Exposure to Political Violence and Psychological Well-being in Bosnian Adolescents: A Mixed Method Approach

Abstract

Previous research on political violence has shown an inverse relationship between overall exposure and psychological well-being. The aim of this study was to examine this relationship in more detail by exploring the impact of specific types of war-related events upon psychological well-being, as well as the role of social and political context in moderating these outcomes. The psychological well-being of 337 Bosnian adolescents living in two towns on opposite sides of the war was assessed using the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Based on the combined symptom scores, and in-depth interviews regarding life history, war experiences, and subjective experience of psychological well-being a gender-matched sub-sample of 40 adolescents was selected and completed a 45-item trauma event scale. Results from the quantitative and qualitative analyses showed that the relationship between exposure, displacement and well-being varied significantly depending on the community in which the adolescents lived. Specific meanings given to different types of war events were important in moderating their effect. Living in a neglected, isolated and depressed community, worry about school performance, missing friends and family breakdown could have as significant an effect on well-being as exposure to war-related events. The findings demonstrate the need to take social context and meaning of events into account when examining the impact of war exposure on psychological well-being.

Keywords

adolescents Bosnia-Herzegovina exposure political violence psychological well-being

Get full access to this article

View all access options for this article.

References

Adjukovic, M. , & Adjukovic, D. (1993). Psychological well-being of refugee children . Child Abuse and Neglect, 17, 843-854 .

Almqvist, K. , & Brobert, A.G. (1999). Mental health and social adjustment in young refugee children 31/2 years after their arrival in Sweden . Journal of the American Academy of Child and Adolescent Psychiatry, 38, 723-730 .

American Association of Child and Adolescent Psychiatry . (1998). Practice parameters for the assessment and treatment of children and adolescents with post traumatic stress disorder . Journal of the American Association of Child and Adolescent Psychiatry, 37(10, Suppl.), 5s-26s .

Apfel, R.J. , & Simon, B. (2000). Mitigating discontents with children in war: An ongoing psychoanalytic inquiry. In A.C.G.M. Robben & M.M. Suarez-Orozco (Eds.), Cultures under siege: Collective violence and trauma (pp. 102-130). Cambridge: Cambridge University Press .

Bodman, F. (1941). War conditions and the mental health of the child . British Medical Journal, 286-288 .

Bryce, J.W. , Walker, N. , Ghorayeb, F. , & Kanj, M. (1989). Life experiences, response styles and mental health among mothers and children in Beirut, Lebanon . Social Science & Medicine, 28, 685-695 .

Cardozo, B.L. , Vergara, A. , Agani, F. , & Gotway, C.A. (2000). Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo . Journal of the American Medical Association, 284, 569-577 .

Carey-Trefzer, C.J. (1949). The results of a clinical study of war damaged children who attended the Child Guidance Clinic, The Hospital for Sick Children, Great Ormond Street, London . Journal of Mental Science, 400, 35-44 .

Dawes, A. , & De Villiers, C. (1987). Preparing children and their parents for prison: The Wynberg seven. In D. Hanson (Ed.), Mental health in transition. Cape Town, South Africa: OASSSA Second National Conference Proceedings .

10.

Elbedour, S. , Ten Bensel, R. , & Bastien, D.T. (1993). Ecological integrated model of children of war: Individual and social psychology . Child Abuse and Neglect, 17, 805-819 .

11.

Farwell, N. (1999). After liberation: Psychosocial well-being of Eritrean youth . Dissertation Abstracts International Section A: Humanities and Social Sciences, 59(8-A), 3208 .

12.

Filstead, W.J. (Ed.). (1971). Qualitative methodology: First hand involvement with the social world. Chicago: Markham .

13.

Foy, D.W. , Madvig, B. , Pynoos, R.S. , & Camilleri, A.J. (1996). Etiologic factors in the development of post-traumatic stress disorder in children and adolescents . Journal of School Psychology, 34(2), 133-145 .

14.

