Cited by 1,524Posttraumatic Stress Disorder ResearchHealth and Conflict StudiesMigration, Health and Trauma

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War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks

Miller, Kenneth E., Rasmussen, Andrew·2010·Social Science & Medicine

DOI 10.1016/j.socscimed.2009.09.029

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Abstract

This paper seeks to bridge the divisive split between advocates of trauma-focused and psychosocial approaches to understanding and addressing mental health needs in conflict and post-conflict settings by emphasizing the role that daily stressors play in mediating direct war exposure and mental health outcomes. The authors argue that trauma-focused advocates tend to overemphasize the impact of direct war exposure on mental health, and fail to consider the contribution of stressful social and material conditions (daily stressors). Drawing on the findings of recent studies that have examined the relationship of both war exposure and daily stressors to mental health status, a model is proposed in which daily stressors partially mediate the relationship of war exposure to mental health. Based on that model, and on the growing body of research that supports it, an integrative, sequenced approach to intervention is proposed in which daily stressors are first addressed, and specialized interventions are then provided for individuals whose distress does not abate with the repair of the social ecology.

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Mirowsky, J., & Ross, C. E. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.023 · Cited by 60
UN Peacekeeping and Households' Well‐Being in Civil Wars
Bove, V., Salvatore, J. D., & Elia, L. (2021) · American Journal of Political Science · doi:10.1111/ajps.12644 · Cited by 66
Review: How should child mental health services respond to the refugee crisis?
Eruyar, Ş., Huemer, J., & Vostanis, P. (2017) · Child and Adolescent Mental Health · doi:10.1111/camh.12252 · Cited by 74
Mental Health, Pre-migratory Trauma and Post-migratory Stressors Among Adult Refugees
Carlsson, J. M., & Sonne, C. (2018) · Springer eBooks · doi:10.1007/978-3-319-97046-2_2 · Cited by 58
Loneliness and social isolation amongst refugees resettled in high-income countries: A systematic review
Nguyen, T. P., Asaad, M. A., Sena, M., & Slewa‐Younan, S. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.117340 · Cited by 74
Context matters: community characteristics and mental health among war‐affected youth in Sierra Leone
Betancourt, T. S., McBain, R. K., Newnham, E. A., & Brennan, R. T. (2013) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12131 · Cited by 59
The Legacy of Wartime Violence on Intimate-Partner Abuse: Microlevel Evidence from Peru, 1980–2009
Østby, G., Leiby, M., & Nordås, R. (2019) · International Studies Quarterly · doi:10.1093/isq/sqy043 · Cited by 58
Refugee, asylum‐seeking and internally displaced children and adolescents
Fazel, M. S., Reed, R., & Stein, A. L. (2015) · Wiley eBooks · doi:10.1002/9781118381953.ch44 · Cited by 60
“Children Are Not Children Anymore; They Are a Lost Generation”: Adverse Physical and Mental Health Consequences on Syrian Refugee Children
Rizkalla, N., Mallat, N. K., Arafa, R., Adi, S., Soudi, L., & Segal, S. P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228378 · Cited by 58
“In addition to war and displacement effects, refugee children suffer from difficulties and stressors faced by their uprooted families and parents [17,18].”
Background
Onset of Posttraumatic Stress Disorder and Major Depression Among Refugees and Voluntary Migrants to the United States
Rasmussen, A., Crager, M., Baser, R., Chu, T., & Gany, F. M. (2012) · Journal of Traumatic Stress · doi:10.1002/jts.21763 · Cited by 58
Self-citation
Immigrant Family Resilience in Context: Using a Community‐Based Approach to Build a New Conceptual Model
Vesely, C. K., Letiecq, B., & Goodman, R. D. (2017) · Journal of Family Theory & Review · doi:10.1111/jftr.12177 · Cited by 58
Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement
Im, H., Ferguson, A., & Hunter, M. (2017) · Transcultural Psychiatry · doi:10.1177/1363461517744989 · Cited by 60
“…or both, but there have been debates over how such factors are linked to mental health and psychological reactions (de Schryver, Vindevogel, Rasmussen, & Cramer, 2015; Li, Liddell, & Nickerson, 2016; Miller & Rasmussen, 2010; Neuner, 2010; Roberts & Browne, 2011; Silove, Ventevogel, & Rees, 2017).”
Background
A Scoping Review of Social Support Research among Refugees in Resettlement: Implications for Conceptual and Empirical Research
Wachter, K., Bunn, M., Schuster, R. C., Boateng, G. O., Cameli, K., & Johnson‐Agbakwu, C. E. (2021) · Journal of Refugee Studies · doi:10.1093/jrs/feab040 · Cited by 65
Forced conscription of children during armed conflict: Experiences of former child soldiers in northern Uganda
Vindevogel, S., Coppens, K., Derluyn, I., Schryver, M. D., Loots, G., & Broekaert, E. (2011) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2011.03.011 · Cited by 58
A controlled trial of trauma-focused therapy versus problem-solving in Islamic children affected by civil conflict and disaster in Aceh, Indonesia
Dawson, K. S., Joscelyne, A., Meijer, C., Steel, Z., Silove, D. M., & Bryant, R. A. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417714333 · Cited by 61
“Some models have noted the important role of current stressors in mental health in post-conflict settings and have emphasized the importance of targeting effects of ongoing stressors rather than focusing on past traumatic experiences (Miller and Rasmussen, 2010).”
Background
ECOLOGICAL NETWORKS AND COMMUNITY ATTACHMENT AND SUPPORT AMONG RECENTLY RESETTLED REFUGEES
Soller, B., Goodkind, J., Greene, R. N., Browning, C. R., & Shantzek, C. (2018) · American Journal of Community Psychology · doi:10.1002/ajcp.12240 · Cited by 52
“However, a growing body of research over the past 20 years has demonstrated the profound impact of post-migration, daily stressors on refugee well-being (Miller & Rasmussen, 2010, 2014; Tempany, 2009).”
Background
Risk for Family Rejection and Associated Mental Health Outcomes Among Conflict-Affected Adult Women Living in Rural Eastern Democratic Republic of the Congo
Kohli, A., Perrin, N., Remy, M. M., Mullany, L. C., Mitima, C. M., Binkurhorhwa, A. K., Mirindi, A. B., Banywesize, J. H., Bufole, N. M., Ntwali, E. M., et al. (2014) · Health Care For Women International · doi:10.1080/07399332.2014.903953 · Cited by 56
