Mental health and coping in a war situation: the case of Bosnia and Herzegovina

The latter part of the twentieth century has seen an increased concern for the implications of war for civilian populations, and more attention has been given to psychosocial impacts of uprooting and displacement. 'Loss of place', acute and chronic trauma, family disruption and problems of family reunification have become issues of concern. The war in Bosnia was characterized by massive displacement, disruption and loss of life, relatives and property. Health and psychosocial well-being were affected in a number of ways. There was an overwhelming loss of perceived power and self-esteem. Over 25%, of displaced people, for example, said they no longer felt they were able to play a useful role; even in non-displaced populations approximately 11% of those interviewed said that they had lost a sense of worth. Widespread depression and feelings of fatigue and listlessness were common and may have prevented people from taking steps to improve their situation. Almost a quarter of internally displaced people had a high startle capacity and said they were constantly nervous. Most adverse psychosocial responses increased with age and in a population that includes many elderly people this poses serious problems. The findings point to major challenges with respect to repatriation and reconstruction. They highlight the importance of family reunification and the facilitating of decision-making by affected people themselves. The findings also shed light on potential problems associated with over-dependence on external assistance and hence the need for people to be given the means of using their skills and knowledge to control their day-to-day lives.     

Effectiveness and specificity of a classroom-based group intervention in children and adolescents exposed to war in Lebanon

The purpose of this study was to examine the effectiveness and specificity of a classroom-based psychosocial intervention after war. All students (n=2500) of six villages in Southern Lebanon designated as most heavily exposed to war received a classroom-based intervention delivered by teachers, consisting of cognitive-behavioural and stress inoculation training strategies. A random sample of treated students (n=101) and a matched control group (n=93) were assessed one month post-war and one year later. Mental disorders and psychosocial stressors were assessed using the Diagnostic Interview for Children and Adolescents - Revised with children and parents. War exposure was measured using the War Events Questionnaire. The prevalence of major depressive disorder (MDD), separation anxiety disorder (SAD) and post-traumatic stress disorder (PTSD) was examined pre-war, one month post-war (pre-intervention), and one year post-war. Specificity of treatment was determined by rating teachers’ therapy diaries. The rates of disorders peaked one month post-war and decreased over one year. There was no significant effect of the intervention on the rates of MDD, SAD or PTSD. Post-war MDD, SAD and PTSD were associated with pre-war SAD and PTSD, family violence parameters, financial problems and witnessing war events. These findings have significant policy and public health implications, given current practices of delivering universal interventions immediately post-war.     

Psychosocial interventions and the demoralization of humanitarianism

This paper critically analyses from a political sociology standpoint the international conceptualization of war-affected populations as traumatized and in need of therapeutic interventions. It argues for the importance of looking beyond the epidemiological literature to understand trauma responses globally. The paper explores how the imperative for international psychosocial programmes lies in developments within donor countries and debates in their humanitarian sectors over the efficacy of traditional aid responses. The aim of the paper is threefold. First, it discusses the emotional norms of donor states, highlighting the psychologizing of social issues and the cultural expectations of individual vulnerability. Second it examines the demoralization of humanitarianism in the 1990s and how this facilitated the rise of international psychosocial work and the psychologizing of war. Third, it draws attention to the limitations of a mental health model in Croatia, a country which has been receptive to international psychosocial programmes. Finally it concludes that the prevalent trauma approaches may inhibit recovery and argues for the need to re-moralize resilience.     

Factors that mitigate war-induced anxiety and mental distress

The effects of war-induced anxiety and mental distress on individuals and groups can either be mitigated or exacerbated by 'humanitarian action'. This paper focuses on two key factors that protect the mental well-being of war-affected populations: organized displacement or assisted relocation; and coordinated humanitarian aid operations that are responsive to local needs. Qualitative data from two internally displaced person (IDP) camps in Eritrea are presented. Analysis of these data serves to substantiate and refine a working hypothesis: that social support of the right type, provided at the right time and level, can mitigate the worst effects of war and displacement on victims/survivors. An integrated model of psychosocial transition is suggested. The implications of this approach for humanitarian policy and practice are discussed in the wider context of current debates and lamentations of the 'humanitarian idea'.     

Experiences and psycosocial impact on soldier boys and girls from the civil war in El Salvador

Exploratory research with 293 excombatants who participated as child soldiers in the El Salvador civil war as FMLN (Marti Front for National Liberation) members or as Armed Forces soldiers was conducted to examine their current living conditions and the impact of past military experience. Although nearly ten years have passed since the peace accords were signed, the excombatant exhibited signs of emotional disturbance. Current underprivileged living conditions and social marginalization were decisive factors which inhibited reentry into civilian life and constituted an important psychosocial impact by placing at risk their integration at the family, community and society levels.     

