The long-lasting effect of armed conflicts deaths on the living: Quantifying family bereavement.

Armed conflicts escalate combatant and civilian mortality and produce considerable levels of family bereavement. Yet, we know little about the prevalence of bereavement in conflict-affected populations. The violent loss of kin affects individuals across several dimensions, including trauma, mental health, socioeconomic status, and caregiving, especially during childhood and old age. Here, we propose a method to quantify population-level loss of parents and offspring in conflict-affected populations. Our analyses demonstrate that bereavement levels consistently surpass fatality rates in 16 conflict-affected settings. Using demographic projections, we show that these populations will continue to experience considerable levels of bereavement in the coming decades, independent of the future development of the respective conflicts. This quantification underscores bereavement as a profound yet understudied consequence of conflict with potentially far-reaching implications lingering long after the conflict's end.

Hope Groups: a protocol for a cluster randomized controlled trial of psychosocial, mental health, and parenting support groups for Ukrainian caregivers during war and conflict.

BACKGROUND: In 2021, more than two-thirds of the world's children lived in a conflict-affected country. In 2022, 13 million Ukrainians were forced to flee their homes after Russia's full-scale invasion. Hope Groups are a 12-session psychosocial, mental health, and parenting support intervention designed to strengthen parents, caregivers, and children affected by war and crisis. The primary objective of this study is to evaluate the effectiveness of Hope Groups among Ukrainians affected by war, compared to a wait-list control group. This protocol describes a promising decentralized intervention delivery model and an innovative research design, which estimates the causal effect of Hope Groups while prioritizing prompt delivery of beneficial services to war-affected participants. METHODS: This protocol describes a pragmatic cluster randomized controlled trial (RCT) among Ukrainians externally displaced, internally displaced within Ukraine, and living at home in war-affected areas. This study consists of 90 clusters with 4-7 participants per cluster, totaling approximately n = 450 participants. Intervention clusters will receive 12-session Hope Groups led by peer facilitators, and control clusters will be wait-listed to receive the intervention after the RCT concludes. Clusters will be matched on the facilitator performing recruitment and intervention delivery. Primary outcomes are caregiver mental health, violence against children, and positive parenting practices. Secondary outcomes include prevention of violence against women and caregiver and child well-being. Outcomes will be based on caregiver report and collected at baseline and endline (1-week post-intervention). Follow-up data will be collected among the intervention group at 6-8 weeks post-intervention, with aims for quasi-experimental follow-ups after 6 and 12 months, pending war circumstances and funding. Analyses will utilize matching techniques, Bayesian interim analyses, and multi-level modeling to estimate the causal effect of Hope Groups in comparison to wait-list controls. DISCUSSION: This study is the first known randomized trial of a psychosocial, mental health, and parenting intervention among Ukrainians affected by war. If results demonstrate effectiveness, Hope Groups hold the potential to be adapted and scaled to other populations affected by war and crisis worldwide. Additionally, methodologies described in this protocol could be utilized in crisis-setting research to simultaneously prioritize the estimation of causal effects and prompt delivery of beneficial interventions to crisis-affected populations. TRIAL REGISTRATION: This trial was registered on Open Science Framework on November 9, 2023. REGISTRATION: OSF.IO/UVJ67 .

Anxiety and depression symptoms among a sample of Khartoum civilians during the 2023 Sudan armed conflict: A cross-sectional study.

BACKGROUND: Mental health during armed conflicts is of paramount importance, as such situations often lead to increased risks of anxiety and depression symptoms among civilians. The military conflict between the Sudanese army and Rapid Support Forces, which began on April 15, 2023, is currently ongoing mainly in Khartoum State. Despite the significant impact of the conflict on the region, there is a lack of data regarding the mental health status of the residents. The aim of this study is to assess anxiety and depression symptoms among residents of Khartoum State during the first months of the 2023 military conflict. METHOD: We conducted a cross-sectional study among residents of Khartoum State between May 27 and June 19 using an online questionnaire. We used standardized screening questionnaires, namely the Generalized Anxiety Disorder (GAD-7) for anxiety and the Patient Health Questionnaire (PHQ-9) for depression. Multiple logistic regression was used to identify sociodemographic factors that are associated with anxiety and depression symptoms. RESULTS: Out of the 393 participants in the study, 70% had symptoms suggestive of depression and 57.3% suffered from anxiety symptoms. Both anxiety and depression were associated with being female (p < 0.001). Being married was a predictor of anxiety (p = 0.028) but not depression (p = 0.3). Other predictors were not significant (p > 0.05). CONCLUSION: High levels of anxiety and depression symptoms were prevalent among Khartoum residents during the conflict, with females and married individuals at higher risk. Immediate medical assessment is essential for identifying cases and providing support. Mental health services should be integrated into emergency response efforts, particularly focusing on vulnerable groups. Future research should address study limitations and explore coping strategies for anxiety and depression in Sudanese adults.

