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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“To avoid confusion, we did not use the term CTS here as there are varied definitions of the construct in relation to whether or not ongoing stress includes daily stressors (Miller & Rasmussen, 2010; Nuttman-Shwartz & Shoval-Zuckerman, 2016).”
Method
Trauma Healing Club: Utilizing Culturally Responsive Processes in the Implementation of an After-School Group Intervention to Address Trauma Among African Refugees
Elswick, S. E., Washington, G., Mangrum-Apple, H., Peterson, C., Barnes, E., Pirkey, P., & Watson, J. J. (2021) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-021-00387-5 · Cited by 33
Development and validation of the Somali WHOQOL-BREF among refugees living in the USA
Redko, C., Rogers, N. L., Bule, L., Siad, H., & Choh, A. C. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0877-3 · Cited by 29
Perspectives of Somali Refugees on Post-traumatic Growth after Resettlement
Ferriss, S. S., & Forrest-Bank, S. S. (2018) · Journal of Refugee Studies · doi:10.1093/jrs/fey006 · Cited by 29
Prevalence and correlates of probable post-traumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe
Verhey, R., Gibson, L., Brakarsh, J., Chibanda, D., & Seedat, S. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1536286 · Cited by 33
“Studies show high comorbidity between depression and PTSD in a variety of population samples, such as those from conflict or post-conflict settings (Miller & Rasmussen, 2010), refugee camps (Gerritsen et al., 2006; Momartin, Silove, Manicavasagar, & Steel, 2004) and combat situations, victims of…”
BackgroundResultInfluential
Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs
Falb, K., Blackwell, A., Stennes, J., hussein, M. K., & Annan, J. R. (2019) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2019.20 · Cited by 28
“Finally, there is a need to adapt and implement targeted mental health interventions for women with high levels of depressive symptoms, traumatic experiences, and ongoing daily stressors (Miller & Rasmussen, 2010; Bass et al. 2013).”
Background
Mental health interventions for immigrant-refugee children and youth living in Canada: a scoping review and way forward
Herati, H., & Meyer, S. B. (2020) · Journal of Mental Health · doi:10.1080/09638237.2020.1818710 · Cited by 31
“Accordingly, this will help program developers and decision-makers to develop mental health policy and to allocate scarce resources (Miller & Rasmussen, 2010).”
Background
Benefits and Challenges of Using a Participatory Approach with Community-based Mental Health and Psychosocial Support Interventions in Displaced Populations
Wood, B., & Kallestrup, P. (2021) · Transcultural Psychiatry · doi:10.1177/1363461520983626 · Cited by 29
“…that, in conflict settings, MHPSS interventions must go beyond the provision of mainly specialised clinical treatments (Allden et al., 2009; Miller & Rasmussen, 2010; Silove, Ventevogel, & Rees, 2017; Tol et al., 2011), and be coupled with an ecological approach that acknowledges the…”
Background
A longitudinal study of mental health before and during the COVID-19 pandemic in Syrian refugees
Akhtar, A., Bawaneh, A., Awwad, M., Al‐Hayek, H., Sijbrandij, M., Cuijpers, P. J., & Bryant, R. A. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1991651 · Cited by 31
Community perceptions of mental distress in a post-conflict setting: A qualitative study in Burundi
Familiar, I., Sharma, S., Ndayisaba, H., Munyentwari, N., Sibomana, S., & Bass, J. (2013) · Global Public Health · doi:10.1080/17441692.2013.819587 · Cited by 29
Experiences and psychosocial adjustment of Darfuri female students affected by war: An exploratory study
Badri, A. B., van den Borne, H. W., & Crutzen, R. (2012) · International Journal of Psychology · doi:10.1080/00207594.2012.696652 · Cited by 29
The Refugee-Mental Health Assessment Package (R-MHAP); rationale, development and first-stage testing amongst West Papuan refugees
Tay, A. K., Rees, S. J., Chen, J., Kareth, M., Mohsin, M., & Silove, D. M. (2015) · International Journal of Mental Health Systems · doi:10.1186/s13033-015-0018-6 · Cited by 29
Psychosocial support among refugees of conflict in developing countries
Alfadhli, K., & Drury, J. (2016) · Intervention · doi:10.1097/wtf.0000000000000119 · Cited by 39
The association between perceived social support and posttraumatic stress symptoms among Eritrean and Sudanese male asylum seekers in Israel
Nakash, O., Nagar, M., Shoshani, A., & Lurie, I. (2017) · International Journal of Culture and Mental Health · doi:10.1080/17542863.2017.1299190 · Cited by 29
“Miller and Rasmussen (Miller & Rasmussen, 2010; Rasmussen et al., 2010) further suggested that stressful social and material conditions (daily stressors) that are exacerbated by the restrictive policies in growing hostile political situations in many industrial countries partially mediate the…”
BackgroundInfluential
The impact of resettlement on Karen refugee family relationships: A qualitative exploration
McCleary, J. S. (2017) · Child & Family Social Work · doi:10.1111/cfs.12368 · Cited by 29
A scoping review of the associations between mental health and factors related to HIV acquisition and disease progression in conflict-affected populations
Koegler, E., & Kennedy, C. E. (2018) · Conflict and Health · doi:10.1186/s13031-018-0156-y · Cited by 29
Psychological practice with unaccompanied immigrant minors: Clinical and legal considerations.
