Psychological impacts of the April 15th armed conflict in Sudan: A cross-sectional study
Abstract
This study examines the psychological repercussions of the April 15th conflict in Sudan, addressing a gap in existing literature on severe mental health issues in post-conflict settings. It emphasises the impact beyond individual experiences, highlighting broader societal dynamics and the need for culturally tailored mental health interventions. This study used a quantitative approach through a cross-sectional design. This study analysed online survey responses from 134 participants (61.9% male, 32.1% female; Mean Age = 26.66, SD = 4.67). It employed the Arabic version of the Lovibond and Lovibond (1995) DASS-21 questionnaire. The findings reveal significant psychological impacts, with "extremely severe" levels of anxiety, depression, and stress. Underscoring the urgent need for comprehensive mental health strategies in post-conflict recovery efforts in Sudan.
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References
- Agbo, K. C., Haruna, U. A., Oladunni, A. A., & Lucero-Prisno III, D. E. (2024). Addressing gaps in protection of health workers and infrastructures in fragile and conflict-affected states in Africa. Discover Health Systems, 3(36), 1-18. https://doi.org/10.3390/healthcare8020100
- Aggarwal, N. K., Cedeño, K., Guarnaccia, P., Kleinman, A., & Lewis-Fernández, R. (2016). The meanings of cultural competence in mental health: An exploratory focus group study with patients, clinicians, and administrators. SpringerPlus, 5, Article 384. https://doi.org/10.1186/s40064-016-2037-4
- Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review. Cureus, 15(5), e39549. https://doi.org/10.7759/cureus.39549
- Amawi, N., Mollica, R. F., Lavelle, J., Osman, O., & Nasir, L. (2014). Overview of research on the mental health impact of violence in the Middle East in light of the Arab Spring. The Journal of Nervous and Mental Disease, 202(9), 625–629. https://doi.org/10.1097/NMD.0000000000000174
- Arkes, J. (2023). Regression analysis: A practical introduction (2nd ed.). London: Routledge.? https://doi.org/10.4324/9781351011099
- Armstead, T. L., Wilkins, N., & Nation, M. (2021). Structural and social determinants of inequities in violence risk: A review of indicators. Journal of Community Psychology, 49(4), 878–906. https://doi.org/10.1002/jcop.22232
- Ball, H. L. (2019). Conducting online surveys. Journal of Human Lactation, 35(3), 413-417. https://doi.org/10.1177/0890334419848734
- Bidargaddi, N., Schrader, G., Klasnja, P., Licinio, J., & Murphy, S. (2020). Designing m-Health interventions for precision mental health support. Translational Psychiatry, 10(1), 222. https://doi.org/10.1038/s41398-020-00895-2
- Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19
- Bitter, C. C., Ngabirano, A. A., Simon, E. L., & Taylor, D. M. (2020). Principles of research ethics: A research primer for low- and middle-income countries. African journal of emergency medicine: Revue africaine de la medecine d'urgence, 10(Suppl 2), S125–S129. https://doi.org/10.1016/j.afjem.2020.07.006
- Bolton, R. E., Bokhour, B. G., Hogan, T. P., Luger, T. M., Ruben, M., & Fix, G. M. (2020). Integrating Personalized Care Planning into Primary Care: a Multiple-Case Study of Early Adopting Patient-Centered Medical Homes. Journal of General Internal Medicine, 35(2), 428-436. https://doi.org/10.1007/s11606-019-05418-4
