In the aftermath of war, communities which continue to experience repeated violence could have a major escalation in rates of post-traumatic stress disorder (PTSD) and severe distress, according to Australian research.
The authors studied Timor-Leste for four years after the end of a long-running and violent war against Indonesian occupation, and again in 2010–11, following a period of prolonged internal conflict.
Dr Derrick Silove from the University of New South Wales and colleagues conducted a survey to estimate the prevalence of common mental disorders among 1,022 adults (600 from a rural village and 422 from an urban district).
“Given that potentially traumatic events were rarer during the internal conflict than during the principal conflict, it seems likely that the effects of recurrent episodes of communal violence on the morale, sense of communal cohesion, and security of the population created a general underlying vulnerability to psychological distress,” he says.
PTSD was not only linked with experience of violent conflict but also with a range of other stressors.
Persisting preoccupations with injustice during two or three periods (the principal conflict 1975–99, internal conflict 2006–7, or the present 2008–10) was linked with a quadrupling of risk for PTSD.
This could have been related to the unsatisfactory truth and reconciliation process that followed independence, together with ongoing human rights abuses.
According to Dr Silove:
“Our findings suggest that a period of internal conflict can result in a major escalation in mental disorders in post-conflict countries. Mental health services should be enhanced in these settings to meet these increased needs. Our experiences highlight the importance of preventing communal violence, alleviating poverty, and addressing past and ongoing injustices in post-conflict communities to help avert both recurring violence and prevent an increase in mental disorders.”*
The research is published in The Lancet Global Health journal.
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