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.

Juggling multiple roles: Navigating challenges and uncertainties in nursing practice, education, and research during wartime in Israel.

The events of October 7, 2023, marked a turning point for Israel, plunging the nation into a state of existential dread and uncertainty due to an ongoing conflict. The nursing profession is multifaceted and can encompass simultaneously diverse roles within various settings, including direct patient care, education, and research. In regular times, there is a delicate balance between mastering these three roles. Yet, in times of war, there is a threat to this balance. The manuscript highlights the personal, unique struggles of nursing doctoral students balancing clinical duties, teaching responsibilities, and research commitments during a war. The authors reflect on their experiences and challenges related to clinical-professional, academic, and personal dimensions as doctoral students. The manuscript highlights the connection between significant events and the resilience and determination among nursing doctoral students and future generations of academics. It provides recommendations to help attenuate the additional stresses experienced by nurses during war. These interventions will not mitigate the complexity and challenges of juggling our multiple professional roles. However, the awareness of these challenges can lead to growth and achievement in patient care, professional and personal development, and academic excellence.

Adaptive coping during protracted political conflict, war and military blockade in Gaza.

Identifying culturally-relevant concepts and coping mechanisms can help protect civilian wellbeing. This study explores how seven professional Palestinian university graduates in the Gaza Strip (occupied Palestinian territories) cope with war, military occupation, military blockade and the challenges of living in a conflict-affected area. Participants were interviewed to determine whether culturally specific modes of coping were used. Thematic analysis was applied. The use of resistance and more specifically sumud, 1 being steadfast and persevering, were identified alongside the motivation to persevere and other adaptive responses to living conditions. Coping strategies identified in this study include adapting, problem-solving, accepting reality, exercising patience, utilising social support, and faith in God (iman) and religion. The implications of this study and the relevance of the findings to mental health and disaster relief are considered.

A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon.

BACKGROUND: Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. METHODS: A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees' community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. RESULTS: Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. CONCLUSION: Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.

Parental Wartime Deployment and Socioemotional Adjustment in Early Childhood: The Critical Role of Military Parents' Perceived Threat During Deployment.

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3-6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers' trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers' perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, ß = .36, p = .007. The association between fathers' perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent-child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.

The relationship between multiple exposures to violence and war trauma, and mental health and behavioural problems among Palestinian children and adolescents.

The current study aims to investigate the effect of cumulative exposure to violence on mental health amongst children and adolescents living in the Gaza Strip. The sample consists of 1029 children and adolescents aged 11-17 years. Of them, 533 (51.8%) were female and 496 (48.2%) were male. War-traumatic events were measured using the War-Traumatic Events Checklist (W-TECh). Violence was derived from the Multicultural Events Schedule for Adolescents (M.E.S.A.) containing three domains: violence at home, violence in the neighbourhood, and violence at school. Emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). Posttraumatic Stress Disorder was measured using the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Finally, depression symptoms were measured by the Depression scale. Around two thirds of the children (64.5%, N = 665) reported that they were exposed to violence at home, 48.2% (N = 497) to violence in the neighbourhood, 78.2% (N = 806) to violence at school. In addition, boys significantly showed more exposure to violence compared to girls. Moreover, the prevalence of PTSD according to DSM-5 is 53.5% (N = 549). The results also showed that cumulative effect of exposure to violence in more contexts (political war trauma, violence at home, neighbourhood and/or school) predicted higher levels of PTSD, social and emotional problems, depression, and overall mental health problems amongst children. Cumulative exposure to violence may increase the propensity of developing mental health problems such as PTSD, emotional and behavioural problems, and depression symptoms and thus interventions should be targeted to these populations.

Could Combat Stress Affect Journalists' News Reporting? A Psychophysiological Response.

Covering war conflicts may compromise the psychological and physical health of journalists because chronic exposure to these environments has been related to depression, memory dissociative processes, and post-traumatic stress disorder; however, acute effects have not been studied yet. Thus, a combat simulation was carried out replicating actual warfare scenarios, including personnel and equipment. Psychophysiological response, memory, and information-processing were analysed of 40 professional soldiers (21 males and 19 females) and 19 journalists (12 males and 7 females) with international experience in current conflict areas such as Afghanistan, Iraq, Bosnia and Herzegovina, and Kosovo, in relation to their experience of a combat intervention. A significant increase (p < 0.05) in metabolic, muscular, cardiovascular, and cortical and psychological anxiety response, as well as a decrease in memory accuracy directly after and 24 h and 72 h post-combat were found; these modifications were modulated by the nature of the stimulus. Journalists presented higher cognitive and memory impairment than soldiers, resulting in a press reporting of real events accuracy of only 27%.