- Brauer, J., & Gissy, W. G. (2017). The Economics of Conflict and Peace. In Google Books. Taylor & Francis. https://books.google.com/books?hl=en&lr=&id=zEQrDwAAQBAJ&oi=fnd&pg=PA229&dq=Foreign+casualties+in+sudan+war&ots=ePa9xBTufH&sig=Pps_qTQjN-SMjz2WQdammjXlJ74
- British Psychological Society. (2021). BPS Human Research Ethics Guidelines. Retrieved from https://www.bps.org.uk/guideline/code-ethics-and-conduct-0
- Bühler, J. L., Orth, U., Bleidorn, W., Weber, E., Kretzschmar, A., Scheling, L., & Hopwood, C. J. (2023). Life events and personality change: A systematic review and meta-analysis. European Journal of Personality, 38(3), 544-568 https://doi.org/10.1177/08902070231190219
- Burani, K., & Nelson, B. D. (2020). Gender differences in anxiety: The mediating role of sensitivity to unpredictable threats. International journal of psychophysiology: official journal of the International Organization of Psychophysiology, 153, 127–134. https://doi.org/10.1016/j.ijpsycho.2020.05.001
- Can, Y. S., Iles-Smith, H., Chalabianloo, N., Ekiz, D., Fernández-Álvarez, J., Repetto, C., Riva, G., & Ersoy, C. (2020). How to relax in stressful situations: A smart stress reduction system. Healthcare, 8(2), Article 100. https://doi.org/10.3390/healthcare8020100
- Capili, B. (2021). Cross-Sectional Studies. The American journal of nursing, 121(10), 59–62. https://doi.org/10.1097/01.NAJ.0000794280.73744.fe
- Castillo, E. G., Ijadi-Maghsoodi, R., Shadravan, S., Moore, E., Mensah, M. O., 3rd, Docherty, M., Aguilera Nunez, M. G., Barcelo, N., Goodsmith, N., Halpin, L. E., Morton, I., Mango, J., Montero, A. E., Rahmanian Koushkaki, S., Bromley, E., Chung, B., Jones, F., Gabrielian, S., Gelberg, L., Greenberg, J. M., Wells, K. B. (2019). Community Interventions to Promote Mental Health and Social Equity. Current Psychiatry Reports, 21(5), 35-48. https://doi.org/10.1007/s11920-019-1017-0
- Cénat J. M. (2023). Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment. Perspectives on psychological science: a journal of the Association for Psychological Science, 18(3), 675–687. https://doi.org/10.1177/17456916221120428
- Cowden, R. G., Davis, E. B., Counted, V., Chen, Y., Rueger, S. Y., VanderWeele, T. J., Lemke, A. W., Glowiak, K. J., & Worthington, E. L., Jr (2021). Suffering, Mental Health, and Psychological Well-being During the COVID-19 Pandemic: A Longitudinal Study of U.S. Adults With Chronic Health Conditions. Well-being, space and society, 2, 100048. https://doi.org/10.1016/j.wss.2021.100048
- Crime Report. (2024). The official police spokesman reveals the total number of reports registered on the electronic report platform. Retrieved from http://tinyurl.com/Sudan-News-Agency
- Crum J. (2021). Understanding Mental Health and Cognitive Restructuring with Ecological Neuroscience. Frontiers in psychiatry, 12, 697095. https://doi.org/10.3389/fpsyt.2021.697095
- Dalecki, L., Lasorsa, D. L., & Lewis, S. C. (2009). The News Readability Problem. Journalism Practice, 3, 1-12. https://doi.org/10.1080/17512780802560708
- Dissanayake, L., Jabir, S., Shepherd, T., Helliwell, T., Selvaratnam, L., Jayaweera, K., ... & Sumathipala, A. (2023). The aftermath of war; mental health, substance use and their correlates with social support and resilience among adolescents in a post-conflict region of Sri Lanka. Child and Adolescent Psychiatry and Mental Health, 17(1), 101. https://doi.org/10.1186/s13034-023-00648-1
- Etz, K.E., & Arroyo, J.A. (2015). Small Sample Research: Considerations Beyond Statistical Power. Prevention Science, 16(7), 1033–1036. https://doi.org/10.1007/s11121-015-0585-4