Continuous chains: childhood maltreatment and intimate partner violence victimization among displaced women in a war context.

BACKGROUND: Childhood victimization has been associated with long-term psychological effects and an increased risk of being victimized in later life. Previous research has primarily focused on sexual abuse during childhood, and a wide range of consequences have been identified. However, a significant gap remains in our understanding of the complex interaction between different forms of childhood abuse and violence in later life, particularly in the context of broader social stressors such as armed conflict and displacement. METHODS: This study examines the association between exposure to different types of childhood maltreatment in the context of family and intimate partner violence (IPV) among displaced women living in refugee camps in northern Iraq. Structured interviews were conducted by trained female psychologists with 332 women aged between 20 and 62 years. RESULTS: Results indicated that over one-third of the participating women reported experiencing at least one occurrence of IPV by their husbands within the past year. In addition, participants reported experiences of different types of maltreatment (physical, emotional, and sexual violence and physical and emotional neglect) perpetrated by family members in their childhood. While all forms of childhood maltreatment showed an association with IPV within the past year, only emotional childhood maltreatment was found to be a significant predictor of IPV in a multivariate analysis. CONCLUSION: The study highlights the ongoing impact of child maltreatment and its contribution to increased vulnerability to IPV victimization in later life. In addition, this study describes the specific cultural and contextual elements that contribute to IPV in refugee camps.

Magnitude of psychological distress and associated factors among war survivor women in Northern, Ethiopia, 2022: a community-based cross-sectional survey.

BACKGROUND: Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. METHODS: A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. RESULT: In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92). CONCLUSION: The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality.

Coping strategies of internally displaced persons and the host community in a region of armed conflict: A cross-sectional study.

BACKGROUND: Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones. METHODS: People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE). RESULTS: A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies. CONCLUSION: Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

Canadian Armed Forces Veterans' Perspectives on the Effects of Exposure to Children in Armed Conflict During Military Service: Protocol for a Qualitative Study.

BACKGROUND: The mental health of military personnel has garnered increased attention over the last few decades; however, the impacts of perpetuating, observing, or failing to prevent acts that transgress deeply held moral standards, referred to as moral injuries, are less understood, particularly in relation to encounters with children during deployment. This paper describes a multiphased research protocol that centers around the lived experiences of Canadian Armed Forces (CAF) Veterans to understand how encounters with children during military deployments impact the well-being and mental health of military personnel. OBJECTIVE: This study has four objectives: (1) highlight the lived experiences of CAF Veterans who encountered children during military deployments; (2) improve understanding of the nature of experiences that military personnel faced that related to observing or engaging with children during military service; (3) improve understanding of the mental health impacts of encountering children during military service; and (4) use participatory action research (PAR) to develop recommendations for improving preparation, training, and support for military personnel deployed to contexts where encounters with children are likely. METHODS: The research project has 2 main phases where phase 1 includes qualitative interviews with CAF Veterans who encountered children during military deployments and phase 2 uses PAR to actively engage Canadian Veterans with lived experiences of encountering children during military deployments, as well as health professionals and researchers to identify recommendations to better address the mental health effects of these encounters. RESULTS: As of January 26, 2024, a total of 55 participants and research partners have participated in the 2 phases of the research project. A total of 16 CAF Veterans participated in phase 1 (qualitative interviews), and 39 CAF Veterans, health professionals, and researchers participated in phase 2 (PAR). The results for phase 1 have been finalized and are accepted for publication. Data collection and analysis are ongoing for phase 2. CONCLUSIONS: Prioritizing and valuing the experiences of CAF Veterans has deepened our understanding of the intricate nature and impacts of potentially morally injurious events involving children during military deployments. Together with health professionals and researchers, the PAR approach empowers CAF Veterans to articulate important recommendations for developing and improving training and mental health support. This support is crucial not only during the deployment cycle but also throughout the military career, helping lessen the effects of moral injury among military personnel. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57146.

