War-Related Trauma and Psychosocial Health in South Sudan and Liberia

Abstract

The study of psychological trauma in humanitarian settings has consistently revealed the negative mental health impact of exposure to war atrocities, especially high rates of post-traumatic stress disorder. However, there is little consensus on what is meant by war trauma, how it should be measured, how ‘levels’ of trauma vary across sociodemographic groups, what individual narratives tell us about culture-specific conceptualizations of trauma, and how this trauma interacts with other factors to influence long-term risk and resilience. The conceptualization, measurement, and impact of war trauma remains a critical area of scientific inquiry, especially given the growing research on the mental health of war-affected populations globally. Moreover, studies on trauma and mental health with conflict-affected populations have mostly employed measurement tools developed in the West, and thus may not accurately reflect the cultural norms of the specific population they were targeting. There is thus an urgent need to incorporate culturally validated tools to understand the war atrocities that people experience, witness, and perpetuate, so that psychosocial services can be appropriately designed. This dissertation uses mixed-methods to examine war-related trauma in internally displaced civilians and combatants in two African countries that are in different stages of post-conflict rehabilitation and recovery: Liberia and South Sudan. Overall, the findings highlight the role of robust measurement research and the cultural richness of qualitative research in contextualizing war-related adversities and their impact. Specifically, Paper 1 uses psychometric analyses to understand how trauma expression is manifested across men and women in South Sudan, and make recommendations for the use of survey measures in global health. Paper 2 uses structural equation modeling to study the complex relations between ethnicity, gender, combat stress, trauma, post-traumatic stress disorder, and perceived security in South Sudan. Paper 3 uses qualitative thematic analysis to understand the long-term determinants of risk and resilience in adults exposed to armed violence in post-conflict Liberia. This dissertation aims to provide the first critical step in the design of appropriate measures and targeted psychosocial interventions in these conflict-affected settings, with the goal of helping policymakers incorporate local priorities into national programs.