Stressors,Supports and the Social Ecology of Displacement: Psychosocial Dimensions of an Emergency Education Program for Chechen Adolescents Displaced in Ingushetia,Russia

This study explored the psychosocial benefits of an emergency education intervention serving adolescents displaced by the war in Chechnya. It set out to describe key stressors and sources of social support available to youth served by the International Rescue Committee's (IRC) emergency education program. Interviews were conducted with 57 Chechen adolescents living in spontaneous settlements in Ingushetia, Russia in the fall of 2000. Of particular interest was the degree to which the education program addressed specified psychosocial goals. Findings indicated that young people and their families faced a number of physical and emotional stressors. The data indicated that the emergency education program provided benefits by enriching sources of social support, providing meaningful activity and a sense of hope for the future, and creating a space for young people to spend time and connect to others. However, the contrast between the desire of adolescents “to live like other kids” and the options available to them presented a dilemma for the emergency education program: adolescents craved normalcy, but for any intervention to be delivered, it had to first begin with creative and adaptive strategies that were by no means a complete replacement for formal, mainstream education. The programmatic and policy implications of these findings are presented here.     

Mine warfare at sea—some legal aspects of the future

Abstract

The paper addresses some of the problems that new weapon technology at sea are posing to traditional legal concepts, and to illustrate these, the sea mine has been taken as the topical weapon. One of the difficulties is that since the Hague Peace Conference of 1907, through the Covenant of the League of Nations and the Paris Treaty of 1928 renouncing war as an instrument of national policy up to the situation after the Charter of the United Nations, it is improbable that any nation will ever again declare war. In the absence of declared war, it is probably most helpful to categorize the threat or use of armed force as either a delict, a sanction, or self‐defense. The use of mines in any legal context gives rise to two fundamental questions:

a. Is the mine a lawful weapon?

b. If it is a lawful weapon what are the legal restraints on its use, if any?

The paper asserts, inter alia, that the Hague Convention No VIII Relative to the Laying of Automatic Submarine Contact Mines does not prohibit the mine as then known, and that the legal status of mines as a weapon of war has not fundamentally changed since 1907.     

Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress,Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.     

The secular trend in the incidence of hemorrhagic stroke in the region of Osijek,Eastern Croatia in the period 1988-2000--a hospital based study

The purpose of the study was to establish the possible environmental influences in the observed peculiar rising and falling oscillations in the numbers of hemorrhagic stroke (HS) in Eastern Croatia (region of Osijek) during the last thirteen-years' period (1988-2000). In this period 1,222 HS were registered and treated. A constant increase in the incidence of HS was observed, from 60 (in 1988) to 139 (in 1998), with an average annual proportion of 16.5% of all stroke cases. A sharp increase in proportion of HS in total stroke incidence was recorded during the war in Croatia (1991-1995), with a peak incidence of 27.4% in 1993. Typical hypertensive intracerebral hemorrhage (ICH) was the most common (57.1%), atypical ICH occurred in 26.4%, subarachnoid hemorrhage (SAH) in 16.5%. Analysis of the annual number of hypertensive-ICH and SAH disclosed peculiar rising and falling oscillations. These variations were in correlation with heavy living conditions. During the war-period the SAH incidence sharply rose. Immediately after the war it suddenly decreased. The authors named this phenomenon a "pool depletion", supposing the relatively stable proportion of the bearers of aneurysms in population. The observed variations seem to be the consequence of the war stress and other negative psychosocial and economic factors in post-war period, which increases the risk for SAH and typical hypertensive-ICH through complex pathophysiological mechanisms.     

Assessing the impacts of war on perceived conservation capacity and threats to biodiversity

The impacts of war and violent conflicts on biodiversity may vary widely across time and different contexts. However, our understanding of the complex effects of war is limited in most cases due to a lack of study or methodological limitations. We examine the impact of war on conservation in the Western Area Peninsula Forest Reserve in Sierra Leone, a biodiversity hotspot and a site of civil war between 1997 and 2002. We utilize a novel combination of methods, including threat reduction assessment (24 focus groups), structured survey (n = 842) and semi-structured interviews (n = 37). We find that perceived threats to biodiversity varied in space and time and increased after the cessation of conflict. We also find that conservation capacity was perceived to be at its lowest during the war, but did not rebound significantly directly after the conflict. These data indicate the importance of maintaining conservation capacity during conflict, and immediately building capacity following conflict, to mitigate increased levels of threat. Our approach also emphasizes the need to assess both conservation threats and capacity to evaluate the full effect of war.     

