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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“…and cultural practices, requires a dramatic shift for those from more collectivist cultures settling in more individualized societies, specifically related to such areas of family life as parenting styles, gender roles, and socio-educational expectations (Davetian, 2001; Miller & Rasmussen, 2005).”
Background
“Making Patients” in Postwar and Resource‐scarce Settings. Diagnosing and Treating Mental Illness in Postwar Kosovo
Kienzler, H. (2020) · Medical Anthropology Quarterly · doi:10.1111/maq.12554 · Cited by 10
Family Relationships and Intra-family Expectations in Unaccompanied Young Refugees
Derluyn, I., & Ang, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108602105.008 · Cited by 11
Psychologists’ Perspectives on the Psychological Suffering of Refugee Patients in Brazil
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“These findings can be explained by the psychological impacts of pre-flight exposure to war, persecution and violence, the displacement experience and post-migration struggles in host countries (Knipscheer and Kleber 2006; Miller and Rasmussen 2010).”
Background
A Data-Driven Analysis of Sociocultural, Ecological, and Economic Correlates of Depression Across Nations
Li, Z., Wei, A. X., Palanivel, V., & Jackson, J. C. (2021) · Journal of Cross-Cultural Psychology · doi:10.1177/00220221211040243 · Cited by 10
“Nations with high levels of conflict—both with other nations and within the nation—may also have higher rates of depression because of the psychological toll of war and other forms of conflict on mental health (Farhood et al., 2013; Miller & Rasmussen, 2010; Thabet et al., 2004).”
Background
Displacement-related stressors in a Sri Lankan war-affected community: Identifying the impact of war exposure and ongoing stressors on trauma symptom severity
Thomas, F. C., Coulombe, S., Girard, T. A., Hart, T. L., Doherty, S., Dass, G., Wickramage, K. P., Siriwardhana, C., Surenthirakumaran, R., & McShane, K. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100129 · Cited by 10
ПСИХІЧНЕ ЗДОРОВ’Я ПЕРСОНАЛУ ОРГАНІЗАЦІЙ В УМОВАХ ВІЙНИ: ОСНОВНІ ВИЯВИ ТА РЕСУРСИ
Карамушка, Л. М. (2022) · Scientific notes of the UniversityKROK · doi:10.31732/2663-2209-2022-67-124-133 · Cited by 10
Psychische Auffälligkeiten von Flüchtlingskindern
Reinelt, T., Vasileva, M., & Petermann, F. (2016) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000207 · Cited by 10
Mental Health Among Adult Survivors of War in Low- and Middle-Income Countries: Epidemiology and Treatment Outcome
Nexhmedin Morina, B. (2018) · Springer eBooks · doi:10.1007/978-3-319-97046-2_1 · Cited by 9
Neural Correlates of Posttraumatic Stress Disorder Symptoms, Trauma Exposure, and Postmigration Stress in Response to Fear Faces in Resettled Refugees
Liddell, B. J., Cheung, J., Outhred, T., Das, P., Malhi, G. S., Felmingham, K. L., Nickerson, A., Den, M. L., Askovic, M., Coello, M., et al. (2019) · Clinical Psychological Science · doi:10.1177/2167702619841047 · Cited by 12
Toward a New Agenda for Rehabilitation and Reintegration Processes for Child Soldiers
Derluyn, I. (2011) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2011.05.006 · Cited by 10
TEACHERS’ EXPERIENCES OF PROFESSIONAL DEVELOPMENT IN (POST)CRISIS KATANGA PROVINCE, SOUTHEASTERN DEMOCRATIC REPUBLIC OF CONGO: A CASE STUDY OF TEACHER LEARNING CIRCLES
Frisoli, P. (2020) · Scholarworks (University of Massachusetts Amherst) · doi:10.7275/k457-dr90 · Cited by 10
Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions
Rocca, B. D., Bello, R., Carbone, M., Pezzella, P., Toni, C., Sampogna, G., Tarsitani, L., Luciano, M., & Fiorillo, A. (2023) · International Journal of Social Psychiatry · doi:10.1177/00207640231214964 · Cited by 11
“Moreover, in addition to the traumatic events that occurred prior to migration, post-migratory stressors may pose a serious threat to the mental health and welfare of refugees (Bryant, 2022; Greenberg & Rafferty, 2021; Li et al., 2016; Miller & Rasmussen, 2010).”
