Trauma in the Kashmir Valley and the mediating effect of stressors of daily life on symptoms of posttraumatic stress disorder, depression and anxiety

• Published in: Conflict and health 2019-12, Vol.13 (1), p.58-58, Article 58
• Main Authors: Housen, Tambri, Lenglet, Annick, Shah, Showkat, Sha, Helal, Ara, Shabnum, Pintaldi, Giovanni, Richardson, Alice
• Format: Article
• Language: English
• Subjects: Analysis; Anxiety; Confidence intervals; Conflict; Depression; Depression (Mood disorder); Diagnosis; Financial management; Health; Health aspects; Health surveys; Households; Mediation; Mental depression; Mental disorders; Mental health; Post traumatic stress disorder; Posttraumatic stress disorder; Psychological stress; Psychology; Statistical analysis; Stressors of daily life; Surveys; Trauma; Violence
• ISSN: 1752-1505; 1752-1505
• DOI: 10.1186/s13031-019-0245-6

The negative psychological impact of living in a setting of protracted conflict has been well studied, however there is a recognized need to understand the role that non-conflict related factors have on mediating exposure to trauma and signs of psychological distress. We used data from the 2015 Kashmir Mental Health Survey and conducted mediation analysis to assess the extent to which daily stressors mediated the effect of traumatic experiences on poor mental health outcomes. Outcomes of interest were probable diagnosis of anxiety, depression, or PTSD; measured using the pre-validated Hopkins Symptoms Checklist (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Total effect mediated were statistically significant but the proportions of effect mediated were found to be small in practical terms. Financial stress mediated 6.8% [95% Confidence Interval (CI) 6∙0-8∙4], 6.7% [CI 6.2-7∙7] and 3.6% [CI 3∙4-4∙0] of the effect of experiencing multiple traumaticogenic events on symptoms of anxiety, depression and PTSD, respectively. Family stress mediated 11.3% [CI 10.3-13.8], 10.3% [CI 9.5-11.9] and 6.1% [CI 5.7-6.7] of the effect of experiencing multiple traumatogenic events on symptoms of anxiety, depression and PTSD, respectively. Poor physical health mediated 10.0% [CI 9.1-12∙0], 7.2% [CI 6.6-8.2] and 4.0% [CI 3.8,4.4] of the effect of experiencing more than seven traumatic events on symptoms of anxiety, depression and PTSD, respectively. Our findings highlight that not only do we need to move beyond a trauma-focussed approach to addressing psychological distress in populations affected by protracted conflict but we must also move beyond focussing on daily stressors as explanatory mediators.