Factors associated with depression among war-affected population in Northeast, Ethiopia.

BACKGROUND: Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia. METHOD: A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULT: The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression. CONCLUSION: This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.

Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study.

Background: Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods: A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results: The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion: This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.

Health and well-being of young mothers displaced by conflict: Experiences from South Sudan and the Kurdistan Region of Iraq.

Giving birth during adolescence is linked to a variety of negative outcomes, including poor health and well-being. Girls who have been displaced by conflict are at increased risk for becoming young mothers. While prevalence rates and health outcomes have been documented, rarely have the complex personal narratives of early motherhood been examined from the perspectives of mothers themselves, particularly in the Global South. This study relies on in-depth, inductive, narrative analysis of qualitative interviews with 67 young mothers and 10 relatives in South Sudan and the Kurdistan Region of Iraq (KRI) who had been displaced by conflict. This study provides deep insights into the contributing circumstances and consequences of young motherhood from sexual and reproductive health and well-being perspectives, with additional insights on mothering in humanitarian crisis.

Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria.

BACKGROUND: Armed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. METHODS: We conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017-2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decision-making, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED. RESULTS: Exposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict-affected men were more likely to support a delay in girls' childbearing. CONCLUSION: Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

Cognitive and Relational Processes Associated to Mental Health in Italian High School Students during COVID-19 and Russian-Ukrainian War Outbreaks.

The negative impact of the COVID-19 pandemic on mental health has been widely demonstrated; however, few studies have investigated the psychological processes involved in this impact, including core beliefs violation, meaning-making disruption, interpersonal support, or one's relational functioning. This study explored the mental health of 215 Italian adolescents during the COVID-19 pandemic and the subsequent outbreak of the Russian-Ukrainian war. By administering a set of questionnaires, several cognitive and emotional variables were investigated, including core belief violation, meaning attribution to the pandemic and war, attachment, and emotion regulation, social media addiction, and relationships with significant others and teachers. We conducted some descriptive, mean difference, correlational, and predictive analyses that revealed a significant association between core belief violation caused by war and pandemic, ability to integrate war and pandemic within personal meaning universe, the relational support received, and mental health. The relationship with teachers during these challenging periods improved significantly according to the respondents' opinion, becoming both more authoritative and empathic. This study offers insights into what cognitive and relational processes are useful to intervene on to reduce the distress of adolescents who are facing significant moments of crisis due to events that challenge their cognitive and emotional balance.

The role of cumulative risk and armed conflict exposure in adolescent psychological symptoms in Turkey.

Exposure to risk factors and adversity may cause immediate, and sometimes prolonged, psychological symptoms in adolescents. Identifying universal and specific risk factors in a particular context and examining their cumulative effects is crucial for understanding the mechanisms underlying psychological symptoms and informing about strategies for intervention. Using concurrent measures, the current study aimed to examine the role of armed conflict experiences and cumulation of other risk factors (e.g., maternal psychological symptoms, socioeconomic indicators) in predicting adolescent psychological symptoms in an underresearched community. The sample included 161 adolescents (54.7% female) aged 11-14 years (M = 12.36, SD = 1.27) and their mothers living in the east of Turkey. The cumulative risk index was calculated by summing the standardized scores of the corresponding factors. Hierarchical multiple regression analyses were conducted to predict internalizing and externalizing symptoms among adolescents by introducing demographic variables (age, gender) in the first step, armed conflict experiences and cumulative risk in the second step, and their interaction in the final step. Results showed that the levels of internalizing and externalizing symptoms were predicted by gender, armed conflict experience and cumulative risk. Being a girl was associated with higher levels of internalizing symptoms and lower levels of externalizing symptoms. Higher levels of internalizing and externalizing symptoms were predicted by exposure to armed and cumulative risk. After controlling for other factors, the interaction of armed conflict experience and cumulative risk significantly predicted externalizing, but not internalizing symptoms. These findings suggested that cumulative risk was a stronger predictor of psychological symptoms, and further amplified the strength of the association between armed conflict experiences and externalizing symptoms. These findings can be used in the formulation of intervention strategies and policies to promote psychological well-being in adolescents living in armed conflict zones under multiple risks.

Social determinants, symptoms and mental problems in adults internally displaced by armed conflict. Soacha, Colombia, 2019.

