Rochelle Frounfelker1,2,3, Stephen E Gilman1,4,5,6, Theresa S Betancourt7,8, Sergio Aguilar-Gaxiola9, Jordi Alonso10,11,12, Evelyn J Bromet13, Ronny Bruffaerts14, Giovanni de Girolamo15, Semyon Gluzman16, Oye Gureje17, Elie G Karam18,19, Sing Lee20, Jean-Pierre Lépine21, Yutaka Ono22, Beth-Ellen Pennell23, Daniela G Popovici24, Margreet Ten Have25, Ronald C Kessler26. 1. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 2. SHERPA Research Centre, CIUSS Centre-Ouest de l-ile de Montreal, Montreal, QC, Canada. 3. McGill University Health Centre Research Institute, Montreal, QC, Canada. 4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 5. Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. 6. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 7. Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA. 8. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 9. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA. 10. Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. 11. Pompeu Fabra University (UPF), Barcelona, Spain. 12. CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 13. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA. 14. Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium. 15. Unit of Epidemiological and Evaluation Psychiatry, IRCCS-St. John of God Clinical Research Centre, Brescia, Italy. 16. Ukrainian Psychiatric Association, Kiev, Ukraine. 17. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. 18. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon. 19. Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon. 20. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong. 21. INSERM UMR-S 1144, Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, Paris, France. 22. Center for Cognitive Behavior Therapy and Training, Tokyo, Japan. 23. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. 24. National School of Public Health, Management and Professional Development, Bucharest, Romania. 25. Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. 26. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. kessler@hcp.med.harvard.edu.
Abstract
PURPOSE: Understanding the effects of war on mental disorders is important for developing effective post-conflict recovery policies and programs. The current study uses cross-sectional, retrospectively reported data collected as part of the World Mental Health (WMH) Survey Initiative to examine the associations of being a civilian in a war zone/region of terror in World War II with a range of DSM-IV mental disorders. METHODS: Adults (n = 3370) who lived in countries directly involved in World War II in Europe and Japan were administered structured diagnostic interviews of lifetime DSM-IV mental disorders. The associations of war-related traumas with subsequent disorder onset-persistence were assessed with discrete-time survival analysis (lifetime prevalence) and conditional logistic regression (12-month prevalence). RESULTS: Respondents who were civilians in a war zone/region of terror had higher lifetime risks than other respondents of major depressive disorder (MDD; OR 1.5, 95% CI 1.1, 1.9) and anxiety disorder (OR 1.5, 95% CI 1.1, 2.0). The association of war exposure with MDD was strongest in the early years after the war, whereas the association with anxiety disorders increased over time. Among lifetime cases, war exposure was associated with lower past year risk of anxiety disorders (OR 0.4, 95% CI 0.2, 0.7). CONCLUSIONS: Exposure to war in World War II was associated with higher lifetime risk of some mental disorders. Whether comparable patterns will be found among civilians living through more recent wars remains to be seen, but should be recognized as a possibility by those projecting future needs for treatment of mental disorders.
PURPOSE: Understanding the effects of war on mental disorders is important for developing effective post-conflict recovery policies and programs. The current study uses cross-sectional, retrospectively reported data collected as part of the World Mental Health (WMH) Survey Initiative to examine the associations of being a civilian in a war zone/region of terror in World War II with a range of DSM-IV mental disorders. METHODS: Adults (n = 3370) who lived in countries directly involved in World War II in Europe and Japan were administered structured diagnostic interviews of lifetime DSM-IV mental disorders. The associations of war-related traumas with subsequent disorder onset-persistence were assessed with discrete-time survival analysis (lifetime prevalence) and conditional logistic regression (12-month prevalence). RESULTS: Respondents who were civilians in a war zone/region of terror had higher lifetime risks than other respondents of major depressive disorder (MDD; OR 1.5, 95% CI 1.1, 1.9) and anxiety disorder (OR 1.5, 95% CI 1.1, 2.0). The association of war exposure with MDD was strongest in the early years after the war, whereas the association with anxiety disorders increased over time. Among lifetime cases, war exposure was associated with lower past year risk of anxiety disorders (OR 0.4, 95% CI 0.2, 0.7). CONCLUSIONS: Exposure to war in World War II was associated with higher lifetime risk of some mental disorders. Whether comparable patterns will be found among civilians living through more recent wars remains to be seen, but should be recognized as a possibility by those projecting future needs for treatment of mental disorders.
Entities:
Keywords:
Anxiety disorders; Civilians in war; Major depressive disorder; World War II
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