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip.

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict-affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi-structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as 'on hold'. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised.

Caring for Child Psychotrauma: Lessons from Bosnia.

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.

War Atrocities and Growing Up: Risks We Have to Think About.

The establishment of the United Nations after World War II raised hopes of a new era of peace. This was over-optimistic. Between 1945 and 1992, there were 149 major wars, killing more than 23 million people. Recent developments in warfare have significantly heightened the dangers for children. During the last decade child war victims have included: 2 million killed; 4-5 million disabled; 12 million left homeless; more than 1 million orphaned or separated from their parents; some 10 million psychologically traumatized. Researches indicate that children do develop PTSD after experiencing very stressful, life-threatening events such as happen in war. Wars of 21st century are often guerrilla-type civil wars in which women and children are not only the main victims, but are deliberately targeted. Thousands are displaced both internally and across borders. Wars at the end of nineties of 20th century in the region of ex Yugoslavian countries brought all the cruelty of war vivid again on European ground. Population were exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. During the War in Bosnia and Herzegovina 1992-1995 there were about 100 000 people killed (20% woman and 3.5% children) and about 18 000 children were orphaned because of war. Children are not capable to regulate their emotions and hyper-arousal on their own. It depends of the way how their parents (caretaker) regulate her/his own emotions. During the war weak child's ego is paralyzed with intensive stimuli and floating anxiety, it does not manage to make constructive solution for traumatic experiences in such a short time. Mothers with small children are especially vulnerable group during the war time: they are supposed to take care about children and feel happiness, what is almost impossible Severe war experiences could cause depressive symptoms in mothers, what reduce their emotional disposability and could lead in different form of the child's neglecting. PTSD symptoms were lasting longer in children if their mothers have had functioning problems. Traumatization of mothers is connected with different behavior problems in their children. Wars are continuing all over the world and there is a continuity of researches about their consequences on children. Any programs that intend to mitigate the psychological effects of such trauma need to adopt a public health approach aimed at reaching many thousands.

Medical Ethics in Extreme and Austere Environments.

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern physician behavior-beneficence, nonmaleficence, autonomy, and social justice-are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur.

Long-term psychological distress of Bosnian war survivors: an 11-year follow-up of former displaced persons, returnees, and stayers.

BACKGROUND: Research on the long-term mental health consequences of war and displacement among civilians who live in post-conflict countries is rare. The aim of this study was to examine the developmental trajectories and predictors of general psychological distress in three samples of Bosnian war survivors over an 11-year period. METHODS: In 1998/99, about three years after the war in Bosnia and Herzegovina, a representative sample of 299 adult Sarajevo citizens was examined in three subsamples: individuals who had stayed in Sarajevo throughout the siege, individuals who had been internally displaced, and refugees who had returned. Of the 138 study participants who could be located 11 years later, 100 were re-assessed (71%) using the Brief Symptom Inventory. RESULTS: Over time, psychological symptoms and general psychological distress decreased in those survivors who had stayed and increased in returnees. Former displaced persons did not show any significant changes. After controlling for other factors, cumulative trauma exposure before and during the war predicted general psychological distress at baseline. Eleven years later, higher trauma exposure during and after the war, returnee status, and more current stressors were all associated with higher levels of general psychological distress. CONCLUSIONS: Levels of psychological symptoms remained high in three subsamples of Bosnian war survivors. The differential symptom trajectories may correspond to distinct war experiences and contemporary stressors. Still, the cumulative effect of war traumata on mental distress persisted more than a decade after war and displacement, although the influence of current stressors seemed to increase over time.

Coping strategies in secondary traumatization and post-traumatic growth among nurses working in a medical rehabilitation hospital: a pilot study.

