Editorial
Throughout the world, populations face trauma as a function of violence, environmental hazards, and economic hardship. Currently, there are ongoing armed conflicts resulting in mass fatalities in the Middle East, Africa, and other regions (Anderson, 2014). These geopolitical conflicts combined with the effects of climate change (e.g., drought) have driven a major refugee crisis (Hovil & Lomo, 2015; Park, 2015). Recent reports from the United Nations indicate that approximately 65,6 million individuals have been displaced (Gladstone, 2017). There have also been significant cultural and economic changes undermining the status and economic security of different populations, and there is evidence that these shifts contribute to increases in mortality from suicide and substance abuse (Case & Deaton, 2015).
The paradigms for considering the public health effects of geopolitical conflict and environmental disasters have changed as a result of globalization and the Internet. Economic and political interdependence extends the reach and consequences of conflicts throughout the world. The impact of every traumatic event is amplified through a multitude of media platforms, as news of traumatic events reaches millions of persons in real time. Traumatic events affect the mental health of those who are victims, as well as those who work to help them, including rescue and recovery workers (Liu, Tarigan, Bromet, & Kim, 2014).
Traumatic events, even those that are not experienced at first hand, have documented effects on mental and physical health and functioning (Boscarino, Hoffman, Adams, Figley, & Solhkhah, 2017; Hollifield et al., 2002; Sabin-Farrell & Turpin, 2003). People living in war zones report greater mental health symptoms, with 30-70% reporting symptoms of Posttraumatic Stress Disorder (PTSD) and depression (Centers for Disease Control and Prevention, CDC, 2014). Women, the elderly, children, and the disabled are especially vulnerable to trauma-related pathology (Murthy & Lakshminarayana, 2006), with some data suggesting that approximately 50% of children living in war zones report symptoms of PTSD and 43% report symptoms of depression (Attanyake et al., 2009). The long-term consequences of widespread exposure to trauma on the mental and physical health of individuals, communities, and nations is not yet well understood.
Traumatic events and their psychosocial and economic consequences can trigger further trauma and prevent recovery from the mental health consequences of trauma exposure. For example, there is a growing aversion toward Islam in many Western countries because of devastating terrorist attacks in Europe, United States, Africa, Middle-East, and Asia (Lipka, 2017; PEW, 2014). At the same time, negative views of Western countries have been increasing throughout the Muslim world (Furia & Lucas, 2008). The economic, psychosocial, and physical effects of prolonged or intense trauma exposure may decrease the personal, social, and economic capital necessary to prevent and resolve future conflicts and to aid recovery (Hobfoll, 2012; O’Collaghan, McMullen, Shannon, Rafferty & Black, 2013; Staub, 2003).
The multifaceted nature of the threats and their consequences for health and well-being are driving the development of new models and methods for intervention (e.g., McDermott & Cobham, 2014). Cultural adaptations of evidence- based interventions are being developed to meet the needs of individuals facing trauma under very different conditions (Hobfoll, 2012; Slobodin & de Jong, 2015). New methods for disseminating evidence- based intervention are in development (Lewis, Roberts, Bethell, & Bisson, 2015; Reifels, Naccarella, Blashki, & Pirkis, 2014).
This volume presents papers addressing themes about the nature and consequences of trauma exposure and potential interventions. The papers include both literature reviews and empirical articles. The international group of authors addresses a wide range of trauma exposures both in the developed world (e.g., USA and Europe) as well as in the developing world, including Africa and Asia, and examines effects on adults and children.
Four articles discuss the complex and diverse nature of the psychosocial wounds of war and other disasters. The effects are seen not only for victims, but for their families and for the community at large. There are also mental health implications for employees and volunteers who support rescue and recovery efforts.
