Early-Life Exposure to War and Later-Life Physical Functional Health.

OBJECTIVES: A growing body of research shows that early-life exposure to war has adverse effects on later-life health. Research has emphasized the importance of exposure timing implicating domain-specific developmental processes and associated critical/sensitive periods. This study looks at the impacts of early childhood war exposure and the repercussions for later-life physical and functional health, with a focus on time of exposure as a source of variability. METHODS: We use residential histories from the Survey of Health Ageing, and Retirement in Europe linked to external data on the location and timing of hostilities to examine the impact of early-life exposure to World War II on later-life physical and functional health. RESULTS: Exposure to war increases the risk of objective (grip strength, chair rise, and peak expiratory flow) and self-reported (mobility limitations and activities of daily living) measures of functional health. Effects are especially pronounced for those born during the war and for those with more prolonged exposures. There is little evidence that the impact of war is mediated by war-related hardships, socioeconomic conditions, health behaviors, or adult chronic disease. DISCUSSION: Our results suggest early-life exposure to war has a lasting impact on physical functional health. Exposure appears to largely operate via direct effects, indicative of altered initial development of physical capacity in early life. Because exposure was so pervasive among some cohorts of older individuals, understanding the health of present older European populations requires wrestling with the residual consequences of wartime exposure at the start of their lives.

The long-term effects of war exposure on psychological health: An experimental study with Turkish conscript veterans.

The study of the effects of war exposure on the psychological health of combatants has so far been constrained by possible selection biases which limits the establishment of causality, the clear identification of dynamics, and the generalizability of findings. In this study, we make use of a population-level natural experiment enabled by the strict military conscription system in Turkey which uses a draft lottery to randomly allocate conscripts to bases across the country, including those south-eastern areas experiencing a long running civil conflict. We build on this setting with a representative field survey of 5024 adult males. Our results indicate that those exposed to high intensity armed conflict environments during their service are more likely to experience depressive symptoms even long after their discharge. Further detailing conflict exposure, we find war traumas to be the primary drivers of the effects we observe.

Оцінювання потреб дорослого населення України у сфері охорони здоров’я, жовтень 2023 р.

Поточна повномасштабна агресія Російської Федерації продовжує створювати безпрецедентний тиск на всі аспекти суспільного життя в Україні. Попри масштабні негативні наслідки війни, результати опитування свідчать про те, що система охорони здоров’я в Україні залишається стійкою, а рівень доступу до послуг з охорони здоров’я є відносно високим.У регіонах, де на початку повномасштабного вторгнення велися активні бойові дії, було відновлено доступ до медичної допомоги, тож ситуація там уже незначущо відрізняється від регіонів, які не були охоплені активними бойовими діями. Утім, жителі областей, де тривають активні бойові дії, та в областях, частина територій яких, непідконтрольні Уряду України мають нижчий рівень доступу до послуг сімейних лікарів і лікарських засобів, ніж жителі решти території країни. У контексті доступу до послуг сімейних лікарів внутрішньо переміщені особи залишаються більш вразливою групою населення, ніж люди, які не покидали своїх громад.Цей звіт ґрунтується на даних щодо потреб населення України у сфері охорони здоров’я, зібраних у рамках четвертого раунду кількісного крос-секційного опитування зі слів респондентів. У ньому представлені результати опитування, проведеного в жовтні 2023 р.

Health needs assessment of the adult population in Ukraine: survey report: October 2023

The ongoing full-scale aggression by the Russian Federation continues to exert unprecedented pressure on all aspects of public life in Ukraine. Despite the significant negative impact of the war, the findings indicate that the country’s health system remains resilient, and that access to health services is relatively good. The regions that experienced active hostilities in the early stages of the invasion have regained access to medical care, and no longer differ significantly from the regions that did not experience active hostilities. However, residents of regions that are still experiencing active hostilities and areas that are not fully controlled by the Government of Ukraine have less access to family doctors and medicines than the rest of the country. In terms of access to a family doctor, people who have been internally displaced continue to be more vulnerable than local communities.This report is based on data collected in the fourth round of the quantitative cross-sectional survey of self-reported health needs of the general population in Ukraine. It presents the results of a survey conducted in October 2023.

