Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed

• Published in: PloS one 2016-05, Vol.11 (5), p.e0156216-e0156216
• Main Authors: Barber, Brian K, McNeely, Clea A, El Sarraj, Eyad, Daher, Mahmoud, Giacaman, Rita, Arafat, Cairo, Barnes, William, Abu Mallouh, Mohammed
• Format: Article
• Language: English
• Subjects: Adult; Appetite; Arabs - psychology; Armed Conflicts - psychology; Biology and Life Sciences; Child soldiers; Conflict; Correlation analysis; Emotions; Energy measurement; Exhaustion; Exploratory factor analysis; Factor analysis; Female; Gender; Health aspects; Humans; Imprisonment; Male; Measures; Medicine and Health Sciences; Mental depression; Mental disorders; Mental health; Middle Aged; Morale; Palestinian people; People and Places; Political activism; Politics; Post traumatic stress disorder; Posttraumatic stress disorder; Psychological aspects; Public health; Refugee camps; Regions; Research and Analysis Methods; Risk factors; Sleep; Social justice; Social Sciences; Stress, Psychological - psychology; Surveys and Questionnaires; Territory; Trauma; Violence; Violence - psychology; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156216

This mixed-methods exploratory study identified and then developed and validated a quantitative measure of a new construct of mental suffering in the occupied Palestinian territory: feeling broken or destroyed. Group interviews were conducted in 2011 with 68 Palestinians, most aged 30-40, in the West Bank, East Jerusalem, and the Gaza Strip to discern local definitions of functioning. Interview participants articulated of a type of suffering not captured in existing mental health instruments used in regions of political conflict. In contrast to the specific difficulties measured by depression and PTSD (sleep, appetite, energy, flashbacks, avoidance, etc.), participants elaborated a more existential form of mental suffering: feeling that one's spirit, morale and/or future was broken or destroyed, and emotional and psychological exhaustion. Participants articulated these feelings when describing the rigors of the political and economic contexts in which they live. We wrote survey items to capture these sentiments and administered these items-along with standard survey measures of mental health-to a representative sample of 1,778 32-43 year olds in the occupied Palestinian territory. The same survey questions also were administered to a representative subsample (n = 508) six months earlier, providing repeated measures of the construct. Across samples and time, the feeling broken or destroyed scale: 1) comprised a separate factor in exploratory factor analyses, 2) had high inter-item consistency, 3) was reported by both genders and in all regions, 4) showed discriminate validity via moderate correlations with measures of feelings of depression and trauma-related stress, and 5) was more commonly experienced than either feelings of depression or trauma-related stress. Feeling broken or destroyed can be reliably measured and distinguished from conventional measures of mental health. Such locally grounded and contextualized measures should be identified and included in assessments of the full impact of protracted political conflict on functioning.