PURPOSE: Secondary traumatization and post-traumatic growth have been recognized as psychological reactions that might occur among the medical staff in general, and among nurses in particular. Nurses in the field of medical rehabilitative care might reveal such reactions as their work involves stress and traumatic situations. Coping strategies might either alleviate or exacerbate work-related stress experienced by nurses. The aims of the current study were to explore the link between secondary traumatization and post-traumatic growth exhibited by nurses in the field of medical rehabilitative care, and to examine the link between problem-focused coping strategies and emotion-focused coping strategies to secondary traumatization and post-traumatic growth. MATERIAL AND METHOD: One hundred and fifty-three rehabilitative nurses completed self-report questionnaires regarding personal data, post-traumatic growth, secondary traumatization, ways of coping strategies and personal negative life events. RESULTS: Correlation matrix for the path analysis model revealed positive significant correlation between secondary traumatization and post-traumatic growth. Both, problem-focused coping and emotion-focused coping strategies were linked to secondary traumatization and post-traumatic growth. CONCLUSIONS: Nurses employed in a medical rehabilitation hospital who cope via problem-focused strategies as well as emotion-focused strategies in their work, might reveal secondary traumatization but might simultaneously benefit from post-traumatic growth.

Exposure to combat and deployment; reviewing the military context in The Netherlands.

This paper reviews the military context of exposure to combat and deployment in Dutch soldiers. It does so by reviewing war victims and military psychiatry after WWII in the Netherlands, and describes Dutch deployments from the late 1970s to the present. 'Who is the Dutch soldier' is asked to articulate the mental load on the individual soldier before, during, and after deployment. The narrative review of this paper allows one to review how the armed forces personnel is challenged in relation to their specific assignment and in what respect the psychological dimensions are addressed and met in the face of risk and adversity. Finally, some critical considerations for future veterans care programmes are raised.

The Dynamic Relations Among Peritraumatic Posttraumatic Stress Symptoms: An Experience Sampling Study During Wartime.

The associations among peritraumatic posttraumatic stress symptoms (P-PTSS) in the immediate aftermath of trauma exposure, including those in the posttraumatic stress disorder clusters of intrusions, avoidance, negative cognitions and mood (NCM), and arousal, might indicate mechanisms through which enduring PTSD develops. During a period of war, exposed participants (N = 181) were sent twice-daily questionnaires for 30 days via smartphone. We repeatedly assessed the predictive associations between the P-PTSS clusters over time. We performed a multilevel pathway analysis built of multiple triple sequence responses (6,221 cases) on each of the four P-PTSS clusters at a mean time lag of 12 hr (Model A) and 24 hr (Model B) for 181 participants, 85 of whom had been diagnosed with a serious mental illness. Arousal predicted intrusion in Models A and B, bA = 0.08, 95% CI [0.03, 0.12], p < .001 and bB = 0.03, 95% CI [0.00, 0.07], p = .051, respectively; and NCM in Models A and B, bA = 0.09, 95% CI [0.05, 0.12], p < .001 and bB = 0.06, 95% CI [0.03, 0.09], p < .001, respectively. Intrusion predicted arousal in Model B, bB = 0.05, 95% CI [0.01, 0.08], p = .010. NCM predicted arousal, bA = 0.10, 95% CI [0.05, 0.14], p < .001, and avoidance bA = 0.05, 95% CI [0.00, 0.11], p = .052, in Model A. Avoidance did not predict any other cluster. Arousal seemed to be acting as a hub, strengthening feedback loops to and from NCM and intrusion.

Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden.

BACKGROUND: The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender. METHODS: Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework. RESULTS: Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern. CONCLUSION: The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.

Validation of a brief measure of combat exposure among Canadian Armed Forces personnel.

BACKGROUND: Exposure to military combat is associated with mental health problems, including posttraumatic stress disorder (PTSD) and depression. To understand the effects of combat on adverse health outcomes, the sound measurement of combat experiences is required; however, many scales used in past research are lengthy. A brief measure of combat exposure benefits militaries by reducing the burden on respondents as well as administration time in post-deployment settings and large population-based health surveys. DATA AND METHODS: The current study sought to describe the psychometric properties of a brief measure of combat exposure among Canadian Armed Forces (CAF) personnel. Data from post-deployment screening were used to compare the psychometric properties of an 8-item scale with the full scale that it was derived from. RESULTS: The 8-item measure did not fit a one-factor solution well and did not offer a statistically significant improvement in model fit over the full 30-item measure. However, its association with increased odds of a number of health outcomes indicates that it could be useful as a brief measure of combat exposure in settings where using the full scale is not feasible. DISCUSSION: Brief measures of combat exposure are valuable for assessing events experienced during deployment among military personnel. Although the 8-item Combat Exposure Scale assessed in the current study represents a potentially useful measure for CAF personnel, further research is necessary to improve its fit.

