TY - JOUR
T1 - Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders
AU - Axinn, William g.
AU - Bruffaerts, Ronny
AU - Kessler, Timothy l.
AU - Frounfelker, Rochelle
AU - Aguilar-Gaxiola, Sergio
AU - Alonso, Jordi
AU - Bunting, Brendan
AU - Caldas-De-Almeida, José miguel
AU - Cardoso, Graça
AU - Chardoul, Stephanie
AU - Chiu, Wai tat
AU - Cía, Alfredo
AU - Gureje, Oye
AU - Karam, Elie g.
AU - Kovess-Masfety, Viviane
AU - Petukhova, Maria v.
AU - Piazza, Marina
AU - Posada-Villa, José
AU - Sampson, Nancy a.
AU - Scott, Kate m.
AU - Stagnaro, Juan carlos
AU - Stein, Dan j.
AU - Torres, Yolanda
AU - Williams, David r.
AU - Kessler, Ronald c.
AU - Al-Hamzawi, Ali
AU - Altwaijri, Yasmin a.
AU - Andrade, Laura helena
AU - Atwoli, Lukoye
AU - Benjet, Corina
AU - Borges, Guilherme
AU - Bromet, Evelyn j.
AU - Chatterji, Somnath
AU - Degenhardt, Louisa
AU - De girolamo, Giovanni
AU - Haro, Josep maria
AU - Harris, Meredith g.
AU - Hinkov, Hristo
AU - Hu, Chi-Yi
AU - De jonge, Peter
AU - Karam, Aimee nasser
AU - Karam, Georges
AU - Kazdin, Alan e.
AU - Kawakami, Norito
AU - Khaled, Salma
AU - Kiejna, Andrzej
AU - Mcgrath, John j.
AU - Medina-Mora, Maria elena
AU - Moskalewicz, Jacek
AU - Navarro-Mateu, Fernando
AU - Nishi, Daisuke
AU - Ten have, Margreet
AU - Viana, Maria carmen
AU - Vigo, Daniel v.
AU - Vladescu, Cristian
AU - Wojtyniak, Bogdan
AU - Woodruff, Peter
AU - Xavier, Miguel
AU - Zaslavsky, Alan m.
N1 - Publisher Copyright:
© 2023 American Medical Association. All rights reserved.
PY - 2023/6/20
Y1 - 2023/6/20
N2 - Importance: Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies.Objective: 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.Design, Setting, and Participants: 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.Exposures: 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.Main Outcomes and Measures: 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.Results: 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.Conclusions: 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.
AB - Importance: Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies.Objective: 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.Design, Setting, and Participants: 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.Exposures: 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.Main Outcomes and Measures: 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.Results: 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.Conclusions: 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.
UR - http://www.scopus.com/inward/record.url?scp=85163858395&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2023.18919
DO - 10.1001/jamanetworkopen.2023.18919
M3 - Article
C2 - 37338903
SN - 2574-3805
VL - 6
SP - 1
EP - 13
JO - JAMA Network Open
JF - JAMA Network Open
IS - 6
M1 - e2318919
ER -