Life outcomes influenced by war-related experiences during the Gulf crisis

Mediating effect of intolerance of uncertainty between feeling of unsafety and depression/well-being among a sample of Lebanese adults

BACKGROUND

Eastern Mediterranean countries, particularly Lebanon, have seen a significant rise in mental disorders, primarily driven by ongoing economic instability, political unrest, and regional conflicts. These conditions fuel feelings of unsafety, which are linked to lower psychological well-being and increased depressive symptoms. Unsafe circumstances inflate apprehension and uncertainty, leaving individuals unable to foresee a stable, secure tomorrow and often trapped in an anticipatory negative thinking state. Therefore, this study posits that in unsafe environments, Intolerance of Uncertainty (IU) may mediate the relationships between the feeling of unsafety and depression/well-being and aims to test this hypothesis among a sample of adults from Lebanon, a frequently crisis-ridden country.

METHODS

A one-time-point online survey was conducted among Lebanese adults from the general population (N = 905; mean age = 27.38 (SD: 9.28); 60% females), recruited anonymously via snowball sampling. The questionnaire included socio-demographic variables and the following Arabic validated scales: Feeling of Unsafety Scale- Arabic (FUSA), World Health Organization Well-Being Index (WHO-5), Patient Health Questionnaire-9 (PHQ-9), and Intolerance of Uncertainty Scale (IUS-12). Statistical analysis was performed using SPSS v.27 with mediation analysis via PROCESS MACRO v3.4 Model 4.

RESULTS

After adjusting for potential confounders, mediation analysis showed that both prospective and inhibitory anxiety fully mediated the association between the feeling of unsafety and depression and partially mediated the association between the feeling of unsafety and well-being. Higher feeling of unsafety was significantly associated with higher prospective and inhibitory anxiety (Beta = 0.32; p < 0.001; 95% CI 0.27; 0.37 and Beta = 0.19; p < 0.001; 95% CI 0.15; 0.23 respectively), which in turn were significantly associated with higher depression (Beta = 0.42; p < 0.001; 95% CI 0.35; 0.48 and Beta = 0.62; p < 0.001; 95% CI 0.54; 0.70 respectively) and lower well-being (Beta = - 0.39; p < 0.001; 95% CI -0.44; -0.33 and Beta = - 0.39; p < 0.001; 95% CI -0.47; -0.32 respectively). It is of note that while higher feeling of unsafety did not show a direct association with higher depression (Beta = - 0.03; p = 0.187; 95% CI -0.09; 0.02 and Beta = -0.02; p = 0.399; 95% CI -0.07; 0.03 respectively), it was significantly and directly associated with lower well-being (Beta = - 0.07; p < 0.01; 95% CI -0.12; -0.03 and Beta = - 0.12; p < 0.001; 95% CI -0.17; -0.07 respectively).

CONCLUSION

The hypothesis that IU mediates the relationships between the feeling of unsafety and depression/well-being is confirmed. This finding highlights a key target for interventions. Psychotherapeutic and public mental health initiatives could enhance psychological well-being by dedicating efforts to promoting uncertainty tolerance, particularly in vulnerable populations facing unstable settings.

First Onset in Adulthood of Mental Disorders: Exposure to War vs. Non-war Childhood Adversities: A National Study

Background

There is evidence that some childhood trauma increases the risk of the first onset of mental disorders and for the first time into adulthood. There are no studies that assessed whether exposure to war has this delayed long-term effect.

Objectives

To fill this gap by investigating the comparative roles of war and non-war trauma on the first onset of adulthood mood and anxiety disorders.

Methods

A nationally representative sample of 2,857 Lebanese was assessed using the World Health Organization Composite International Diagnostic Interview 3.0. with the onset of exposure to trauma and of first onset of mood and anxiety disorders.

Results

Non-war childhood traumata especially those belonging to family malfunctioning continue to exert their effect for the first time well beyond their occurrence as they were the most universal predictors for adult onset of both mood and anxiety disorders. War trauma during childhood predicted mood anxiety and mood (anxiety only in males) only below age 18 y. war childhood trauma predicts the first onset of mood and anxiety disorders before age 18 y in females, but only anxiety in males.

