War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks

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Abstract

This paper seeks to bridge the divisive split between advocates of trauma-focused and psychosocial approaches to understanding and addressing mental health needs in conflict and post-conflict settings by emphasizing the role that daily stressors play in mediating direct war exposure and mental health outcomes. The authors argue that trauma-focused advocates tend to overemphasize the impact of direct war exposure on mental health, and fail to consider the contribution of stressful social and material conditions (daily stressors). Drawing on the findings of recent studies that have examined the relationship of both war exposure and daily stressors to mental health status, a model is proposed in which daily stressors partially mediate the relationship of war exposure to mental health. Based on that model, and on the growing body of research that supports it, an integrative, sequenced approach to intervention is proposed in which daily stressors are first addressed, and specialized interventions are then provided for individuals whose distress does not abate with the repair of the social ecology.

Section snippets

Looking beyond the direct effects model

Recent interest in examining the ways in which war exposure and daily stressors might both contribute to mental health status has its roots in three sets of research findings: (1) the consistently large amount of unexplained variance in mental health outcomes when war exposure is used as the sole predictor of psychological distress (i.e., concern over the limited explanatory power of the direct effects model); (2) research with refugees in developed nations showing that that post-migration or

Why are daily stressors so stressful?

Having established the important contribution that daily stressors make to mental health and psychosocial functioning in conflict and post-conflict settings, it may be fruitful ask why daily stressors are so impactful. We suggest four reasons. First, daily stressors represent proximal or immediate stressors, whereas war exposure is often more of a distal experience, particular in post-conflict settings or situations of low intensity warfare where violence is episodic rather than constant.

Are daily stressors really daily? Unpacking the construct

In seeking to broaden the focus of research beyond the effects of direct war exposure, we suggested that research on major life events and daily hassles might offer a useful framework. On closer inspection, however, there are some reasonable objections that might be raised to this parallel. First, daily hassles are generally conceptualized as just that: hassles that occur on a daily basis. However, some of the phenomena we have considered in the category of daily stressors do not necessarily

Implications for intervention: a sequenced, integrated model

The findings from the literature we have reviewed in this paper suggest the potential utility of an integrated approach to intervention that addresses, in a sequential manner, both daily stressors (low intensity and potentially traumatic) and war exposure. They also suggest the utility of an empirically-informed set of guidelines for the allocation of mental health resources and the development of interventions aimed at improving mental health and psychosocial wellbeing in conflict and

Conclusion

In this paper, we have sought to bridge the longstanding and unhelpful division between advocates of trauma-focused and psychosocial approaches to understanding and addressing mental health needs in conflict and post-conflict settings. We have suggested that among the various factors underlying this split in the field is a fundamental difference in perception regarding what factors most critically affect mental health in the wake of organized violence. Until recently, there was a paucity of

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