Long-term participation of Dutch service members with combat-related injury.

BACKGROUND: After deployment service members need to adapt to civilian life and return to participation in family, vocational and community life. AIMS: To assess the level of activity and participation of service members with combat-related injury after their rehabilitation intervention and to measure the effect of injury severity, adaptive coping, number of deployments and traumatic stress. METHODS: The physical functioning scale of the 36-Item Short Form Health Survey (SF-36 PF), the Assessment of Life Habits short version (LIFE-H), the Impact of Event Scale (IES-R) and the Cognitive Emotion Regulation Questionnaire (CERQ) were administered to service members who sustained combat-related injury. The Injury Severity Score (ISS) was calculated, and the number of deployments was noted. Correlations were calculated between the LIFE-H and ISS, IES-R, number of deployments and adaptive coping and between the SF-PF and ISS, IES-R, number of deployments and adaptive coping. RESULTS: The response rate was 55% (32 service members). A moderate correlation was found between LIFE-H and IES (r = -0.49) and a very weak correlation was found between LIFE-H and injury severity (r = 0.31). No correlation was found between SF-36 PF and ISS, IES, number of deployments or CERQ and between LIFE-H and number of deployments or CERQ. CONCLUSIONS: A moderate correlation was found between level of participation and traumatic stress in service members with combat-related injury in a 5-year follow-up. Therefore, it is advisable to screen for traumatic stress symptoms and monitor these symptoms during the rehabilitation intervention.

Revisiting Desmond Doss (1919-2006): Merging Combat Medicine and Benevolence on the Battlefield.

Conscientious objectors are typically defined only by their unwillingness to serve in the armed forces. Desmond Doss participated in World War II as a combat medic and a conscientious objector by providing emergency medicine on active battlefields while refusing to handle a weapon or harm another human being. Born and raised with humility, Doss developed spiritually as a Seventh Day Adventist. Although fixated on the Ten Commandments and "Thou shall not kill," Doss felt a call to serve and voluntarily enlisted in the U.S. Army with aspirations of becoming a combat medic. Throughout his training he was met with physical, spiritual, and political obstacles as his superiors unsuccessfully tried to convince him and eventually to force him out of the military or to take up arms and fight. Doss was granted his request as a combat medic, was not required to handle a weapon or fight, and was deployed with the 307th Infantry Regiment overseas. His heroism on the battlefield saved hundreds of lives and earned him the Medal of Honor. A thorough yet concise examination of Doss' formative years, the obstacles presented by the country he aimed to serve, how he evolved from a conscientious objector to a combat medic worthy of emulation, and his lasting legacy is a necessary reminder of what we risk when courageous people are limited by outdated and potentially unconstitutional policies and perceptions.

Bands of brothers and in-laws: Waorani warfare, marriage and alliance formation.

The root of modern human warfare lies in the lethal coalitionary violence of males in small-scale societies. However, there is a paucity of quantitative data concerning the form and function of coalitionary violence in this setting. Debates exist over how lethal coalitions are constituted, as well as the motivations and benefits for males to join such groups. Data from a lowland Amazonian population, the Waorani of Ecuador, illuminate three issues: (i) the degree to which raiding parties are composed of groups of fraternal kin as opposed to strategic alliances of actual or potential affinal kin; (ii) the extent to which individuals use pre-existing affinal ties to motivate others to participate in war or leverage warfare as a mechanism to create such ties; and (iii) the extent to which participation in raiding is driven by rewards associated with future marriage opportunities. Analyses demonstrate that Waorani raiding parties were composed of a mix of males who were potential affines, actual affines and fraternal kin, suggesting that men used pre-existing genetic, lineal and social kin ties for recruiting raid partners and used raiding as a venue to create novel social relationships. Furthermore, analyses demonstrate that males leveraged raiding alliances to achieve marriage opportunities for themselves as well as for their children. Overall, it appears that a complex set of motivations involving individual rewards, kin marriage opportunities, subtle coercion and the assessment of alliance strength promote violent intergroup conflict among the Waorani. These findings illustrate the complex inter-relationships among kin selection, coalition building and mating success in our species.