Conclusion

Childhood traumata are not equal in predicting the first onset of mood and anxiety disorders into adulthood. Family malfunctioning looks to carry the longest such risk and war more of shorter immediate effects. This might change though with re-exposure to war in adulthood which might unravel dormant vulnerability.

Trajectories of Posttraumatic Stress in Youths After Natural Disasters

IMPORTANCE

Disaster exposure is associated with the development of posttraumatic stress (PTS) symptoms in youths. However, little is known about how to predict which youths will develop chronic PTS symptoms after disaster exposure.

OBJECTIVE

To evaluate PTS symptom trajectories among youths after 4 major US hurricanes and assess factors associated with those trajectories.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used integrative data analysis to combine data from 4 studies of youths' responses to natural disasters (hurricanes Andrew [1992], Charley [2004], Ike [2005], and Katrina [2008]) at time points ranging from 3 to 26 months after the disasters. Those studies recruited and surveyed youths aged 6 to 16 years at schools via convenience sampling of schools near the path of destruction for each hurricane. This study was conducted from August 2017 to August 2020, and pooled data were analyzed from February 2019 to October 2020.

EXPOSURE

Experience of a natural disaster during the ages of 6 to 16 years.

MAIN OUTCOMES AND MEASURES

Posttraumatic stress symptoms were assessed using the University of California, Los Angeles, Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) and the UCLA PTSD-RI-Revised. Latent class growth analyses were used to evaluate the youths' PTS symptom trajectories and associated factors.

RESULTS

Among 1707 youths included in the study, the mean (SD) age was 9.61 (1.60) years, 922 (54%) were female, and 785 (46%) self-identified as White non-Hispanic. Four PTS symptom trajectories were identified: chronic (171 participants [10%]), recovery (393 [23%]), moderate-stable (563 [33%]), and low-decreasing (580 [34%]). Older youths were less likely to be in the chronic group; compared with the chronic group, each 1-year increase in age was associated with increased odds of being in the other groups (recovery: odds ratio [OR], 1.78 [95% CI, 1.29-2.48]; moderate-stable: OR, 1.94 [95% CI, 1.43-2.62]; and low-decreasing: OR, 2.71 [95% CI, 1.99-3.71]). Compared with males, females had higher odds of being in the chronic group than in any other group (recovery group: OR, 0.48 [95% CI, 0.26-0.91]; moderate-stable group: OR, 0.37 [95% CI, 0.21-0.64]; and low-decreasing group: OR, 0.25 [95% CI, 0.14-0.44]).

CONCLUSIONS AND RELEVANCE

In this cohort study, few youths reported chronic distress, and trajectories among most youths reflected recovery or low-decreasing PTS symptoms. Older age and identification as male were factors associated with decreased odds of a chronic trajectory. Youths with chronic or moderate-stable trajectories may benefit from intervention.

Childhood exposure to violence is associated with risk for mental disorders and adult's weight status: a community-based study in Tunisia

BACKGROUND

We sought to investigate the relationship between social violence and adult overweight/obesity and the role of common mental disorders (CMD) in mediating this relationship.

METHODS

A cross-sectional study was conducted from January to June 2016 in Tunisia. Participants were selected from randomly selected Primary Health Care Centers. The Arabic version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used.

RESULTS

A total of 2120 participants were included. Women exposed to social ACEs had higher rates of overweight/obesity than men (13.5 versus 9.5%; P = 0.004). For women, statistically significant partial mediation effects of CMD were observed for exposure to community violence (% mediated = 17.7%). For men, partial mediation was found for the exposure to peer violence (% mediated = 12.5%).

CONCLUSION

Our results provide evidence of the independent increase of overweight/obesity after exposure to social ACEs. Efforts to uncover and address underlying trauma in health care settings may increase the effectiveness of obesity interventions.

