It's become common sense to admit that war can make soldiers crazy — the condition has been called everything from "shell shock" to "post traumatic stress disorder." But now a study published yesterday offers concrete evidence that war drives civilians crazy too. In the first nationwide study of civilian mental health in war zones, a group of researchers in Lebanon surveyed thousands of people in that country to correlate their exposure to war with the likelihood that they would develop a mental illness. The results don't bode well for the future mental health of the globe.
It's worth quoting rather extensively from a release about this study, which makes a somewhat subtle point. First, the researchers explored three different types of mental illness, ranging from mild to severe. They also point out that people in Lebanon on average don't have a higher rate of mental illness than people in other countries. When Lebanese civilians have been directly exposed to war, however, the likelihood that they will develop mental illness increases 3- to 13-fold. (Also, note that the researchers carefully define what "exposure to war" means.)
From a release about the study:
Elie Karam and colleagues . . . used a World Health Organization (WHO) interview tool to diagnose mental health disorders in a sample of 3,000 adults in Lebanon representative of the population. They investigated the question of lifetime prevalence (the proportion of Lebanese who have a mental disorder at some point in their lives) and the age of onset of mental disorders, as well as the delay they experienced in receiving treatment . . . They also asked each participant in the study about their experience of traumatic events relating to war, including whether they had been a refugee (38 % of people in the study), a civilian in a war zone (55%), or witnessed death or injury (18%). Although the relationship between war and the mental health of people serving in the military has been described before, this is the first time that a nationally representative study has assessed the effect of war on the first onset of mental disorders in a civilian population.
The authors describe that one in four Lebanese in this study had a mental health disorder during their lifetime, according to the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV) criteria that the WHO tool uses, with major depression being the most common disorder. This is similar to prevalence of mental illness in the United Kingdom and lies within the range observed in the WHO's World Mental Health Surveys in other countries. The researchers also estimated that one in three Lebanese would have one or more mental disorders by the age of 75, which is also similar to survey results in other countries. Only half the surveyed people with a mental disorder had ever received professional help; of those who did have a mental disorder, the delay in treatment ranged from 6 years for mood disorders to 28 years for anxiety disorders. Finally, exposure to war-related events increased the risk of developing an anxiety, mood, or impulse -control disorder by 6-fold, 3-fold and 13-fold respectively.
Given that more and more people are being exposed to war, or having to flee countries or cities to escape from it, this study makes it clear that we should expect to see more mental illness across the world generally. Of course, the authors make it clear that more studies are needed. Still, the data so far look grim indeed.
Lifetime Prevalence of Mental Disorders in Lebanon [PLoS Medicine]