Perceived morningness–eveningness predicts academic adjustment and substance use across university,but social jetlag is not to blame

Past research has consistently found that evening-types typically report poorer academic adjustment and higher levels of substance use compared to morning-types. An important development within the morningness–eveningness and psychosocial adjustment literature has been the hypothesis that social jetlag (i.e. the asynchrony between an individual’s “biological” and “social” clocks) is one factor that may explain why evening-types are at a greater risk for negative psychosocial adjustment. Yet, only a handful of studies have assessed social jetlag. Furthermore, the few studies that have assessed social jetlag have done so only with concurrent data, and thus have not been able to determine the direction of effects among morningness–eveningness, social jetlag and psychosocial adjustment. To address this important gap in the literature, the present 3-year longitudinal study employed the use of a cross-lagged auto-regressive model to specifically examine the predictive role of perceived morningness–eveningness and social jetlag on two important indices of psychosocial adjustment among university students: academic adjustment and substance use. We also assessed whether there would be an indirect effect between perceived morningness–eveningness and psychosocial adjustment through social jetlag. Participants were 942 (71.5% female; M?=?19 years, SD?=?0.90) undergraduates at a mid-sized university in Southern Ontario, Canada, who completed a survey at three assessments, each one year apart, beginning in first-year university. Measures were demographics (age, gender and parental education), sleep problems, perceived morningness–eveningness, social jetlag, academic adjustment and substance use. As hypothesized, results of path analyses indicated that a greater perceived eveningness preference significantly predicted higher social jetlag, poorer academic adjustment and higher substance use over time. In contrast, we found no support for social jetlag as a predictor of academic adjustment and substance use, indicating that social jetlag did not explain the link between perceived morningness–eveningness and negative psychosocial adjustment. An important finding was the significant predictive effect of higher substance use on social jetlag over time. Results of the present study highlight the importance of employing a longitudinal framework within which to specifically determine the direction of effects among the study variables in order to validate proposed theoretical models that aim to guide our understanding of how perceived morningness–eveningness, social jetlag, academic adjustment and substance use relate to each other.     

Long-term effects of STN DBS on mood: psychosocial profiles remain stable in a 3-year follow-up

Background

Deep brain stimulation of the subthalamic nucleus significantly improves motor function in patients with severe Parkinson's disease. However, the effects on nonmotor aspects remain uncertain. The present study investigated the effects of subthalamic nucleus deep brain stimulation on mood and psychosocial functions in 33 patients with advanced Parkinson's disease in a three year follow-up.

Methods

Self-rating questionnaires were administered to 33 patients prior to surgery as well as three, six, twelve and 36 months after surgery.

Results

In the long run, motor function significantly improved after surgery. Mood and psychosocial functions transiently improved at one year but returned to baseline at 36 months after surgery. In addition, we performed cluster and discriminant function analyses and revealed four distinct psychosocial profiles, which remained relatively stable in the course of time. Two profiles featured impaired psychosocial functioning while the other two of them were characterized by greater psychosocial stability.

Conclusion

Compared to baseline no worsening in mood and psychosocial functions was found three years after electrode implantation. Moreover, patients can be assigned to four distinct psychosocial profiles that are relatively stable in the time course. Since these subtypes already exist preoperatively the extent of psychosocial support can be anticipatory adjusted to the patients' needs in order to enhance coping strategies and compliance. This would allow early detection and even prevention of potential psychiatric adverse events after surgery. Given adequate psychosocial support, these findings imply that patients with mild psychiatric disturbances should not be excluded from surgery.

     

Factors associated with anxiety in family caregivers of children with chronic diseases

Background

Currently, information on factors associated with anxiety in family caregivers of children with chronic diseases is unavailable, indicating a significant gap in the literature. Therefore, this study aims to identify the psychosocial and sociodemographic variables associated with anxiety in family caregivers of children with chronic diseases.

Methods

In 2018, a nonprobability sample of 446 family caregivers was recruited at the National Institute of Health in Mexico City. The participants completed a sociodemographic variable questionnaire, clinical questions, and 18 psychosocial assessment scales, including a scale to assess family caregiver anxiety.

Results

Family caregiver anxiety was correlated with almost all psychosocial variables and one out of three clinical variables but with none of the sociodemographic variables. Furthermore, a multiple linear regression model with five psychosocial variables was established to predict family caregiver anxiety.

Conclusions

Some psychosocial variables have effects on caregiver anxiety that are relevant for interventions. Clinical interventions should be implemented based on the psychosocial variables associated with family caregiver anxiety.

     

Analysis of México’s Narco-War Network (2007–2011)

Since December 2006, more than a thousand cities in México have suffered the effects of the war between several drug cartels, amongst themselves, as well as with Mexican armed forces. Sources are not in agreement about the number of casualties of this war, with reports varying from 30 to 100 thousand dead; the economic and social ravages are impossible to quantify. In this work we analyze the official report of casualties in terms of the location and the date of occurrence of the homicides. We show how the violence, as reflected by the number of casualties, has increased over time and spread across the country. Next, based on the correlations between cities in the changes of the monthly number of casualties attributed to organized crime, we construct a narco-war network where nodes are the affected cities and links represent correlations between them. We find that close geographical distance between violent cities does not imply a strong correlation amongst them. We observe that the dynamics of the conflict has evolved in short-term periods where a small core of violent cities determines the main theatre of the war at each stage. This kind of analysis may also help to describe the emergence and propagation of gang-related violence waves.     

