“No safe place”: Applying the transactional stress and coping model to active warfare.

Abstract

Objective: The mental health consequences of political violence arise within active, dynamic processes of appraisal and coping. Understanding the psychological sequela of war is an urgent task; yet, we have little on the ground exploration of the quotidian events within and the accompanying psychological responses of the totalizing experience of war. Using a transactional-based model of stress and coping, in this study, we use a novel method-retrospective diaries-to explore the shifting, unpredictable, and traumatic nature of life during a major military operation. Method: Our sample consisted of 21 Palestinian women recruited via an intervention for teachers in Gaza. Women's retrospective chronological diaries were analyzed using content analysis. Results: Our analysis drew out the cyclical process of coping within political violence, demonstrating five essential temporal dimensions: warning; bombings, with injuries, death, and destruction; reintegrating within flight and resettlement; ongoing political insecurity within precarious truces and rampant loss and destruction; and persevering: restarting life amid pervasive trauma. Conclusion: Our findings draw attention to vital temporal dimensions and the cyclical nature of stress and coping that underlie the sequela of mental health in a highly charged context. In tracing warfare, its psychosocial consequences, and distinct patterns of emotional and logistical survival, our study contributes to the growing field of psychological epidemiology of war. Clinical Impact StatementThe transactional model of coping is often used to help understand the complex sequalae resulting from stress and trauma. Here, we demonstrate the importance of using that framework while prioritizing the cyclical and collective nature of coping within the immense and ongoing stress of political violence. Through building on the strengths and strategies women elucidate in our study, we are better able to leverage these protective factors in interventions aimed at ameliorating the psychological effects of war. Furthermore, in demonstrating the complex and lasting mental health issues related to not only acute assaults but also ongoing stressors related to political and economic siege, our study bolsters the movement to engage in efforts to prevent war and occupation.

Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies

“…So, he fell in front of the door and was caught by the rebels' commando. " (Direct quote from a participant) [41] Insufficient access to resources meeting basic needs Armed conflict and destroyed infrastructure hindered access to basic commodities such as food, water, electricity and fuel [51,54,[59][60][61]. The lack of resources and options resulted in a grief of not being able to provide their children more than absolutely necessary [39,59].…”

“…Being exposed to war also entailed a significant socio-economic stress involving unemployment, difficulties earning a living, and inability to maintain the previous lifestyle [39,47,52,56,61]. Women lived in crowded, temporary, and unsafe housing situations [47,54]. When living in refugee camps, women experienced significant challenges, including food shortages, insanitary conditions and inadequate shelters [38,41,42,45,55,61].…”

“…Gaining expanded responsibilities within the family was described, leading to empowerment, greater independence, and a capacity to challenge traditional gender roles [46,48,52,62]. Another positive effect was strengthened relationships with family members and others in similar positions [47,48,54].…”

“…Reduced safety and exposure to general violence Life became unstable and unsafe, with increased risk of violence [37][38][39][40][41][42][43][44][45][46][47][48][49][50] Conflicts resulted in destruction of societal structures and relationships [40, 45-47, 49, 58, 59] Violence was expressed as threats, destruction, bombings, torture, sexual violence, theft, shootings, murders, obstacles to work, and arbitrary arrests [38-40, 45-49, 52-56] Killings, abuse, and violence against family members and neighbors were witnessed [39,40,46,56,60] Women suffered violence based on ethnicity and religion [40,55,57] Family relationships changed and family bonds were disrupted [37, 39-41, 44, 46-49, 57, 59] Insufficient access to resources meeting basic needs War reduced the access to resources needed to meet basic needs [42,51,54,59,60] Grief over being unable to provide resources, safety and optimism for children [39,59,60] Socioeconomic stress was experienced, including financial and housing difficulties [39,42,47,54] When living in refugee camps, women experienced significant challenges, including food shortages, insanitary conditions and inadequate shelters [38,41,42,45...…”

“…Psychological distress and during migration Legal and illegal migration routes involved fear and uncertainty among women [43, 45-48, 56, 59] Women were reminded about dangers when witnessing the death of people [53] Having to take responsibility of others during migration involved psychological distress [45,51] Women placed in refugee camps experienced the setting as: (i) unsafe associated with significant suffering [42,43,45,55,59]; and (ii) inhospitable environments lacking basic facilities and involving poor living conditions [38,41,42,45,55,61] Being forced to migrate involved feeling a loss of identity, difficulties accepting their identity, challenges when trying to adjust, and feeling grief or emptiness when missing and longing for their previous life and country of origin [43-46, 52, 56] Being exposed to risks during pregnancy and childbirth Pregnancy and childbirth involved a risk of violence, resulting in serious consequences [55] Severe violence and risks when pregnant led to feeling unsafe and taking precautions [55] Migration meant little possibilities to access adequate postpartum care [39,51] Migration led mothers to discontinue breastfeeding and had difficulties feeding children [39,51] Being exposed to violence and discrimination as a woman Women were exposed to intensified violence in public and private settings [38-40, 45, 46, 50, 54, 55, 61, 62] The regime, military, and civilians were perpetrators of violence against women [39,40,45] Violence resulted in fear, panic, grief, feeling unsafe, and physical consequences [37,54,55] Violence continued in refugee camps and during migration [45,52,53,55,…”