Gergen, M. (1988). Narrative structures in social explanation. In C. Antaki (Ed.), Analysing everyday explanation: A casebook of methods (pp. 94-112). Sage: London .

15.

Glaser, B.G. , & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine .

16.

Henwood, K. , & Pidgeon, N. (1992). Qualitative research and psychological theorising . British Journal of Psychology, 83, 97-111 .

17.

Human Rights Watch . (1998). Bosnia and Herzegovina, ‘a closed, dark place’: Past and present human rights abuses in Foča. New York: Human Rights Watch .

18.

Jensen, P.S. , & Shaw, J. (1993). Children as victims of war: Current knowledge and future research needs . Journal of the American Academy of Child and Adolescent Psychiatry, 32, 697-708 .

19.

Jones, L. (2002). Adolescent understandings of political violence . A qualitative study. Social Science & Medicine, 55, 1351-1371 .

20.

Jones, L. , & Kafetsios, K. (2002). Assessing adolescent mental health in war-affected societies: The significance of symptoms . Child Abuse and Neglect, 26, 1059-1080 .

21.

Jones, L. , Rrustemi, A. , Shahini, M. , & Uka, A. (2003). Mental health services for war affected children: Report of a survey in Kosovo . British Journal of Psychiatry, 183, 540-546 .

22.

Kostelny, K. , & Garbarino, J. (1994). Coping with the consequences of living in danger: The case of Palestinian children and youth . International Journal of Behavioral Development, 17, 595-611 .

23.

Kuterovac, G. , Dyregrov, A. , & Stuvland, R. (1994). Children in war: A silent majority under stress . British Journal of Medical Psychology, 67, 363-375 .

24.

Locke, C.J. , Southwick, K. , McCloskey, L.A. , & Fernandez-Esqier, M.E. (1996). The psychological and medical sequelae of war in Central American refugee mothers and children . Archives of Pediatric and Adolescent Medicine, 150, 822-828 .

25.

Macksoud, M.S. (1992). Assessing war trauma in children: A case study of Lebanese children . Journal of Refugee Studies, 5(1), 3-15 .

26.

Macksoud, M.S. , & Aber, J.L. (1996). The war experiences and psychosocial development of children in Lebanon . Child Development, 67, 70-88 .

27.

Mastnak, L. (1995). The process of engagement in nonviolent collective action: Case studies from the 1980s. Unpublished PhD dissertation, University of Bath, UK.

28.

McCallin, M. (1998). Community involvement in the social integration of child soldiers. In P.J. Braken & C. Petty (Eds.), Rethinking the trauma of war (pp. 60-75). London: Free Association Press .

29.

Mghir, R. , Freed, W. , Raskin, A. , & Katon, W. (1995). Depression and post-traumatic stress disorder among a community sample of adolescent and young adult Afghan refugees . Journal of Nervous and Mental Disease, 183, 24-30 .

30.

Mollica, R. , Caspi-Yavin, Y. , Bollini, P. , Truong, T. , Tor, S. , & Lavelle, J. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and post-traumatic stress disorder in Indochinese refugees . Journal of Nervous and Mental Diseases, 180, 111-116 .

31.

Mollica, R.F. , Caspi-Yavin, Y. , Lavelle, J. , Tor Svang, Y.-T. , Chan, S. , Pham, T. , Ryan, A. , & De Marneffe, D. (1991). The Harvard Trauma Questionnaire, manual: Cambodian, Laotian and Vietnamese versions. Boston: Harvard Program In Refugee Trauma .

32.

Mollica, R.F. , Poole, C. , Son, L. , Murray, C.C. , & Tor, S. (1997). Effects of war trauma on Cambodian refugee adolescent’s functional health and mental health status . Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1098-1106 .

33.

Orona, C.J. (1997). Temporality and identity loss due to Alzheimer’s disease. In A. Strauss & J. Corbin (Eds.), Grounded theory in practice (pp. 171-196). London: Sage .

34.