What the future held: childhood psychosocial adversity is associated with health deterioration through adulthood in a cohort of British women

Childhood psychosocial adversity is associated with accelerated onset of reproductive effort in women. Adaptive explanations for this phenomenon are built on the assumption that greater childhood psychosocial adversity is statistically associated with having a shorter period of healthy adult life during which reproduction will be possible. However, this critical assumption is never actually tested using individual-level longitudinal data. In this study, I revisit a large, longitudinally-studied cohort of British women. In an earlier paper, we showed that a simple index of psychosocial adversity in the first seven years of life predicted age at first pregnancy in a dose-dependent manner. Here, I show that the same index of adversity also predicts accelerated deterioration of health across the potentially reproductive period, and increased levels of the inflammatory biomarker c-reactive protein at age 44–46. These associations are robust to controlling for adult socioeconomic position, and do not appear to be solely a consequence of accelerated reproductive schedule. I argue that childhood psychosocial adversity may cause latent somatic damage that will, in adulthood, accelerate age-related physical decline. This provides a compelling adaptive rationale for the accelerated reproductive schedules observed in women who experience childhood psychosocial adversity.     

Health,humanitarian relief,and survival in former Yugoslavia.

Since the World Health Organisation''s effort in former Yugoslavia started in July 1992 it has been concerned with the public health policies of survival. It has provided advice to the United Nations High Commission for refugees, helped the voluntary agencies coordinate their work, assessed health needs, and provided practical help in the field to all parties to the conflict. Three features of the Bosnia war have particularly deplorable effects on health: ethnic cleansing, deliberate attacks on hospitals, and systematic rape. The WHO''s response has included initiatives in nutrition, winter survival, and medical supplies. This experience shows that the WHO can have a useful role complementary to that of other agencies in situations where the basic elements for survival of the population are seriously compromised by war.     

改良拔河针法对膝关节骨性关节炎患者远期关节功能和生活质量的影响

摘要 目的：探讨改良拔河针法对膝关节骨性关节炎患者远期关节功能和生活质量的影响，以期为膝关节骨性关节炎患者的治疗提供更加合理方案。方法：选取2016年3月至2019年10月深圳市中西医结合医院收治的60例膝关节骨性关节炎患者为研究对象。采用系统随机化法分为常规针刺组、改良拔河针法组各30例。常规针刺组采用常规针刺治疗，改良拔河针法组采用改良拔河针法治疗。分别于疗程结束时比较两组临床有效率，于治疗前、治疗后及治疗后3个月比较两组患者疼痛评级指数（PRI）评分、Oswestry功能障碍指数问卷表（ODI）评分及简明健康状况调查量表（SF-36）评分。结果：改良拔河针法组临床有效率86.67%，略高于常规针刺组的80.00%，但组间比较差异无统计学意义（P＞0.05）。组内比较显示，两组患者治疗后、治疗后3个月的PRI评分、ODI评分及SF-36评分较治疗前均降低（P＜0.05），且治疗后3个月的PRI评分、ODI评分及SF-36评分低于治疗后（P＜0.05）。组间比较显示，两组患者治疗前、治疗后PRI评分、ODI评分及SF-36评分比较差异均无统计学意义（P＞0.05），但改良拔河针法组治疗后3个月的ODI评分及SF-36评分优于常规针刺组（P＜0.05）。结论：改良拔河针法治疗膝关节骨性关节炎患者可获得普通针刺法相当的临床效果，且在改善患者远期关节功能和生活质量方面效果更佳，值得临床推广应用。     

Inching toward Armageddon: a psychiatric view

The existence of thermonuclear arsenals capable of destroying much of humanity takes its origins from, and has an influence on, processes that are largely psychological. The threat to use a single nuclear bomb to resolve contemporary conflict is an anathema in part because complex nation-states did not evolve with surviving a nuclear war in mind. The atomic arms race has proceeded apace because of maladaptive psychological mechanism including denial, distortion, projection, and, most relevantly, the need to enhance bonding within groups by creating stereotypes. One consequence of the arms race is a climate of fear and hopelessness, and especially destructive effect of which is seen in children. The physician's role in the prevention of nuclear war is critical, but divided between contradictory roles. On one hand, the physician is traditionally identified as a non-political advocate of the sick; on the other, as an advocate for the public health. It is this second model that enables physicians most legitimately to work for the prevention of nuclear war and to deal with the psychiatric concomitants of a planet drifting toward disaster.