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Findings from the World Mental Health Surveys of Civil Violence Exposure and Its Association with Subsequent Onset and Persistence of Mental Disorders

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dc.contributor.author Axinn, W.G.
dc.contributor.author Bruffaerts, R.
dc.contributor.author Kessler, T.L.
dc.contributor.author Frounfelker, R.
dc.contributor.author Aguilar-Gaxiola, S.
dc.contributor.author Alonso, J.
dc.contributor.author Bunting, B.
dc.contributor.author Caldas-De-Almeida, J.M.
dc.contributor.author Cardoso, G.
dc.contributor.author Chardoul, S.
dc.contributor.author Chiu, W.T.
dc.contributor.author Cía, A.
dc.contributor.author Gureje, O.
dc.contributor.author Karam, E.G.
dc.contributor.author Kovess-Masfety, V.
dc.contributor.author Petukhova, M.V.
dc.contributor.author Piazza Ferrand, Marina Julia
dc.contributor.author Posada-Villa, J.
dc.contributor.author Sampson, N.A.
dc.contributor.author Scott, K.M.
dc.contributor.author Stagnaro, J.C.
dc.contributor.author Stein, D.J.
dc.contributor.author Torres, Y.
dc.contributor.author Williams, D.R.
dc.contributor.author Kessler, R.C.
dc.date.accessioned 2023-09-06T20:45:09Z
dc.date.available 2023-09-06T20:45:09Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14072
dc.description.abstract 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 18212 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 16116 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. en_US
dc.language.iso eng
dc.publisher American Medical Association
dc.relation.ispartofseries JAMA Network Open
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Mental Health en_US
dc.subject Surveys en_US
dc.subject Civil Violence en_US
dc.subject Mental Disorders en_US
dc.subject.mesh Salud Mental
dc.subject.mesh Encuestas y Cuestionarios
dc.subject.mesh Violencia
dc.subject.mesh Trastornos Mentales
dc.title Findings from the World Mental Health Surveys of Civil Violence Exposure and Its Association with Subsequent Onset and Persistence of Mental Disorders en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1001/jamanetworkopen.2023.18919
dc.relation.issn 2574-3805


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