Paardekooper, B. , de Jong, J.T.V.M. , & Hermanns, J.M.A. (1999). The psychological impact of war and the refugee situation on South Sudanese children in refugee camps in Northern Uganda: An exploratory study . Journal of Child Psychology and Psychiatry, 40, 529-536 .

35.

Perrin, S. , Smith, P. , & Yule, W. (2000). Practitioner review: The assessment and treatment of post traumatic stress disorder in children and adolescents . Journal of Child Psychology and Psychiatry, 41, 277-289 .

36.

Protacio-Marcelino, E. (1989). Children of political detainees in the Philippines: Sources of stress and coping patterns . International Journal of Mental Health, 18, 71-86 .

37.

Punamäki, R.L. (1996). Can ideological commitment protect children’s psychosocial well-being in situations of political violence? Child Development, 67, 55-69 .

38.

Punamäki, R.L. , & Suleiman, R. (1990). Predictors and effectiveness of coping with political violence among Palestinian children . British Journal of Social Psychology, 29, 67-77 .

39.

Qouta, S. , Punamäki, R.L. , & El Sarraj, E. (1995a). The impact of the peace treaty on psychological well-being: A follow-up study of Palestinian children . Child Abuse and Neglect, 19, 1197-1208 .

40.

Qouta, S. , Punamäki, R.L. , & El Sarraj, E. (1995b). The relations between traumatic experiences, activity, and cognitive and emotional responses among Palestinian children . International Journal of Psychology, 30, 289-304 .

41.

Raphael B. , & Wilson, J. (Eds.). (2000). Psychological debriefing: Theory, practice and evidence. Cambridge: Cambridge University Press .

42.

Richman, N. (1993). Annotation: Children in situations of political violence . Journal of Child Psychology and Psychiatry, 34, 1286-1302 .

43.

Sack, W.H. , Clarke, G.N. , & Seeley, J. (1996). Multiple forms of stress in Cambodian adolescent refugees . Child Development, 67, 107-116 .

44.

Sack, W.H. , Him, C. , & Dickson, M.A. (1999). Twelve-year follow-up study of Khmer youths who suffered massive war trauma as children . Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1173-1179 .

45.

Sack, W.H. , Seeley, J.R. , & Clarke, G.N. (1997). Does PTSD transcend cultural barriers? A study from the Khmer Adolescent Refugee Project . Journal of the American Academy of Child and Adolescent Psychiatry, 36, 49-54 .

46.

Salama, P. , Spiegel, P. , van Dyke, M. , Phelps, L. , & Wilkinson, C. (2000). Mental health and nutritional status among the adult Serbian minority in Kosovo . Journal of the American Medical Association, 284, 578-584 .

47.

Savin, D. , Sack, W.H. , Clarke, G.N. , Meas, N. , & Richart, I. (1996). The Khmer Adolescent Project: III . A study of trauma from Thailand’s Site II refugee camp. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 384-391 .

48.

Straker, G. , Mendelsohn, M. , Moosa, F. , & Tudin, P. (1996). Violent political contexts and the emotional concerns of township youth . Child Development, 67, 46-54 .

49.

Strauss, A. , & Corbin, J. (Eds.). (1997). Grounded theory in practice. London: Sage .

50.

Tashakkori, A. , & Teddlie, C. (1998). Mixed methodology: Combining qualitative and quantitative approaches. London: Sage .

51.

Thabet, A. , & Vostanis, P. (1999). Post-traumatic stress reactions in children of war . Journal of Child Psychology and Psychiatry, 40, 385-391 .

52.

The International Criminal Tribunal for the Former Yugoslavia. (1999). Indictment of Milorad Krnojelac: Case No: IT-97-25-I.

53.

Walton, J.R. , Nuttall, R.L. , & Nuttall, E.V. (1997). The impact of war on the mental health of children: A Salvadoran study . Child Abuse and Neglect, 21, 737-749 .

54.

Ziv, A. , & Israeli, R. (1973). Effects of bombardment on the manifest anxiety level of children living in Kibbutzim . Journal of Consulting and Clinical Psychology, 40, 287-291 .