The article “Mothers and children of violence: Memorialization, reconciliation, and victims in post-genocide Rwanda,” by Adriano Zamperini, Marta Bettini, Francesco Spagna, and Marialuisa Menegatto, discusses the ways in which the nature of trauma shapes the possibility for recovery and social reconciliation. The authors conducted qualitative research among women who experienced the Rwanda genocide. Rape was a common occurrence during this period, and children born as a result of these rapes raise complex moral issues. This article examines the context of these traumas and explores the perceptions and emotions of mothers when they disclose paternity to their adolescent offspring. The authors identify the implication of their research for policies of reconciliation and forgiveness.
The article “Developmental crises and global crises: Helping bereaved children and adolescents,” by Illene N. Cupit, reviews literature on the ways in which current global crises have caused hundreds of thousands of infants, children, adolescents, and young adults to lose family members. But the conditions under which the deaths of these family members occur may also impair the capacity for these children and young adults to grieve. This paper discusses the ways in which widespread trauma can interrupt the ability to process grief and loss and highlights the importance of considering loss within an ecological framework.
The article “The coping, the hardiness, and the sense of coherence as maintaining factors for military personnel’s mental health,” by Iulia C. Giurcă, Anamaria Cătană, Raluca Sassu, and Mihaela Dana Bucuță, examines personality characteristics that may support resilience among military service members as they anticipate confrontation with a major stressful event. This paper provides insight into mechanisms that link trauma exposure to recovery among risk populations, including military personnel.
The article “Posttraumatic Stress Disorder post 9/11: A review of the evidence and implications for public health policy,” by Robert Crupi and Elizabeth Brondolo, reviews the literature on the effects of the 9/11 terrorist attacks on the World Trade Center. Posttraumatic Stress Disorder (PTSD) is the one most commonly studied. The authors highlight differences among groups in their risk of PTSD, identifying potentially vulnerable populations including children and lay volunteers. They review evidence documenting the occurrence of persistent PTSD in some individuals and the emergence of late-onset PTSD. These findings suggest ongoing monitoring and treatment may be a necessity following mass fatality events. The review also reveals that there is good evidence supporting interventions to reduce symptoms of PTSD, but major gaps in knowledge about the best strategies to prepare communities and employees prior to traumatic events to prevent mental health sequelae.
The next set of articles addresses the ways in which both trauma exposure and the consequences of trauma exposure can maintain conflict. As these articles illustrate, ongoing conflict is partly a function of the effects of trauma on psychological functioning. But conflict also persists when the demands and needs of communities and individuals overwhelm existing resources.
The article “Clash of civilizations? Terror Management Theory and the role of the ontological representations of death in contemporary global crisis,” by Sheldon Solomon, Ines Testoni and Simone Bianco, presents some reflections, starting from the perspective of the Terror Management Theory (TMT, Greenberg, Pyszczynski, & Solomon, 1986). TMT is a wide area of psychosocial research, which shows how basic human conflict results from having a desire to live, but realizing that death is inevitable, produces terror, from which cultural belief systems and the adherence to the standards of value associated with them derive. The present discord between Western and Middle-Eastern cultures could be explained by the role of religion and secularism in contemporary intercultural hostilities, which characterizes the contemporary global crisis. The starting point is the consideration of the ontological representations of death in the construction of cultural worldviews, since it provides a sense of meaning and value and affords opportunities to obtain literal and symbolic immortality from which a specific analysis of the clash of civilizations has been developed (Testoni, De Cataldo, Ronconi, & Zamperini, 2017; Testoni, Parise, Visintin, Zamperini, & Ronconi, 2016).
The article “Geopolitics: Needs of migrants, refugees, and asylum seekers-needs in Europe,” by Albert Persaud presents interesting data that shed light on the scale of contemporary humanitarian crises. Even though specifically focused on the European condition, it provides context by delineating the international circumstances from which it originated. The importance of this contribution rests on the discussion of the large number of subjects who need help and the kind of necessities arising from their situations.
The third set of articles discusses new models and methods for intervention. New models are needed because of the complex nature of the trauma exposures and the degree to which whole communities or workplaces are involved. New methods are needed to meet a growing demand for service and a shortage of service providers.