NeMoyer, A., Rodriguez, T., & Álvarez, K. (2019) · Translational Issues in Psychological Science · doi:10.1037/tps0000175 · Cited by 28
“Family and societal protective factors include family adaptability and cohesion, social support, community integration, experience of safety and security, and school belonging and connectedness (Ehntholt & Yule, 2006; Fazel, Reed, Panter-Brick, & Stein, 2012; Miller & Rasmussen, 2010).”
Internet Gaming Disorder: Compensating as a Draenei in World of Warcraft
Morcos, M., Stavropoulos, V., Rennie, J., Clark, M., & Pontes, H. M. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00098-x · Cited by 28
Prevalence and co-existence of morbidity of posttraumatic stress and functional impairment among Burundian refugee children and their parents
Scharpf, F., Kyaruzi, E. S., Landolt, M. A., & Hecker, T. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1676005 · Cited by 30
“This is a major shortcoming as the precarious living conditions in refugee camps can increase the risk for children’s mental health problems above and beyond the experiences of uprooting and flight (Miller & Rasmussen, 2010).”
Background
7ROSES, a transdiagnostic intervention for promoting self-efficacy in traumatized refugees: a first quantitative evaluation
van Heemstra, H. E., Scholte, W. F., Haagen, J. F. G., & Boelen, P. A. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1673062 · Cited by 27
“Therewith it responds to the critique (Lambert & Alhassoon, 2015; Miller & Rasmussen, 2010) on the domination of PTSD as a focus in treatment methods for refugees.”
Background
Families on hold: How the context of an asylum centre affects parenting experiences
Lietaert, I., Verhaeghe, F., & Derluyn, I. (2019) · Child & Family Social Work · doi:10.1111/cfs.12706 · Cited by 28
Traumatic experiences, acculturation, and psychological distress among Syrian refugees in Turkey: The mediating role of coping strategies
Kurt, G., Acar, İ. H., İlkkurşun, Z., Yurtbakan, T., Acar, B., Uygun, E., & Acartürk, C. (2021) · International Journal of Intercultural Relations · doi:10.1016/j.ijintrel.2021.02.001 · Cited by 27
‘The War Made Me a Better Person’: Syrian Refugees’ Meaning-Making Trajectories in the Aftermath of Collective Trauma
Matos, L., Costa, P. A., Park, C. L., Indart, M. J., & Leal, I. M. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168481 · Cited by 28
“War and other forms of collective violence can threaten individual and community assumptions of safety, predictability, and control, disintegrate the fabric of society, and lead to the mass displacement of civilians from their communities and countries in search of safety [1,2].”
Background
Our flesh is here but our soul stayed there: A qualitative study on resource loss due to war and displacement among internally-displaced women in the Republic of Georgia
Seguin, M., Lewis, R., Amirejibi, T., Razmadze, M., Makhashvili, N., & Roberts, B. (2016) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.12.045 · Cited by 28
Suffering as “Symptom”: Psychiatry and Refugee Youth
Raju, P., Stein, D., & Dushimiyimana, F. R. (2018) · Springer eBooks · doi:10.1007/978-3-319-64838-5_19 · Cited by 27
Evaluation of the Early Adolescent Skills for Emotions (EASE) intervention in Lebanon: A randomized controlled trial
Jordans, M. J. D., Brown, F. L., Kane, J. C., Taha, K., Steen, F., Ali, R., Elias, J., Meksassi, B., Aoun, M., Greene, M. C., et al. (2023) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2023.152424 · Cited by 27
“These present significant risks to healthy development and positive wellbeing [3].”