Background
Confronting the Mental Health Challenges of Large-Scale Combat Operations
Cole, R., & Remondelli, M. H. (2025) · Military Medicine · doi:10.1093/milmed/usaf156 · Cited by 9
Post-migration stress mediates associations between potentially traumatic peri-migration experiences and mental health among Middle Eastern refugees in Germany
EL‐Awad, U., Eves, R., Hachenberger, J., Bozorgmehr, K., Entringer, T. M., Hecker, T., Razum, O., Sauzet, O., & Lemola, S. (2025) · BMC Public Health · doi:10.1186/s12889-025-23660-w · Cited by 10
“…cumulative or particularly demanding peri-migration stressors may be more likely to face exposure to post-migration stress due to downstream social and structural consequences of trauma—such as unstable living conditions, lower access to resources, or disrupted support networks [37, 38].”
Migration and Mental Health of Arabic-Speaking Communities
Hammad, J., & Hamid, A. (2021) · Mental health and illness worldwide · doi:10.1007/978-981-10-2366-8_37 · Cited by 10
The impact of maternal depressive symptoms and traumatic events on early childhood mental health in conflict-affected Timor-Leste
Rees, S. J., Mohsin, M., Klein, L. A., Steel, Z., Tol, W. A., Dadds, M. R., Eapen, V., Costa, Z. M. D., Savio, E., Tam, N., et al. (2022) · BJPsych Open · doi:10.1192/bjo.2022.20 · Cited by 8
Intergenerational trauma and war-induced PTSD in Kosovo: insights from the Albanian ethnic group
Duraku, Z. H., Jahiu, G., & Geci, D. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1195649 · Cited by 9
“According to research, various ethnic groups can have varied postconflict experiences and responses to trauma (Miller and Rasmussen, 2010).”
Background
Macro level system mapping of the provision of mental health services to young people living in a conflict context in Colombia
Fenton, S., Rengifo, J. R., Roncancio, M. V. P., Casas, G., Carranza-Franco, F., Weber, S., Jackson, P., & Romero, J. P. A. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-10602-2 · Cited by 9
“For young people living in a conflict or post-conflict context, there is increased likelihood of having poor mental health [2].”
Background
Enhancing Mental Health Predictions: A Gradient Boosted Model for Sri Lankan Camp Refugees
Sahoo, I., Amona, E. B., Kuttikat, M., & Chan, D. M. (2024) · Social Sciences · doi:10.3390/socsci13050255 · Cited by 11
Who is the subject of trauma? An interdisciplinary scoping review of trauma and selfhood in the Arab region
Hosny, N., Tanous, O., Koga, P. M., Abbott, B. T., & Joseph, S. (2024) · SSM - Mental Health · doi:10.1016/j.ssmmh.2024.100321 · Cited by 12
Mediators of the relation between war experiences and suicidal ideation among former child soldiers in Northern Uganda: the WAYS study
Amone‐P’Olak, K., Lekhutlile, T. M., Meiser‐Stedman, R., & Ovuga, E. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0271-2 · Cited by 9
Informal and Formal Supports for Former Child Soldiers in Northern Uganda
Vindevogel, S., Wessells, M., Schryver, M. D., Broekaert, E., & Derluyn, I. (2012) · The Scientific World JOURNAL · doi:10.1100/2012/825028 · Cited by 10
Application of conservation of resource theory with camp refugees
George, M. (2017) · Migration and Development · doi:10.1080/21632324.2017.1320825 · Cited by 9
“As mentioned in some studies (Fernando et al., 2010; Miller & Rasmussen, 2010), family conflicts usually come to light after the complex family dynamics became noticed by outsiders and after significant intervention could have prevented worsened health conditions.”