Internal displacement and health among the Palestinian minority in Israel
Daoud, N., Shankardass, K., O'Campo, P. J., Anderson, K. M., & Agbaria, A. K. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.12.041 · Cited by 56
War Trauma, Psychological Distress, and Coping Among Afghan Civilians Seeking Primary Health Care
Wildt, H., Umanos, J., Khanzada, N. K., Saleh, M., Rahman, H. U., & Zakowski, S. G. (2017) · International Perspectives in Psychology · doi:10.1037/ipp0000065 · Cited by 54
“…events in this study were related to material loss including becoming a refugee, loss of property and wealth, and loss of family income, and previous research has indicated that daily stressors may be psychologically more impactful than trauma directly related to war (Miller & Rasmussen, 2010).”
Result
A multidimensional model of resilience: Family, community, national, global and intergenerational resilience
Shevell, M. C., & Denov, M. S. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105035 · Cited by 66
Mindfulness-Based Trauma Recovery for Refugees (MBTR-R): Randomized Waitlist-Control Evidence of Efficacy and Safety
Aizik-Reebs, A., Yuval, K., Hadash, Y., Gebremariam, S. G., & Bernstein, A. (2021) · Clinical Psychological Science · doi:10.1177/2167702621998641 · Cited by 57
“Of public health importance, these data indicate that similar populations of asylum seekers may be unlikely to demonstrate spontaneous improvement in their symptoms over time (Miller & Rasmussen, 2010, 2014).”
Background
Psychological and environmental factors influencing resilience among Ukrainian refugees and internally displaced persons: a systematic review of coping strategies and risk and protective factors
Rizzi, D., Ciuffo, G., Landoni, M., Mangiagalli, M., & Ionio, C. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1266125 · Cited by 75
The Youth Readiness Intervention for War-Affected Youth
Newnham, E. A., McBain, R. K., Hann, K., Akinsulure‐Smith, A. M., Weisz, J. R., Lilienthal, G. M., Hansen, N. B., & Betancourt, T. S. (2015) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2015.01.020 · Cited by 55
Afectaciones psicológicas de niños y adolescentes expuestos al conflicto armado en una zona rural de Colombia.
Ramírez, N. H., Gantiva, C., Maldonado, A. V., Rodríguez, M. P. C., Hernández-Olaya, N. L., Juárez, F., & Baños, A. J. P. (2014) · Acta Colombiana de Psicología · doi:10.14718/acp.2014.17.1.9 · Cited by 55
Determinants of Mental Disorders in Syrian Refugees in Turkey Versus Internally Displaced Persons in Syria
Tekeli‐Yeşil, S., IŞIK, E., Ünal, Y., Almossa, F. A., Ünlü, H. K., & Aker, A. T. (2018) · American Journal of Public Health · doi:10.2105/ajph.2018.304405 · Cited by 55
Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review
Bosqui, T. J., Mayya, A., Farah, S., Shaito, Z., Jordans, M. J. D., Pedersen, G. A., Betancourt, T. S., Carr, A., Donnelly, M., & Brown, F. L. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152483 · Cited by 74
Testing a cycle of family violence model in conflict-affected, low-income countries: A qualitative study from Timor-Leste
Rees, S. J., Thorpe, R., Tol, W. A., Fonseca, M., & Silove, D. M. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.02.013 · Cited by 59
The relationship between organized violence, family violence and mental health: findings from a community-based survey in Muhanga, Southern Rwanda
Rieder, H., & Elbert, T. R. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.21329 · Cited by 63
Mental health service responses to human trafficking: a qualitative study of professionals’ experiences of providing care
Domoney, J., Howard, L. M., Abas, M., Broadbent, M. T. M., & Oram, S. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0679-3 · Cited by 54
“The broader literature on depression and PTSD also indicates that ongoing social stressors can exacerbate and perpetuate symptoms [13, 14].”
Background
Measuring everyday processes and mechanisms of stress resilience: Development and initial validation of the Sustainability of Living Inventory (SOLI).
Hou, W. K., Lai, F. T. T., Hougen, C., Hall, B. J., & Hobfoll, S. E. (2019) · Psychological Assessment · doi:10.1037/pas0000692 · Cited by 53
Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health
Goodkind, J. R., Bybee, D. I., Hess, J. M., Amer, S., Ndayisenga, M., Greene, R. N., Choe, R., Isakson, B. L., Baca, B., & Pannah, M. (2020) · American Journal of Community Psychology · doi:10.1002/ajcp.12418 · Cited by 53
“However, growing research has documented the link between post-migration stressors and mental health among refugees (Miller & Rasmussen, 2010; Rasmussen et al., 2010), which, for refugees in the United States, include limited English proficiency, lack of social support and valued social roles, and…”
Background
Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia
Jaraba, S. M. R., Toro, N. Q., Sierra, M. O., Sánchez, L. R., Jímenez, M. A. G., Salazar-Barrientos, M., Bedoya, E. B., Álvarez, G. A. V., Langer, A., Gausman, J., et al. (2020) · Conflict and Health · doi:10.1186/s13031-020-00273-1 · Cited by 43
Experiences of mental health and functioning among conflict-affected populations: A qualitative study with military veterans and displaced persons in Ukraine.
Singh, N. S., Bogdanov, S., Doty, B., Haroz, E. E., Girnyk, A., Чернобровкіна, В., Murray, L. K., Bass, J., & Bolton, P. A. (2021) · American Journal of Orthopsychiatry · doi:10.1037/ort0000537 · Cited by 62
Exposure to violence during adolescence as a predictor of perceived stress trajectories in emerging adulthood
Heinze, J. E., Stoddard, S. A., Aiyer, S. M., Eisman, A. B., & Zimmerman, M. A. (2017) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2017.01.005 · Cited by 62
“This finding is consistent with psychosocial-focused approaches to trauma exposure, which emphasize not only the direct experiences of violence, but also the ongoing environmental stressors that can exacerbate the negative effects of violence experiences (Miller & Rasmussen, 2010).”
Result
Mental health in a conflict area: Migration, economic stress and religiosity in the three southernmost provinces of Thailand
Ford, K., Jampaklay, A., & Chamratrithirong, A. (2016) · International Journal of Social Psychiatry · doi:10.1177/0020764016685119 · Cited by 52
“The living conditions created by conflict, in addition to the effects of direct exposure to violence, can affect the mental health of a population (Miller & Rasmussen, 2010).”
BackgroundInfluential