- Gass, N. (2023). A need for a holistic approach to mental healthcare. Nature. Mental Health, 1, 388. https://doi.org/10.1038/s44220-023-00079-z
- Getha-Taylor, H., Holmes, M. H., & Moen, J. R. (2020). Evidence-Based Interventions for Cultural Competency Development Within Public Institutions. Administration & Society, 52(1), 57-80. https://doi.org/10.1177/0095399718764332
- Gilmer, T. P., Center, K., Casteel, D., Choi, K., Innes-Gomberg, D., & Lansing, A. E. (2021). Developing trauma resilient communities through community capacity-building. BMC Public Health 21, 1681- 1689. https://doi.org/10.1186/s12889-021-11723-7
- Gilster, M. E., & Meier, C. L. (2016). Formal and Informal Neighborhood Social Organization: Which Promotes Better Resident Health?. Health & Social Work, 41(3), 182–190. https://doi.org/10.1093/hsw/hlw024
- Goldstein, J. S. (2001). War and Gender. In Encyclopedia of Sex and Gender (pp. 301–322). Springer, Boston, MA. https://doi.org/10.1007/978-0-306-47770-6
- Grasser L. R. (2022). Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?. Risk Management and Healthcare Policy, 15, 909–922. https://doi.org/10.2147/RMHP.S270233
- Greco, E. (2023). Keeping eyes on Sudan – keeping eyes on austerity. Review of African Political Economy, 50(175), 1–8. https://doi.org/10.1080/03056244.2023.2240675
- Henson, C., Truchot, D., & Canevello, A. (2020). What promotes post-traumatic growth? A systematic review. European Journal of Trauma & Dissociation, 4(4), 100195. https://doi.org/10.1016/j.ejtd.2020.100195
- Hobfoll S. E. (1989). Conservation of resources. A new attempt at conceptualizing stress. The American psychologist, 44(3), 513–524. https://doi.org/10.1037//0003-066x.44.3.513
- Kelly, B. P. (2023). The power politics of the Holy See: the church, the state, and its citizens. Politics and Religion, 16(4), 682–707. https://doi.org/10.1017/S175504832300024X
- Kestel, D., Lewis, S., Freeman, M., Chisholm, D., Siegl, O. G., & van Ommeren, M. (2022). A world report on the transformation needed in mental health care. Bulletin of the World Health Organization, 100(10), 583. https://doi.org/10.2471/BLT.22.289123
- Kohnert, D. (2023). On the impact of the 2023 Sudanese war on Africa and beyond. Retrieved from https://mpra.ub.uni-muenchen.de/117583/
- Korostelina, K. V., Rothbart, D., & Gjeloshi, B. (2023). Production of the meaning of justice in the aftermath of war in Sudan. Peace and Conflict: Journal of Peace Psychology, 29(3), 306–316. https://doi.org/10.1037/pac0000667
- Kurapov, A., Danyliuk, I., Loboda, A., Kalaitzaki, A., Kowatsch, T., Klimash, T., & Predko, V. (2023). Six months into the war: a first-wave study of stress, anxiety, and depression among in Ukraine. Frontiers in psychiatry, 14, 1190465. https://doi.org/10.3389/fpsyt.2023.1190465
- Lim, I. C. Z. Y., Tam, W. W. S., Chudzicka-Czupa?a, A., McIntyre, R. S., Teopiz, K. M., Ho, R. C., & Ho, C. S. H. (2022). Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-affected areas: A meta-analysis. Frontiers in psychiatry, 13, 978703. https://doi.org/10.3389/fpsyt.2022.978703
- Lim, I. C. Z. Y., Tam, W. W. S., Chudzicka-Czupa?a, A., McIntyre, R. S., Teopiz, K. M., Ho, R. C., & Ho, C. S. H. (2022). Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-affected areas: A meta-analysis. Frontiers in psychiatry, 13, 978703. https://doi.org/10.3389/fpsyt.2022.978703