Оцінювання потреб дорослого населення України у сфері охорони здоров’я: звіт за результатами опитування, квітень 2023 р.

Поточна повномасштабна агресія Російської Федерації продовжує створювати безпрецедентний тиск на всі аспекти суспільного життя в Україні. Попри масштабні негативні наслідки війни, результати свідчать про те, що система охорони здоров’я в Україні залишається стійкою, а рівень доступу до послуг з охорони здоров’я є відносно високим. У регіонах, де в перші дні повномасштабного вторгнення велися активні бойові дії, уже відновили доступ до медичної допомоги, тож ситуація там уже не суттєво відрізняється від регіонів, де активні бойові дії не велися. Утім, жителі регіонів, де досі ведуться активні бойові дії, та в областях, частина територій яких, непідконтрольні Уряду України, мають нижчий рівень доступу до сімейних лікарів і лікарських засобів, аніж жителі решти території країни. Якщо говорити про доступ до сімейних лікарів, внутрішньо переміщені особи залишаються в цьому плані більш вразливими, аніж люди, що залишилися у своїх рідних громадах. Цей звіт ґрунтується на даних щодо потреб населення України у сфері охорони здоров’я, зібраних у рамках третього раунду кількісного крос-секційного опитування респондентів. У ньому представлені результати опитування, проведеного у квітні 2023 р.

Effects of war exposure on pubertal development in refugee children.

Increasing research shows pubertal development accelerates following threats while it decelerates following deprivation. Yet, these environmental stressors are unlikely to occur in isolation. We investigated how war exposure and energetic stress impact pubertal development using data from the longitudinal Biological Pathways of Risk and Resilience in Syrian Refugee Children study. Our sample included 1,600 male and female Syrian refugee children and their caregivers who lived in temporary settlements in Lebanon. We hypothesized that (a) energetic stress suppresses pubertal development; (b) war exposure accelerates pubertal timing in boys and increases risk of menarche in girls, but only when energetic stress is low; and (c) when energetic stress is elevated, effects of war exposure on pubertal development will be attenuated. Among boys, we did not find support for Hypothesis 1, but Hypotheses 2 and 3 were supported. Exposure to morbidity/mortality threats accelerated pubertal timing; this effect was attenuated under conditions of elevated energetic stress. Among girls, we found support for Hypothesis 1, but not for Hypotheses 2 and 3. Elevated energetic stress decreased the risk of menarche in girls. Neither war exposure, nor any interactions with energetic stress, predicted risk of menarche. Sensitivity analyses revealed a significant interaction between bombing exposure and the amount of time since leaving Syria. Bombing decreased the risk of menarche, but only for girls who had left Syria four or more years prior to data collection. We discuss implications for translational efforts advocating for puberty screening in medical and mental health settings to identify trauma-exposed youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The longitudinal impact of war exposure on psychopathology in Syrian and Iraqi refugee youth.

BACKGROUND: War and natural disasters lead to forced migration - and increased risk of adverse psychological outcomes - in approximately 1% of the global population. Though recent years have brought a greater understanding of the consequences of war exposure on mental health outcomes for refugee children, little is known about the longitudinal and developmental impact of these experiences on youth. AIMS: The aim of this study was to assess the effect of direct exposure to war and/or combat on trajectories of symptoms related to anxiety and post-traumatic stress disorder (PTSD) in Syrian and Iraqi refugee youth following resettlement. Prevalence of possible anxiety disorders and PTSD was also assessed. METHOD: Participants included accompanied refugee youth resettled in the state of Michigan in the U.S. (n = 74). Youth filled out self-report measures of trauma exposure, anxiety symptoms, and PTSD symptoms upon arrival and 2 years later. Linear mixed-effects modeling was used to assess the effect of war exposure over time. RESULTS: Upon arrival, 38% screened positive for an anxiety disorder and 4.1% met diagnostic thresholds for PTSD. While war exposure did not predict changes to PTSD symptom trajectories (p = .481), anxiety symptoms increased over time among children reporting war exposure (B = 10.13, SE = 4.22, t = 2.40, p = .019). CONCLUSIONS: Our findings suggest that without appropriate interventions, anxiety- and trauma-related symptoms often do not decrease. Further, exposure to war trauma may lead to progressive worsening of symptoms. These findings suggest that assessing for type of trauma exposure, rather than focusing solely on migration status, may inform focused attention and interventions among trauma-exposed children resettling as refugees.

