Does the War End When the Shooting Stops? The Psychological Toll of War1

From the Frontline to the Homefront: The Experience of Israeli Veterans

In 1948, the state of Israel was created as a homeland for the Jewish people after 2,000 years of persecution and deportations in the diaspora. During the past 72 years, its inhabitants have experienced several wars and numerous terrorist attacks. Therefore, the issue of trauma goes beyond academic study, it is part of daily life. These circumstances have, unfortunately, turned Israel into a natural stress laboratory, which has enabled the systematic research of the biopsychosocial effects of traumatic stress on soldiers and civilians. This article reviews the findings of a series of studies that examine (a) the short- and long-term mental health effects of war on combat veterans; (b) the effects of repeated exposure to war on veterans; (c) trajectories of PTSD; and, specifically, (d) reactivation and (e) delayed-onset PTSD. We present the findings of two decades of systematic trauma research, which have followed the ongoing psychopathological effect of war on veterans. In understanding the ripple effects of trauma, it can be seen that veterans do not leave the events of the war behind once they are home; rather, it is with them wherever they go. Consequently, the trauma has a ripple effect that may carry over to veterans' spouses and offspring. The multiple manifestations and trajectories of both acute and chronic trauma will be presented. Clinical ramifications and implications will also be discussed.

Psychopathology of children of genocide survivors: a systematic review on the impact of genocide on their children`s psychopathology from five countries

Background

: The health consequences of genocides on children of survivors are increasingly discussed but conclusions have been conflicting.

Methods

We systematically reviewed studies from five electronic databases (EMBASE, PILOTS, PUBMED, PsycINFO, Web of Science), which used a quantitative study design and included: (i) exposure to the genocides of Armenians in Nazi Germany, Cambodia, Rwanda and Bosnia; (ii) mental health outcomes; (iii) validated instruments; (iv) statistical tests of associations. Study quality was appraised using a quality assessment tool for genocide studies. PRISMA reporting guidelines were followed.

Results

From 3352 retrieved records, 20 studies with a total of 4793 participants involving 2431 children of survivors and 2362 controls met the eligibility criteria. Studies were conducted in seven countries: Australia, Canada, Italy, Israel, Norway, Rwanda and the USAs over the past seven decades, using the Genocide Studies Quality Assessment Tool. Data from the high quality studies provide no consistent evidence that children of genocide survivors are more likely to have mental health problems than comparators who were not children of genocide survivors.

Conclusions

Methodological characteristics were associated with findings: studies investigating random samples of genocide survivors did not find an impact of genocides on health of children of survivors. Potential confounders (e.g. recent life events, poverty) need further investigation. Future studies of the impact of genocides on mental health should report using a standardized structure, such as the quality tool used here.

Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.

Living in danger: the impact of chronic traumatization and the traumatic context on posttraumatic stress disorder

In this article on the effects of chronic traumatization, research is reviewed regarding the association between chronicity of traumatization and posttraumatic stress disorder (PTSD) symptomatology. The contribution of the broader traumatic context to PTSD symptomatology is also examined. This review focuses on three populations: combat veterans, child sexual abuse survivors, and survivors of domestic violence. The challenges of defining chronicity of a traumatic event and traumatic context are addressed. Finally, suggestions for future directions are provided.

Posttraumatic stress symptoms in Croatian children exposed to war: a prospective study

This study examined symptoms of posttraumatic stress in 252 school-aged children from Osijek, Croatia, which was subjected to massive military attacks from Yugoslavian forces. The children's symptoms were assessed in 1994 while the war was still going on and 30 months later when the war was over. In addition to changes in posttraumatic stress disorder symptoms over time, the study examined the predictive power of (a) different types and number of war traumata, (b) loss of social community, (c) the children's demographic characteristics (age and gender), (d) types of coping strategies and locus of control, and (e) the perceived availability of different kinds of social support. Although symptoms of posttraumatic stress declined over time, 10% of the children reported a severe level of symptomatology 30 months after the war. The results supported the hypothesized predictive power of all investigated factors for predicting short- and long-term posttraumatic stress reactions.

CHRONIC IDENTITY DIFFUSION IN TRAUMATIZED COMBAT VETERANS

The traumatic effects of combat are elaborated as having long lasting deleterious effects on veterans. The modal age of combat duty for these veterans is seen as coinciding with Erikson's postulated stage of psychosocial development, when identity is hypothesized to be crystallizing. The spectrum of resulting symptoms and problems are conceptualized within the rubric of Post Traumatic Stress Disorder. The persistent identity diffusion with which these veterans present is addressed within the theoretical framework of psychosocial development. Treatment implications are discussed.