Background
Interactive Effect of Immigration-Related Factors with Legal and Discrimination Acculturative Stress in Predicting Depression Among Asian American Immigrants
Singh, S., Schulz, A. J., Neighbors, H. W., & Griffith, D. M. (2016) · Community Mental Health Journal · doi:10.1007/s10597-016-0064-9 · Cited by 27
Barriers to cardiovascular disease secondary prevention care in the West Bank, Palestine – a health professional perspective
Collier, J., & Kienzler, H. (2018) · Conflict and Health · doi:10.1186/s13031-018-0165-x · Cited by 27
Outside/inside: social determinants of mental health
Gnanapragasam, S., Wright, L. A., Pemberton, M., & Bhugra, D. (2021) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2021.49 · Cited by 29
“Children and young people may go on to develop emotional and behavioural problems (Miller & Rasmussen, 2010) and poor attention (Ziol-Guest & McKenna, 2014).”
Background
Does armed conflict increase individuals’ religiosity as a means for coping with the adverse psychological effects of wars?
Shai, O. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.114769 · Cited by 27
“If I speak English, what am I? I am full man, me”: Emotional impact and barriers for refugees and asylum seekers learning English
Salvo, T., & Williams, A. C. D. C. (2017) · Transcultural Psychiatry · doi:10.1177/1363461517746315 · Cited by 32
“…status, detention, unemployment and poverty (Brewin, Andrews, & Valentine, 2000; Carswell, Blackburn, & Barker, 2011; Chung & Kagawa-Singer, 1993; Gorst-Unsworth & Goldenberg, 1998; Li et al., 2016; Miller & Rasmussen, 2010; Momartin et al., 2006; Silove, 2002; Steel, Frommer, & Silove, 2004).”
Mental health problems from direct vs indirect exposure to violent events among children born and growing up in a conflict zone of southern Thailand
Jayuphan, J., Sangthong, R., Hayeevani, N., Assanangkornchai, S., & McNeil, E. B. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01732-8 · Cited by 26
Social anxiety among unaccompanied minor refugees in Norway.The association with pre-migration trauma and post-migration acculturation related factors
Jore, T., Oppedal, B., & Biele, G. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110175 · Cited by 29
A Contextual Adaptation of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Victims of the Armed Conflict in Colombia
Castro-Camacho, L., Rattner, M., Quant, D. M., González, L., Moreno-Villamizar, J. D., & Ametaj, A. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.08.002 · Cited by 30
A Lifetime of Trauma: Mental Health Challenges for Higher Education in a Conflict Environment in Afghanistan
Babury, M. O., & Hayward, F. M. (2013) · Education Policy Analysis Archives · doi:10.14507/epaa.v21n68.2013 · Cited by 26
The association between post-traumatic stress-related symptoms, resilience, current stress and past exposure to violence: a cross sectional study of the survival of Quechua women in the aftermath of the Peruvian armed conflict
Suarez, E. B. (2013) · Conflict and Health · doi:10.1186/1752-1505-7-21 · Cited by 26
Short‐ and longer‐term impacts of Child Friendly Space Interventions in Rwamwanja Refugee Settlement, Uganda
Metzler, J., Diaconu, K., Hermosilla, S., Kaijuka, R., Ebulu, G., Savage, K., & Ager, A. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13069 · Cited by 26
“With a growing emphasis on the role of social ecologies in shaping the experience of children (Betancourt et al., 2011; Masten & Narayan, 2012; Miller & Rasmussen, 2010), studies have considered not only the effectiveness of specialist clinical interventions but also of nonspecialist treatment and…”
Background
Trajectories of psychological distress and social integration in newly resettled refugees: findings from the Building a New Life in Australia longitudinal study
Nguyen, T. P., Slewa‐Younan, S., & Rioseco, P. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02528-7 · Cited by 27
“Thus, psychosocial interventions targeting post-resettlement factors may be considered a more effective strategy for refu-gees when compared to pre-settlement stressors because they are more easily managed in the short term and are more proximal predictors of current psychological distress [9].”
Background
Displacement contexts and violent landscapes: How conflict and displacement structure women's lives and ongoing threats at the Thai-Myanmar border
Koning, S. M. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112557 · Cited by 27
Psychological, social, and welfare interventions for torture survivors: A systematic review and meta-analysis of randomised controlled trials
Hamid, A., Patel, N., & Williams, A. C. D. C. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002919 · Cited by 25
“Outcomes representing broader health and participation in society were neglected, as was the context of social, economic, and political uncertainties survivors face; threats to civil and legal status, accommodation, safety, connections with family and friends, and other assaults on well-being [8,33,34].”
Background
Acculturation, Social Support and Mental Health Outcomes among Syrian Refugees in Germany
Green, M., King, E. J., & Fischer, F. (2019) · Journal of Refugee Studies · doi:10.1093/jrs/fez095 · Cited by 25

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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