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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“Loneliness and isolation have been identified as post-migration stressors that impair mental health of refugees (Chen et al., 2017; Miller and Rasmussen, 2010; Steel et al., 1999).”
A Systematic Review of the Literature on the Mental Health of Journalists Reporting on War, Conflict and Terrorism: Gaps and Recommendations for Future Studies
Mohammed, I. (2025) · Journalism and Media · doi:10.3390/journalmedia6030129 · Cited by 11
“In contrast, Miller and Rasmussen (2010) argued that trauma-focused approaches overemphasize the impact of direct war exposure on mental health and fail to consider the contributions of daily stressors.”
Trauma and mental health among North Korean refugees living in South Korea: The role of acculturative stress
Choi, Y. A., Park, S., Lee, H., Cha, J., & Surkan, P. J. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22934 · Cited by 6
Evaluating Program Enhancement Strategies for Remedial Tutoring: A Cluster-Randomized Control Trial With Syrian Refugee Students in Lebanon
Brown, L. E., Gjicali, K., Kim, H. Y., Dolan, C. T., Frisoli, P., Bwary, M., & Aber, J. L. (2023) · AERA Open · doi:10.1177/23328584231209268 · Cited by 6
“It’s also possible that regulatory and stress mechanisms operate differently in conflict-affected contexts marked by chronic daily difficulties (Miller & Rasmussen, 2010).”
Background
Psychological scars of genocide: a systematic review of post-traumatic outcomes in Kurdish Anfal survivors
Mahmood, H. N., Ahmed, D. R., Neldner, S., & Neuner, F. (2024) · Current Psychology · doi:10.1007/s12144-024-05863-3 · Cited by 7
Development of a non-specialist worker delivered psychological intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda and Ukraine
Nadkarni, A., Massazza, A., Tol, W. A., Bogdanov, S., Andersen, L. S., Moore, Q., Roberts, B., Weiss, H. A., Singh, S., Neuman, M., et al. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-024-00656-4 · Cited by 6
Exploring adolescents' mental health in Kampala, Uganda in the context of COVID-19: a mixed methods study
Mbithi, G., Sarki, A. M., Mabrouk, A., Odhiambo, R., Namuguzi, M., Atukwatse, J., Kabue, M. N., Mulupi, S., & Abubakar, A. A. (2025) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2025.1419043 · Cited by 9
Rethinking pathways to well-being: the function of faith practice in distress alleviation among displaced Muslim women affected by war
Rutledge, K. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1335640 · Cited by 6
Global surgery in a postconflict setting - 5-year results of implementation in the Russian North Caucasus
Lunze, F. I., Lunze, K., Tsorieva, Z. M., Esenov, C. T., Reutov, A., Eichhorn, T., & Offergeld, C. (2015) · Global Health Action · doi:10.3402/gha.v8.29227 · Cited by 6
“prevalent in a postconflict society with ongoing violence (16) impaired our access to patients.”
Background
Health non-governmental organizations (NGOs) amidst civil unrest: Lessons learned from Nicaragua
Hartmann, C., Hartmann, J. M. K., Lopez, A., & Flores, P. N. (2020) · Global Public Health · doi:10.1080/17441692.2020.1789193 · Cited by 6
“…as social conflict is positively associated with mental health problems (Summerfield, 2000), providing culturally relevant, trauma-based, psychosocial interventions from local mental health professionals is essential to improving population health (Miller & Rasmussen, 2010; Stanciu & Rogers, 2011).”
Background
Trauma Narration in Family Therapy with Refugees
Haene, L. D., Adriaenssens, P., Deruddere, N., & Rober, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108602105.011 · Cited by 7
The effects of perceived discrimination, social support and ethnic identity on mental health of immigrant adolescents
Ergin, D. A. (2021) · Scandinavian Journal of Child and Adolescent Psychiatry and Psychology · doi:10.21307/sjcapp-2021-014 · Cited by 6
Assessing meaning violations in Syrian refugees: A mixed‐methods cross‐cultural adaptation of the Global Meaning Violations Scale–ArabV
Matos, L., Água, J., Sinval, J., Park, C. L., Indart, M. J., & Leal, I. M. P. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22819 · Cited by 6
A longitudinal study of dispositional compassion in Syrian origin young adults resettling in the Netherlands
Laceulle, O. M., Stellar, J. E., Alajak, K., Alisic, E., Sawaf, Z. A., Meijer, L., Moopen, N., Mooren, T. T. M., Özoruç, İ., Rahim, H. F., et al. (2022) · European Journal of Personality · doi:10.1177/08902070221081316 · Cited by 7
“…Furthermore, post-migration living problems may be surprising given previous research that identified a link between post-migration living problems and increased psychological problems (Li et al., 2016; Miller & Rasmussen, 2010) as well as lower quality of life (Correa-Velez et al., 2020).”
