilar-Gaxiola Sergio S Alonso Jordi J Bunting Brendan B Caldas-de-Almeida José Miguel JM Cardoso Graça G Chardoul Stephanie S Chiu Wai Tat WT Cía Alfredo A Gureje Oye O Karam Elie G EG Kovess-Masfety Viviane V Petukhova Maria V MV Piazza Marina M Posada-Villa José J Sampson Nancy A NA Scott Kate M KM Stagnaro Juan Carlos JC Stein Dan J DJ Torres Yolanda Y Williams David R DR Kessler Ronald C RC

Study Outcome 

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Statistics
Citations :  Doctors Without Borders . The enormous mental health needs for displaced people in Ukraine. Accessed December 2, 2022. https://www.msf.org/enormous-mental-health-needs-displaced-people-ukraine
Authors :  26
Identifiers
Doi : e2318919
SSN : 2574-3805
Study Population
Male,Female
Mesh Terms
Adult
Other Terms
Study Design
Cross Sectional Study
Study Approach
Country of Study
Niger
Publication Country
United States