OBJECTIVE: To characterise social determinants of health, mental health problems and potentially problematic symptoms in the adult population displaced by internal armed conflict in Colombia. METHODS: Cross-sectional descriptive study with a random sample of 98 adults forcefully displaced to Soacha, Colombia, due to internal armed conflict. The Self Report Questionnaire to detect potentially problematic mental health problems and symptoms, and a structured questionnaire on social determinants of health were applied. RESULTS: The median age was 38 [interquartile range, 28-46] years, and women predominated (69.39%). The median time since displacement was 36 [16-48] months, and time since settlement in Soacha, 48 [5-48] months. 86.32% survived on less than the minimum wage per month and 93.87% did not have an employment contract. 42.86% and 7.14% reported being owners of their homes before and after displacement, respectively. Upon arriving in Soacha, 79.60% went to primary support networks and 3% to institutions. Before displacement, 16.33% lacked health insurance and 27.55% afterwards. Regarding mental health problems; there were possible depressive or anxious disorders in 57.29%; possible psychosis in 36.73%; and potentially problematic symptoms in 91.66%, being more prevalent and serious in women (p = 0.0025). CONCLUSIONS: A deterioration in living conditions and a higher prevalence of potentially problematic mental health problems and symptoms was reported in displaced adult populations settled in Soacha compared to other regions of the country. Analyses with complementary perspectives are required to evaluate these differences.

A Systematic Review of Chronic Pain Management Interventions Among Veterans of Recent Wars and Armed Conflicts.

OBJECTIVES: To identify chronic pain management strategies aimed to reduce pain intensity and enhance functional outcomes in veterans of wars and armed conflict. DESIGN: Systematic review without meta-analysis. DATA SOURCES: Key words "chronic pain," "veterans," and "injuries" were used to search for articles in the MEDLINE, CINAHL, APA PsycInfo, and Embase databases. Articles published in English between 2000 and 2023 were included. REVIEW/ANALYSIS METHODS: A systematic literature search was conducted in June 2020, updated in April 2023, and managed using Covidence review software. Inclusion criteria focused on combat-injured veterans with chronic pain, excluding nonveterans and civilians treated for acute or chronic pain. Data from included studies were extracted, summarized, and critically appraised using the 2018 Mixed Methods Appraisal Tool. This review is registered with PROSPERO (CRD42020207435). RESULTS: Fourteen studies met the inclusion criteria, with 10 of them supporting nonpharmacological approaches for managing chronic pain among veterans of armed conflicts and wars. Interventions included psychological/behavioral therapies, peer support, biofeedback training via telephone-based therapy, manual therapy, yoga, cognitive processing therapy, cognitive-behavioral therapy, and social and community integration to reduce pain intensity and enhance functional outcomes. CONCLUSION: Nonpharmacological treatments for chronic pain have increased in recent years, a shift from earlier reliance on pharmacological treatments. More evidence from randomized controlled trials on the benefits of combined pain interventions could improve pain management of veterans with complex care needs.

The impact of 24/7 news coverage on the mental health of Israelis in the 'Iron Swords' War: A cross-sectional analysis among television audience.

This study aims to assess the impact of continuous 24/7 news broadcasting on the mental well-being of Jewish Israelis during the 'Iron Swords' War and compare it to findings from the 2014 Conflict. An internet-based cross-sectional panel survey was conducted on 11-12 October 2023, during the 'Iron Swords' War. The study focused on Israel's adult Jewish population, enabling comparisons with a previous 2014 study. Participants reported news consumption changes, attitudes towards newscasts (burdensome, relaxing, stressful, addictive, Fear Of Missing Out [FOMO], avoidance), opinions on 24/7 news, and anxiety symptoms. Among 802 adult Jewish participants in Israel, 83.8% increased news consumption. While more than 70% of respondents found the newscast stressing at least a medium level, more than 40% said they do not try to avoid them at all. Nearly 24% found it much addictive. Women and younger individuals reported more FOMO, stress, and addiction. More than 70% reported experiencing at least one anxiety symptom, and 21% of all four. Linear regression explained 42.9% of the variance of reported anxiety, with gender, age, news stress, addiction, and FOMO as predictors. The current study results show an increase in all measurements compared to a separate study conducted using the same tools in 2014. Jewish Israelis struggled with news consumption during the recent war, harming mental health. Heightened anxiety was observed, compared to 2014, and affected all demographics.

A longitudinal study of societal resilience and its predictors during the Israel-Gaza war.

