War-Affected Populations and Mental Health Throughout the Lifespan: From World War II to Sierra Leone

Abstract

Objective: There is a need to understand the epidemiology and long-term trajectories of the mental health of war-affected populations. Two papers in this dissertation use cross-sectional, retrospectively reported data collected as part of the World Mental Health (WMH) Survey Initiative to examine the association between four categories of predictors and forced displacement in World War II as well as the association between being a civilian in a war zone/region of terror in World War II with subsequent first onset and persistence of mental disorders. The third paper uses cross-sectional, retrospectively reported data collected as part of a longitudinal study of war-affected youth in Sierra Leone to examine the association between war traumas and symptoms of PTSD. Methods: The associations of predictors and forced displacement, as well as the association of war exposures with lifetime onset and persistence of mental disorders, were assessed with discrete-time survival analysis and conditional logistic regression. For the third paper, the association between war exposures and PTSD symptom severity was assessed with linear regression. Results: Respondent age at the beginning of World War II, country, urbanicity of childhood residence, and war-related traumatic experiences were significantly associated with increased risk of displacement. Being a civilian in a war zone or region of terror in World War II was associated with an increased risk of subsequent lifetime occurrence of major depressive disorder and anxiety disorder. The association of war exposure with first onset of major depressive disorder was strongest in the early years after the war and decayed over time, while the association with anxiety disorders increased with age. War exposure was associated with low 12-month persistence of anxiety disorders among lifetime cases. In the third paper, war exposures including injuring or killing others, death of a father, and death of a mother were associated with symptoms of PTSD. Conclusions: Experiencing war can have a detrimental effect on mental health and functioning of youth not only in the short term, but also into adulthood. Understanding how different patterns of war exposures are related to mental health will help identify those youth most in need of services.