- Liu, H., & Boyatzis, R. E. (2021). Focusing on Resilience and Renewal from Stress: The Role of Emotional and Social Intelligence Competencies. Frontiers in Psychology, 12, 685829. https://doi.org/10.3389/fpsyg.2021.685829
- Makonye, F. (2023). Political reflections on the Sudanese Civil War 2023: A qualitative study. African Journal of Peace and Conflict Studies, 12(3), Article 4. https://hdl.handle.net/10520/ejc-aa_ubuntu1_v12_n3_a4
- Miller, C. J., Smith, S. N., & Pugatch, M. (2020). Experimental and quasi-experimental designs in implementation research. Psychiatry Research, 283, 112452. https://doi.org/10.1016/j.psychres.2019.06.027
- Miller, K. E., & Rasmussen, A. (2016). The mental health of civilians displaced by armed conflict: an ecological model of refugee distress. Epidemiology and Psychiatric Sciences, 26(2), 129–138. https://doi.org/10.1017/s2045796016000172
- Mohammed Bilal, M., Moawia Balla Elnour, S., Mohamed Elmahdi, Z. Z., & Mustafa Mudawi Ahmed, E. (2024). Mental health consequences among Sudanese due to the armed conflicts and civil unrest of 2023: A cross-sectional study. The International Journal of Social Psychiatry, 70(3), 563–573. https://doi.org/10.1177/00207640231221101
- Mootz, J. J., Stabb, S. D., & Mollen, D. (2017). Gender-Based Violence and Armed Conflict: A Community-Informed Socioecological Conceptual Model From Northeastern Uganda. Psychology of Women Quarterly, 41(3), 368–388. https://doi.org/10.1177/0361684317705086
- Murray, L. K., Tol, W., Jordans, M., Zangana, G. S., Amin, A. M., Bolton, P., Bass, J., Bonilla-Escobar, F. J., & Thornicroft, G. (2014). Dissemination and implementation of evidence-based, mental health interventions in post-conflict, low-resource settings. Intervention (Amstelveen, Netherlands), 12(Suppl 1), 94–112. https://doi.org/10.1097/WTF.0000000000000070
- Murthy, R. S., & Lakshminarayana, R. (2006). Mental health consequences of war: a brief review of research findings. World psychiatry: official journal of the World Psychiatric Association (WPA), 5(1), 25–30. Mental health consequences of war: a brief review of research findings - PubMed (nih.gov). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472271/
- Musisi, S., & Kinyanda, E. (2020). Long-term impact of war, civil war, and persecution in civilian populations—Conflict and post-traumatic stress in African communities. Frontiers in psychiatry, 11, 20-29. Lausanne, Switzerland: Frontiers Media SA. https://doi.org/10.3389/fpsyt.2020.00020
- Nichols, M., & Michael, M. (2024, January 20). Ethnic killings in one Sudan city left up to 15,000 dead, UN report says. London. Reuters. https://www.reuters.com/world/africa/ethnic-killings-one-sudan-city-left-up-15000-dead-un-report-2024-01-19/
- Park, E. R., Luberto, C. M., Chad-Friedman, E., Traeger, L., Hall, D. L., Perez, G. K., Goshe, B., Vranceanu, A. M., Baim, M., Denninger Md PhD, J. W., Fricchione Md, G., Benson Md, H., & Lechner, S. C. (2021). A Comprehensive Resiliency Framework: Theoretical Model, Treatment, and Evaluation. Global advances in health and medicine, 10, 21649561211000306. https://doi.org/10.1177/21649561211000306
- Passarelli, M., Casetta, L., Rizzi, L., & Perrella, R. (2021). Responses to Stress: Investigating the Role of Gender, Social Relationships, and Touch Avoidance in Italy. International journal of environmental research and public health, 18(2), 600. https://doi.org/10.3390/ijerph18020600
- Pattanshetty, S., Bhatt, K., Inamdar, A., Dsouza, V., Chattu, V. K., & Brand, H. (2023). Health Diplomacy as a Tool to Build Resilient Health Systems in Conflict Settings: A Case of Sudan. Sustainability, 15(18), 13625. https://doi.org/10.3390/su151813625