This study assesses the resilience of Israeli society during the ongoing Israel-Gaza conflict and pinpoints factors that influence this resilience in prolonged national crises. A longitudinal study was carried out with two surveys, both using the same questionnaire to gage societal, community, and individual resilience levels, along with hope, morale, distress, perceived threats, and government support. The initial survey was administered 5 days after the war escalated and the second 1 month later. The study's results reveal a decline in societal resilience over time. The regression analysis identified four major associations at both resilience measurement points. The key variables are community resilience and hope, both contributing positively. Attitudes towards government support (specifically being a government supporter vs. an opponent) also played a role. Additionally, there was a negative association with levels of religiosity, particularly distinguishing between ultra-orthodox and secular individuals. In the temporal analysis predicting future resilience (from data at the first time point to predict resilience at the second time point), societal resilience at the first measurement was the strongest forecaster of its resilience at the second measurement. Additionally, the main continuous variable from the previous analysis, community resilience, continued to be an influential and positive forecaster in the time-based analysis. The research suggests that the initial unifying effect of the conflict, similar to a "Rally around the flag" phenomenon, may be short-lived. The study underlines the importance of community strength, hope, government support, and religious considerations in shaping societal resilience in the face of conflict.

Exploring the Self-Reported Physical and Psychological Effects in a Population Exposed to a Regional Conflict.

BACKGROUND: Conflict profoundly impacts community health and well-being. While post-conflict research exists, little is known about initial effects during active hostilities. OBJECTIVE: To assess self-reported changes in health behaviors, distress, and care access within one month of regional warfare onset in a conflict-affected community. METHODS: An online survey was conducted in November 2023 among 501 residents (mean age 40.5 years) of a community where war began October 7th. Measures evaluated physical health, mental health, diet, substance use, sleep, weight changes, and healthcare access before and after the declaration of war. RESULTS: Relative to pre-war, respondents reported significantly increased rates of tobacco (56%) and alcohol (15%) consumption, worsening sleep quality (63%), elevated distress (18% sought help; 14% needed but didn't receive it), and postponed medical care (36%). Over a third reported weight changes. Distress was higher among females and those endorsing maladaptive coping. CONCLUSION: Within one month, substantial impacts on community psychosocial and behavioral health emerged. Unmet mental health needs and risk-taking behaviors were early indicators of conflict's health consequences. Continuous monitoring of conflict-affected communities is needed to inform tailored interventions promoting resilience and prevent entrenchment of harms over time.

Mental health consequences among Sudanese due to the armed conflicts and civil unrest of 2023: a cross-sectional study.

AIM: To investigate depression, anxiety, PTSD, and insomnia levels among Sudanese citizens during the 2023 Armed Forces conflict in Sudan. METHODS: An online survey was distributed. It is composed of five parts, covering the following areas: (a) sociodemographic data; (b) depression assessment; (c) generalized anxiety disorder assessment; (d) post-traumatic stress disorder assessment; and (e) insomnia assessment.Statistical Package for Social Sciences version 27 was used for data analysis; frequency and percentage were used to describe the qualitative variables. The Pearson correlation coefficient and Chi-square test were used for correlation and association analysis; a p-value equal to or less than .05 was considered statistically significant. RESULTS: The study included 221 participants, whose ages were 35.02 ± 11.83 years. Among the participants, 57.5% were female. The length of stay in the war zone was 39.29 ± 31.71 days. The sound of gunfire, bombs, or explosions was the most frequent war violence personally experienced by participants or their family members, friends, or acquaintances, in 203 (91.8%) and 221 (100%), respectively. Moderate-severe and severe depression were present in 25.3% and 62.0%, respectively. Moderate and severe anxiety were present in 36.2% and 52.9%, respectively. 58.8% had PTSD. Sub-threshold insomnia was present in 57.5%. There was a negative correlation between sex (female) and depression (correlation coefficient = -.183, p-value = .006), which indicates that depression is more likely to be in females. For PTSD, there was a negative correlation between age and PTSD (correlation coefficient = -.150, p-value = 0.026), which indicates that younger age groups were more likely to experience PTSD. Additionally, there was a negative correlation between marital status (married) and PTSD (correlation coefficient = -.175, p-value = .009), which indicates that married participants were more likely to experience PTSD. CONCLUSIONS: Exposure to war-related trauma can also lead to mental health issues. These findings emphasize the urgent need for proper mental health support and interventions in war-affected areas to address the prevalent mental disorders.