Authors: Miller, K. E., & Rasmussen, A.
Affiliations: Harvard University (US)
New York University (US)
Corresponding author: Miller, Kenneth E.
ORCID: Miller, Kenneth E.
Rasmussen, Andrew
Venue: Social Science & Medicine
Publisher: Elsevier BV
Published: 2010-01
Volume: 70
Issue: 1
Pages: 7-16
ISSN: 0277-9536 (ISSN-L)
DOI: 10.1016/j.socscimed.2009.09.029
OpenAlex: W1984065858
Cited by: 1,524
References: 98
Citations by year: 2026: 140 · 2025: 96 · 2024: 117 · 2023: 102 · 2022: 83 · 2021: 110 · 2020: 195 · 2019: 83 · 2018: 101 · 2017: 117 · 2016: 71 · 2015: 67 · 2014: 82 · 2013: 58 · 2012: 41
FWCI: 36.01
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Social Science & Medicine (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Fordham Research Commons (Fordham University) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords: war exposure, daily hassles, mental health, conflict settings, post-conflict societies, psychosocial approach, mediation, social ecology, mental health interventions
MeSH terms: Adaptation, Psychological, Health Status, Humans, Life Change Events, Mental Health, Models, Psychological, Social Environment, Socioeconomic Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, Violence, Warfare

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War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks

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