BackgroundResult
Recommendations for Canadian Mental Health Practitioners Working With War-Exposed Immigrants and Refugees
Kanagaratnam, P., Pain, C., McKenzie, K. J., Ratnalingam, N., & Toner, B. B. (2017) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2017-010 · Cited by 8
Risk Factors for and Consequences of Substance Use in Post-Conflict Liberia: A Qualitative Study
Prust, M. L., Curry, L. A., Callands, T. A., Drakes, J., McLean, K. E., Harris, B. L., & Hansen, N. B. (2017) · Community Mental Health Journal · doi:10.1007/s10597-017-0154-3 · Cited by 10
“Experts have recently pointed out how many researchers and advocates have focused on the impact of direct war exposure on health outcomes while failing to consider the contributions of stressful social and material conditions (Miller and Rasmussen 2010).”
Background
Psychology, migration studies, and their disconnections: a review of existing research and future possibilities
Palmary, I. (2018) · South African Journal of Psychology · doi:10.1177/0081246317751276 · Cited by 9
“It is worth noting that within this literature, there is a fairly substantive focus on children and trauma, and particularly war trauma (see Betancourt & Khan, 2008; Miller & Rasmussen, 2010; Summerfield, 2000, for some examples).”
Background
Coming of age in a conflict area: Mental health, education, employment, migration and family formation in the southernmost provinces of Thailand
Ford, K., Jampaklay, A., & Chamratrithirong, A. (2018) · International Journal of Social Psychiatry · doi:10.1177/0020764018756436 · Cited by 9
“Young adults in areas of civil conflict Exposure to traumatic events has been found to increase risk of post-traumatic stress disorder (PTSD) as well as depression and other mental disorders (Axinn, Gilmore, & Williams, 2013; Miller & Rasmussen, 2010).”
Background
Well‐being and pressures of daily life in two West Bank villages—Exploring context and history
Rabaia, Y., de Jong, J. T. V. M., Abdullah, A., Giacaman, R., & van de Ven, P. M. (2018) · International Journal of Psychology · doi:10.1002/ijop.12495 · Cited by 9
Current state of the literature on mental health in Liberia: A systematic review
Hook, K., Ando, K., Ghebrehiwet, S., Harris, B. L., Ojediran, B., Syeda, H. S., Henderson, D. C., & Borba, C. P. C. (2020) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v26i0.1502 · Cited by 9
Procesos de acompañamiento psicosocial en el marco del conflicto armado: una revisión crítica de la literatura
Tobón, M. A. A. (2021) · Revista Virtual Universidad Católica del Norte · doi:10.35575/rvucn.n62a12 · Cited by 9
Migration experience and mental health: A qualitative study in France and Brazil
Brunnet, A. E., Kristensen, C. H., Lobo, N. D. S., & Dérivois, D. (2021) · International Journal of Social Psychiatry · doi:10.1177/0020764021999695 · Cited by 10
“Indeed, although several studies make a direct link between the pre-migration context and the migrant mental health status, the impact of daily stressors should not be overlooked (Miller & Rasmussen, 2010, 2016).”
Background
Factors Contributing to Violence Against Children: Insights From a Multi-informant Study Among Family-Triads From Three East-African Refugee Camps
Hecker, T., Kyaruzi, E. S., Borchardt, J., & Scharpf, F. (2021) · Journal of Interpersonal Violence · doi:10.1177/08862605211013960 · Cited by 9
Labeling and Stigma
Link, B. G., & Phelan, J. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.024 · Cited by 11
“My Heart Feels Chained”
Akesson, B., & Badawi, D. (2020) · doi:10.1093/oso/9780190874551.003.0011 · Cited by 9
Psychological Reactions after Disasters
Amiri, H., & Jahanitabesh, A. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.109007 · Cited by 9
Violencia comunitaria en adolescentes desfavorecidos: exposición, impacto percibido y consecuencias psicológicas
Mels, C., & Fernández, L. (2015) · Revista de psicología · doi:10.5354/0719-0581.2015.36863 · Cited by 9
Exposure to Trauma and Forced Migration: Mental Health and Acculturation Patterns Among Asylum Seekers in Israel
Lurie, I., & Nakash, O. (2015) · Springer eBooks · doi:10.1007/978-3-319-17335-1_10 · Cited by 10

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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