Оцінювання потреб дорослого населення України у сфері охорони здоров’я: звіт за результатами опитування, вересень 2022 року

Повномасштабне вторгнення в Україну призвело до зниження рівня доступу до послуг із охорони здоров’я та лікарських засобів у країні, особливо для людей, які проживають у регіонах, наближених до лінії фронту, і на територіях, які є частково або повністю непідконтрольними Уряду України, а також для внутрішньо переміщених осіб. Вартість, обмеження, пов’язані з часом, необхідним для того, щоб дістатися закладів охорони здоров’я і назад, та обмеження транспортного сполучення були основними перешкодами для доступу до основних послуг із охорони здоров’я. Водночас результати свідчать про те, що система охорони здоров’я в Україні залишається стійкою, а загальний рівень доступу до послуг із охорони здоров’я є досить високим. Цей звіт ґрунтується на даних щодо потреб населення України у сфері охорони здоров’я, зібраних за допомогою кількісного поперечного опитування зі слів респондентів. У ньому представлені результати першого раунду опитування, проведеного у вересні 2022 року, які можуть допомогти задовольнити специфічні потреби відповідних груп населення у сфері охорони здоров’я.

War exposure, posttraumatic stress disorder, and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war.

BACKGROUND: High rates of posttraumatic stress disorder (PTSD) have been documented in war-affected populations. The prevalence of Complex PTSD (CPTSD) has never been assessed in an active war zone. Here, we provide initial data on war-related experiences, and prevalence rates of ICD-11 PTSD and CPTSD in a large sample of adults in Ukraine during the Russian war. We also examined how war-related stressors, PTSD, and CPTSD were associated with age, sex, and living location in Ukraine. METHOD: Self-report data were gathered from a nationwide sample of 2004 adult parents of children under 18 from the general population of Ukraine approximately 6 months after Russia's invasion. RESULTS: All participants were exposed to at least one war-related stressor, and the mean number of exposures was 9.07 (range = 1-26). Additionally, 25.9% (95% CI = 23.9%, 27.8%) met diagnostic requirements for PTSD and 14.6% (95% CI = 12.9%, 16.0%) met requirements for CPTSD. There was evidence of a strong dose-response relationship between war-related stressors and meeting criteria for PTSD and CPTSD. Participants who had the highest exposure to war-related stressors were significantly more likely to meet the requirements for PTSD (OR = 4.20; 95% CI = 2.96-5.95) and CPTSD (OR = 8.12; 95% CI = 5.11-12.91) compared to the least exposed. CONCLUSIONS: Humanitarian responses to the mental health needs of the Ukrainian population will need to take account of posttraumatic stress reactions. Education in diagnosing and treating PTSD/CPTSD, especially in the situation of a significant lack of human resources and continuing displacement of the population, is necessary.

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children.

Altered secretion of cortisol, the primary effector of the hypothalamus-pituitary-adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6-18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.

Respiratory Health Among Older Adults in Vietnam: Does Earlier-Life Military Role and War Exposure Matter?

ObjectiveWe explore how earlier-life military roles and war trauma associate with later-life respiratory health in Vietnam. Method: The population-based sample aged 60+ is from the 2018 Vietnam Health and Aging Study. Poisson and binary logistic regressions investigate correlates of overall lung health, measured as total number of four conditions, and individual conditions, with focus on earlier-life wartime experiences. Results: Exposure is associated with lung conditions. Overall, a one-standard deviation increase in exposure results in 0.529 more conditions (p ≤ .001). Association varies across military roles and is partially explained by PTSD and smoking. Civilians heavily exposed to war trauma exhibit worse lung health than similarly exposed formal and informal military personnel. Discussion: Earlier-life war exposure is an important predictor of late-adulthood respiratory health in lower- and middle-income countries. Evidence calls for attention to the long-term impacts of war on health among not only formal and informal military personnel but also civilians.