BackgroundResult
Long-term efficacy of brief psychological treatments for common mental disorders in Myanmar refugees in Malaysia: 12-month follow-up of a randomized, active-controlled trial of integrative adapt therapy v. cognitive behavioral therapy
Tay, A. K., Mohsin, M., Foo, C. Y. S., Rees, S. J., & Silove, D. M. (2022) · Psychological Medicine · doi:10.1017/s0033291722003245 · Cited by 6
Failure of motor function—A Developmental Embodiment Research perspective on the systemic effects of stress
Krüger, M., & Lux, V. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1083200 · Cited by 6
“For example, extreme or even traumatic as well as recurrent experiences of stressful situations could lower the threshold for a situation to be perceived as stressful and the health impact of minor stressors, as seen in the effects of early childhood adversity (Smith and Pollak, 2020), war crime trauma (Miller and Ras…”
Background
The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System
Hoffman, S. J., Vukovich, M. M., Fulkerson, J. A., Gewirtz, A. H., Robertson, C. L., Fredkove, W. M., & Gaugler, J. E. (2023) · Journal of Family Nursing · doi:10.1177/10748407231164747 · Cited by 7
“However, trauma sequelae are multidetermined, and can be either mitigated or compounded through the influence of protective factors or current and ongoing resettlement stressors, and the individual responses to these experiences, that impact overall well-being (Miller & Rasmussen, 2010, 2014).”
Background
The cumulative impact of trauma, chronic illness, and COVID-19 stress on mental health in a case-control study of adults with psychotic disorders in Ethiopia
Sharma, M., Kebede, M. A., Girma, E., Milkias, B., Stevenson, A., Gelaye, B., Koenen, K. C., & Teferra, S. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152508 · Cited by 6
“…and could be due to several factors, including the role of daily stressors in exacerbating the cumulative impact of prior trauma on mental health [20], increased anxiety and depression during COVID-19 among persons living with mental illness [15,16], and the general disruption of mental health…”
Pathways from conflict-related trauma and ongoing adversity to posttraumatic stress disorder symptoms amongst West Papuan refugees: The mediating role of anxiety and panic-like symptoms
Tay, A. K., Rees, S. J., Chen, J., Kareth, M., & Silove, D. M. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.08.005 · Cited by 6
“involved [1,3,38].”
BackgroundMethodInfluential
Mental Health and Psychosocial Support in Humanitarian Settings
Weissbecker, I., Ventevogel, P., Hanna, F., & Pathare, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108348607.026 · Cited by 10
Anger, Guilt and Shame as Mediators in the Relationship Between war Experiences and PTSD: Testing the Moderating Role of Child Soldier Status
Murphy, S., Elklit, A., Dokkedahl, S. B., & Shevlin, M. E. (2016) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-016-0124-x · Cited by 6
“…studies that demonstrate civil conflict and other post-war factors, such as displacement, death and disappearance of family members, inadequate housing, and poor healthcare, contribute to ongoing psychological distress in post-war environments (AmoneP’Olak et al. 2014; Miller and Rasmussen 2010).”
Background
Islamophobia and the Mental Health of Rohingya Refugees
Majeed, S. (2018) · Springer eBooks · doi:10.1007/978-3-030-00512-2_24 · Cited by 6
PTSD as a consequence of past conflict experience, recent exposure to violence and economic marginalization in post-conflict contexts: A study from Nepal, Guatemala and Northern Ireland
Eide, A. H., & Dyrstad, K. (2019) · International Journal of Social Psychiatry · doi:10.1177/0020764019858122 · Cited by 6
“The hypothesis of the current study is that negative events occurring after exposure to war will contribute together with negative socioeconomic circumstances and other daily stressors (Miller and Rasmussen 2010) in maintaining and possibly aggravating PTSD over time.”
Background
Promoting Mental Health for Children and Their Caregivers Affected by the Syrian Conflict
El‐Khani, A., & Calam, R. M. (2019) · Integrating psychiatry and primary care · doi:10.1007/978-3-030-15872-9_15 · Cited by 6
Working with refugee families
Haene, L. D., & Rousseau, C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108602105.002 · Cited by 6
Social Determinants of Health
Sood, A. B., Avula, D. T. K., & Wiley, T. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108551830.004 · Cited by 6
Human Trafficking
Sidun, N. M., & Flores, Y. G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108348607.019 · Cited by 6
Human Rights and Reconciliation
Vélez, G., Twose, G. H. J., & López‐López, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108348607.037 · Cited by 6
Torture, Psychological Inflexibility, and Mental Health Outcomes among Resettled Refugees in the United States
Gray, B. L., Dewey, L. M., & Fondacaro, K. M. (2022) · Journal of Refugee Studies · doi:10.1093/jrs/feaa044 · Cited by 6
A Qualitative Approach to Informing Mental Health Programming in Central African Republic
Patel, S. G., Unanue, I., Crittenden, P., Kieschnick, D. W., Froming, K. B., Brown, L. M., Ntakarutimana, F., Lazaret, A. B., Dailami, M., & Froming, W. J. (2020) · International Perspectives in Psychology · doi:10.1037/ipp0000144 · Cited by 7
Health of war-affected Karen adults 5 years post-resettlement
Hoffman, S. J., Shannon, P. J., Horn, T. L., Letts, J., & Mathiason, M. A. (2020) · Family Practice · doi:10.1093/fampra/cmaa147 · Cited by 6
“It is essential to consider protective factors, for example, the size and strength of the local Karen community (40).”
Background
Posttraumatic stress disorder and psychological distress in Rwandan refugees living in Zambia
Mwanamwambwa, V., & Pillay, B. J. (2021) · South African Journal of Psychology · doi:10.1177/00812463211031812 · Cited by 7
“This finding supports other research that depression and PTSD are common psychological distresses among refugee populations (Im et al., 2017; Miller & Rasmussen, 2010).”
Result
A temporal analysis of mental health symptoms relative to separation from the military
Porter, B., Carey, F. R., Roenfeldt, K. A., Rull, R. P., & Castro, C. A. (2022) · Depression and Anxiety · doi:10.1002/da.23246 · Cited by 6

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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