Posttraumatic Stress Symptom Trajectories Among Children After Disaster Exposure: A Review

Natural disasters, such as hurricanes and floods, are increasing in frequency and scope. Youth exposed to disasters are at risk for developing posttraumatic stress symptoms (PTSS). However, not all youth who report initially elevated PTSS report persistent PTSS that last beyond the first three to six months postdisaster. Thus, it is crucial to understand how and why youth differ in their patterns of PTSS. This study reviewed the literature on children's postdisaster PTSS, evaluating the typical number and types of patterns for children's PTSS trajectories, as well as risk and protective factors predicting trajectory membership. This review identified eight empirical studies on youth PTSS trajectories following natural disasters; these studies included 8,306 children aged 3 to 18 years. All studies identified resilience, recovery, and chronic trajectories. Evidence for a delayed trajectory was mixed. Proportions of children falling into each trajectory varied widely across studies, but overall, resilience was the most prevalent trajectory. These findings were consistent across study factors (i.e., analytic strategy, assessment timing, and study selection criteria). Female gender, disaster exposure, negative coping, and lack of social support were significant risk factors for chronic trajectories across several studies. Future research should combine individual level participant data across studies of children's responses to disasters to better understand PTSS trajectories.

Age-Period-Cohort Modeling of Multiple Sclerosis Incidence Rates in Kuwait: 1980-2014

BACKGROUND

Multiple sclerosis (MS) is a complex immune-mediated disorder of the central nervous system with undefined etiology. Genetic predisposition and environmental factors play an imperative role in MS causation and its sustained increasing burden worldwide. This study examined the age, period, and cohort effects on MS incidence rates in Kuwait.

METHODS

In this retrospective cohort study, data on MS cases diagnosed between January 1, 1980 and December 31, 2014 and registered in National MS Registry and reference population were obtained. Age-period-cohort (APC) analysis was conducted using a loglinear Poisson regression model to supplement the descriptive and graphical presentation. Descriptive statistics were complemented with APC parameters' estimates including net drift, local drift, age at onset curve, and longitudinal age trend. Age effect was presented as incidence rates (per 105 person-years), whereas period and cohort effects were presented as adjusted relative rates.

RESULTS

A total of 1,131 cases were diagnosed in 1,385,923 person-years. Overall age-standardized MS incidence rate was 64.5 (95% CI 52.4-79.8). An estimated annual percentage change revealed 7.4% annual increase in MS incidence rate during the study period (Net drift = 7.4%; 95% CI 4.1-10.8%). APC "fitted" age-at-onset curve showed a bimodal pattern with peaked incidence rates at 20-24 years and 45-49 years of age. Compared with the referent period (1980-1984) and cohort (1970-1974), MS incidence rates progressively and significantly (p < 0.001) increased during subsequent time periods and in successive cohorts. Results of APC analysis are descriptive in nature and specific etiological hypotheses were not evaluated. However, the findings of this study substantiated the notion of multiplicity of genetic and/or environmental risk factors' contributions.

CONCLUSION

A substantial increase in MS incidence rates was recorded, which significantly varied in all 3 temporal dimensions during the study period. Future studies may contemplate biological basis for recorded temporal increase in MS risk.

Displaced Syrian children's reported physical and mental wellbeing

BACKGROUND

Surviving a warzone inflicts harmful consequences on the physical health and the psychosocial wellbeing of children. This study aimed at exploring the physical and psychosocial perceived state of health of displaced Syrian refugee children in Jordan.

METHODS

A cross-sectional explorative design was applied. Structured questionnaires were used to collect data through face-to-face interviews with 250 Syrian refugee children. Descriptive and inferential statistics were used.

RESULTS

Children had fair levels of physical health; their health concerns were minor. Psychosocially, 25% (n = 63) suffered from loneliness and 24% (n = 59) reported feeling depressed. The majority of children (>60%) had low rates of somatic pain. Age had a negative correlation with hyperactivity (r = -.14, p = .034); gender differences were found in anger expression and anger trait (p < .05).

