New research is suggesting repeated violence could escalate the prevalence of mental illness in post-conflict communities. But researchers say having more mental health services in war-torn countries isn’t enough to solve the problem.
New research has suggested repeated violence could escalate the prevalence of post-traumatic stress disorder, anxiety and depression in post-conflict communities.
The six year study surveyed more than 1000 locals in Timor-Leste to measure the prevalence of mental disorders. Over the six years, researchers found rates of post-traumatic stress disorder (PTSD) increased sevenfold. Depression and anxiety rates rose nearly three times as much.
The findings are published in The Lancet Global Health.
Lead researcher Professor Derrick Silove from the University of New South Wales began the study in 2004, four years after Timor-Leste’s conflict with Indonesian occupation.
During this time, the researchers collected data on the mental health of 1,022 Timorese locals.
"Our team at UNSW – in collaboration with others – was involved with setting up mental health services in East Timor, after the humanitarian crisis of 1999," he said.
"To our surprise, in the large sample that we studied – over one thousand people – we found that rates of PTSD and depression were remarkably low compared to other conflict-affected countries," said Professor Silove, who is also the Director of the Ingham Institute Psychiatry Research & Teaching Unit at Liverpool Hospital.
He theorised that the comparatively low rates of mental illness were due to the country’s recent independence from Indonesia, and the general sense of optimism that ran through the county.
He said these positive events might have helped to mitigate the trauma they were exposed to, but when the team returned to Timor-Leste six years later, the results were startlingly different.
Ongoing conflict associated with ‘massive increase’ in mental illness
Between 2006 and 2007, Timor-Leste went through a tumultuous period of internal conflict in which Prime Minister Xanana Gusmão and former President José Ramos-Horta were nearly assassinated.
"Sadly, that gave us the opportunity for the first time internationally to examine what the impact of recurrent violence is on the mental health of a population that already suffered a great deal of trauma," said Professor Silove.
"We expected at least a mild or significant increase in mental disorder. But actually what we found was a massive increase."
PTSD rates increased sevenfold, from 2.3 per cent in 2004 to 16.7 per cent in 2010. Severe distress rates nearly tripled (5.6 per cent to 15.9 per cent).
Listen: Full interview with Professor Derrick Silove
Causes of mental disorders in post-conflict communities
Professor Silove said that while conflict and traumatic events were associated with the rise in mental illness in Timor-Leste, there were other factors at play.
"Firstly the sense of injustice – that is, the cumulative sense that we’ve been through too much, we’ve been exposed to too many human rights violations without any redress over and over again," he told SBS. "This was highly correlated with the increase of mental disorder in the population."
He said poverty and the ongoing sense of insecurity were major issues as well.
Within six years, the Timor-Leste community had gone from relative security to national instability.
"So it seems that although trauma was important… the general sense of insecurity that eventuated in East Timor was also important," Professor Silove said. "It switched from a situation of hope and security to one [where there was a] loss of hope, loss of optimism."
More mental health services not the answer
Despite these findings, Professor Silove doesn’t believe more mental health services in war-torn communities will ever be a complete solution.
"While we do need mental health services, they are never going to solve the problem on their own," he said. "With such high rates of post-traumatic stress disorders and depression, it’s inconceivable that we’re going to have services in this resource-poor environment to treat everybody on a one-to-one basis, and even on a family basis."
While difficult, it is better to tackle core issues such as poverty, employment, justice and political stability, he said.
"It’s not easy, but if you can achieve the core issues that are going to help these people to recover naturally – which is basically securing peace, giving them hope for a better future, countering poverty, providing jobs and generally developing a society that is fair and justice.
"None of those are easy things to achieve, but that’s the healing environment that is needed."