The article “Development of a Web-based scalable intervention to reduce mental health risks in medical examiner personnel,” by Elizabeth Brondolo, Amandeep Kaur, Thomas J. Brondolo, Joseph E. Schwartz, and Douglas L. Delahanty, describes the development of a scalable intervention to reduce risk for poor mental health among medical examiner employees. Medical examiners identify the deceased, determine the cause and manner of death, and communicate this information to various stakeholders including law enforcement, public health authorities, and families of victims. Basic research has identified risk factors for mental health symptoms in this group which include both work-related trauma exposure, and negative schemas which emerge as a function of trauma exposure on the job. The paper describes a pilot intervention to improve the employees’ ability to reduce risk of mental health symptoms and improve their emotion regulation capacities. The intervention was Web-based permitting dissemination across many work-sites.
The article “The use of the Clinical Ethnographic Narrative Interview to understand and support help seeking after gender based violence,” by Denise M. Saint Arnault, addresses issues of Gender Based Violence (GBV) in international conflict. GBV includes abduction or rape of women and girls to humiliate, intimidate, and traumatize them and their communities. GBV can result in long-term physical injuries, psychological trauma, and social and cultural stigma. The article describes the use of Clinical Ethnographic Narrative Interview (CENI). CENI offers a method to examine the complex interplay between culture and help seeking among those who are suffering. This paper reviews the challenges and benefits of the narrative approach after trauma and highlights the ways in which cultural adaptation can facilitate the use of narrative methods to address profound trauma.
Together these papers highlight the challenges facing both victims of trauma and those who must help them. The papers address only a small portion of the traumatic circumstances individuals face around the globe and focus primarily on the mental health consequences of these exposures. Many of the papers are literature reviews, designed to raise new questions. Overall, the papers highlight the need for further empirical research.
As the papers indicate, individuals across the world face a wide range of trauma exposures, and, in many cases, whole communities are affected. Trauma exposures clearly affect the health and well-being of the victims, but the effects vary across developmental periods and across social and political contexts. Additional research is needed to identify more effective methods for documenting the short-and long-term effects of trauma exposure on the functioning of individuals, families, and communities. It will be critical to identify factors, which moderate the effects of exposure, which may include family relationships, governmental support, and the duration and type of trauma exposure (United Nations, 2008). The skills, traits, and contexts which promote resilience must be identified.
Additional research is needed on the mechanisms through which different contexts and types of exposure affect the capacity to recover. As these papers illustrate, the capacity for individuals and communities to recover depends on the unique circumstances and traumas they face. Specifying these effects can help policy makers identify the types and quantities of resources that will be needed to maintain health in the face of ongoing crises. Finally, new methods of intervention and new methods of disseminating these interventions are needed to provide support in a complex, threatening global environment (Slobodin & De Jong, 2015).
To the core contributions of this special issue, which are a reflection on the new competencies required for responding to global conflict, a final article “The interplay of attachment avoidance and anxiety in affecting nurse’s caregiving style and emotional exhaustion” is added by Silvia Golia, Monica Pedrazza, Sabrina Berlanda, and Elena Trifiletti. This article concerns the psychological variables which can affect the relationships between nurses and patients. Findings are also applicable to the relationship between nurses and migrant patients.
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Attanayake, V., McKay, R., Joffres, M., Singh, S., Burkle, F. Jr., & Mills, E. (2009). Prevalence of mental disorders among children exposed to war: A systematic review of 7,920 children. Medicine Conflict and Survival, 25, 4-19. doi:10.1080/13623690802568913
Boscarino, J. A., Hoffman, S. N., Adams, R. E., Figley, C. R., & Solhkhah, R. (2017). Mental health outcomes among vulnerable residents after Hurricane Sandy: Implications for disaster research and planning. American Journal of Disaster Medicine, 9(2), 97-106.
Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.
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