CONCLUSIONS

The results in this study highlight a number of physical and psychosocial health concerns among refugee children. The health needs of displaced Syrian children need to be addressed using comprehensive assessment and care. Our findings documented the physical and psychosocial health needs of the displaced Syrian children in Jordan and addressed areas of focus to guide health promotion interventions and community health efforts for them.

Schools and Disasters: Safety and Mental Health Assessment and Interventions for Children

This article draws on experiences and lessons from global disasters and utilizes the United Nations Comprehensive School Safety Framework to highlight the necessary role of safe schools in protecting children, as well as adult staff, from the immediate threats and long-term implications of disasters. Specifically, we focus on three well-established pillars of school safety: Pillar I: Safe Learning Facilities; Pillar II: Disaster Management; and Pillar III: Risk Reduction and Resilience Education. In addition, we propose a potential fourth pillar, which underscores the function of schools in postdisaster mental health assessment and intervention for children. We argue that schools offer a central location and trusted institutional space for mental health assessment and intervention after disasters. We also examine the important linkages between schools, child mental health, and household and family recovery. We conclude with recommendations for filling gaps in research and practice related to ensuring the safety of schools and the associated health and well-being of children in the face of future disasters.

Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability

OBJECTIVE

To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability.

PARTICIPANTS

Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009).

DESIGN AND MAIN OUTCOME MEASURES

The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model.

RESULTS

ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health.

CONCLUSIONS

ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.

School performance after experiencing trauma: a longitudinal study of school functioning in survivors of the Utøya shootings in 2011

BACKGROUND

The psychological impact on survivors of terrorism has been well documented. However, studies on adolescent survivors and the academic performance of high school students following a terrorist attack are lacking.

OBJECTIVE

This study investigated academic performance, absenteeism, and school support amongst survivors of a terrorist attack in Norway.

METHOD

Data from a longitudinal interview study were linked to officially registered grades of students (N=64) who successfully completed their 3-year senior high school program. Statistical tests of mean differences and linear regression were used to compare the survivors' registered grades with the national grade point average, before and after the event, as well as to assess absenteeism, self-reported grades and to test the association with school support.

RESULTS

The students' grades were lower the year after the event than they had been the year before, and they were also lower than the national grade point average (p<0.001). However, their grades improved in the last year of high school, indicating possible recovery. Absence from school increased after the event, compared to the previous year. However, students reported high satisfaction with school support.

CONCLUSION

The results indicate that academic functioning was reduced in the year after the traumatic event, but for students who successfully completed high school, the school situation improved 2 years after the event. The findings underscore the importance of keeping trauma-exposed students in school and providing support over time. A more defined educational approach to maintaining school attendance and educational measures which compensate for learning loss are needed in trauma-sensitive teaching.

Parent and child distress after war exposure

OBJECTIVES

The purpose of this study was to examine multiple distress symptoms (i.e., post-traumatic stress [PTS], anxiety, depression) among parents and children exposed to the Gulf Crisis in 1990-1991. Profiles of parent distress were identified, and the relationship between parent distress and specific child distress symptoms was examined.

DESIGN

Parents and children were assessed at one time point.

METHODS

Participants included 151 children (Mage = 10.62 years; 51% female) and 140 parents (Mage = 40 years; 81% female).

RESULTS

Utilizing latent profile analysis, three parallel profiles of parent distress were identified: low distress, moderate distress, and high distress. Parent distress was a risk factor for child depression, but it was not a risk factor for child PTS or anxiety.

CONCLUSIONS

Findings support the importance of broadening the scope of research conducted after exposure to traumatic events to include the assessment of anxiety and depression, as well as PTS, among both parents and children. Additional implications for research and clinical work are discussed.

PRACTITIONER POINTS

Findings support the importance of screening for multiple distress symptoms among both children and parents after war exposure. Based on our findings, clinicians may want to consider including parents in therapy for children reporting psychological distress, especially depression symptoms, after exposure to traumatic events. This study was cross-sectional. Thus, we are not able to infer direction or causality. The generalizability of our study should be interpreted with caution, as findings will need to be replicated across other populations and other cultures.