Civilians Share in the Emotional Weight of War
> 4/3/2008 2:45:28 PM

Studies regarding the effects of PTSD and other psychosocial complications on returning combat veterans have received coverage from all major media outlets. Such concerns are particularly prescient in a time of conflict, but we cannot negate the impact of battle on its most easily dismissed victims: innocent citizens of the lands that serve as battlegrounds. A new study sponsored by the National Institute of Mental Health looks to reveal some of the lasting damage wrought upon those for whom such struggles are a simple fact of daily life.

Few areas of the world have seen more armed conflict over the last several decades than the Middle East. Due to a lack of social services and adequate health care, mental health services are tragically insufficient in large swaths of this land. Yet no real research on the psychological effects of ongoing warfare in this area has been performed - until now. Lebanese and American researchers, supported by the NIMH, surveyed some 3,000 men and women living around greater Lebanon to ascertain effects of ongoing military conflicts on the general population's mental health status. They unsurprisingly found that mental illness, particularly those disorders relating to anxiety, self-control, and violence, was considerably more common among citizens directly affected by war.

The fact that this study was the first of its kind to be performed in the volatile Middle East region is unfortunate but understandable. Many of the area's most deeply affected hot spots are too unstable to allow extensive study, especially that involving representative surveys that require face-to-face interviews with the general population. Lebanon began its thus-far brief existence as an occupied state established by the French, and it has seen more than its share of social, political, and military upheaval. The Lebanese slogged through a 15-year civil war and the country most recently suffered serious damage to its infrastructure in a brief but significant 2006 conflict with Israel. This tumultuous history leaves Lebanon a perfect candidate for a study tracing the psychological impact of war on an affected populace.
The interviews, based on standard World Health Organization surveys, included questions regarding traumatic war experiences and emotional self-assessments. Results were, if anything, less severe than expected: more than 2/3 of those interviewed had witnessed or suffered at least one of a group of traumatic events including murder, kidnapping, robbery, and extended refugee status, but just over 25% of participants qualified for a positive diagnosis of a disorder at some point during their lives. 17% qualified in the year preceding the study and, accounting for a projected 75-year lifespan, researchers estimated that approximately 1/3 of the subject pool would qualify at some point in their lives.

The influence of violent conflict, however, was clear. Individuals who'd experienced some form of war-related trauma were 6 times as likely to suffer from anxiety disorders and more than 3 times as likely to suffer from mood disorders. Interestingly, impulse control disorders seemed to be the group most dramatically affected by war - citizens who'd directly lived through such traumas were a full 13 times as likely to qualify for impulse control diagnoses, and only 15% of those affected had ever sought treatment. This trend is particularly worrisome because such disorders often encourage a volatile temperament prone to violence in the form of intermittent explosive disorder or episodes of domestic abuse.

The final numbers were, unexpectedly, not much higher than those recorded among Americans and Britons. Lebanon's health care system is not particularly under-staffed, but researchers believe that this trend may be attributed to poor diagnostic practices and a general acceptance of the country's state of seemingly intractible war and civil unrest. According to researchers, biases and stigmas surrounding mental illness are almost certainly more common in this area of the world as well, and the subjects of this study were therefore less likely to report their own symptoms than affected individuals in the U.S. or Britain. More importantly, the percentage of the given sample who sought any form of treatment was small. Less than half of those suffering from mood disorders had received treatment, and the average delay between initial symptoms and treatment was 6 years.

The most obvious issue raised by this study is a need to increase awareness and encourage citizens to seek treatment for their conditions. Researchers guess that the lower-than-expected numbers may, in part, stand as a testament to human resilience: the ability to weather whatever horrific conditions daily life throws into our paths. Still, these innocent victims need to understand that treatment options exist and that they do not have to suffer the traumas of war without professional support.

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