- Rabenu, E., & Yaniv, E. (2017). Psychological Resources and Strategies to Cope with Stress at Work. International journal of psychological research, 10(2), 8–15. https://doi.org/10.21500/20112084.2698
- Ranganathan, P., & Caduff, C. (2023). Designing and validating a research questionnaire: Part 1. Perspectives in clinical research, 14(3), 152–155. https://doi.org/10.4103/picr.picr_140_23
- Rozanov, V., Fran?iškovi?, T., Marini?, I., Macarenco, M. M., Letica-Crepulja, M., Mužini?, L., Jayatunge, R., Sisask, M., Vevera, J., Wiederhold, B., Wiederhold, M., Miller, I., & Pagkalos, G. (2019). Mental health consequences of war conflicts. In A. Javed & K. Fountoulakis (Eds.), Advances in Psychiatry (pp. 281–304) Cham. Springer. https://doi.org/10.1007/978-3-319-70554-5_17
- Rutherford, S., & Saleh, S. (2019). Rebuilding health post-conflict: Case studies, reflections, and a revised framework. Health Policy and Planning, 34(3), 230–245. https://doi.org/10.1093/heapol/czz018
- Singh, V., Kumar, A., & Gupta, S. (2022). Mental Health Prevention and Promotion-A Narrative Review. Frontiers in psychiatry, 13, 898009. https://doi.org/10.3389/fpsyt.2022.898009
- Slone, M., & Shoshani, A. (2022). Effects of war and armed conflict on adolescents’ psychopathology and well-being: Measuring political life events among youth. Terrorism and Political Violence, 34(8), 1797-1809. https://doi.org/10.1080/09546553.2020.1839427
- Southard, A. C. (2018). Male Warrior Hypothesis. In: Shackelford, T., Weekes-Shackelford, V. (eds) Encyclopedia of Evolutionary Psychological Science. Springer Cham. https://doi.org/10.1007/978-3-319-16999-6_645-1
- Ssali, S. N., & Theobald, S. (2016). Using life histories to explore gendered experiences of conflict in Gulu District, northern Uganda: Implications for post-conflict health reconstruction. South African Review of Sociology, 47(1), 81–98. https://doi.org/10.1080/21528586.2015.1132634
- Stewart, R., Wright, B., Smith, L., Roberts, S., & Russell, N. (2021). Gendered stereotypes and norms: A systematic review of interventions designed to shift attitudes and behaviours. Heliyon, 7(4), e06660. https://doi.org/10.1016/j.heliyon.2021.e06660
- Tajfel, H. (1981). Human Groups and Social Categories: Studies in Social Psychology. Cambridge. Cambridge University Press. https://archive.org/details/humangroupssocia0000tajf
- Tajfel, H., & Turner, J. C. (2004). The Social Identity Theory of Intergroup Behavior. In J. T. Jost & J. Sidanius (eds.), Political psychology: Key readings (pp. 276–293) New York. Psychology Press. https://doi.org/10.4324/9780203505984-16
- Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411-429. https://doi.org/10.1037/0033-295x.107.3.411
- Tucker, J., Whitehead, L., Palamara, P., Rosman, J. X., & Seaman, K. (2020). Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions. BMC Nursing, 19(1), 106. https://doi.org/10.1186/s12912-020-00495-x
- United Nations Office for the Coordination of Humanitarian Affairs. (2024). Sudan: One year of conflict - Key facts and figures. Retrieved from https://www.unocha.org/
- Van Ommeren, M. (2019). Mental health conditions in conflict situations are much more widespread than we thought: But there’s a lot we can do to support people. World Health Organization (WHO). Retrieved from https://www.who.int/news-room/commentaries/detail/mental-health-conditions-in-conflict-situations-are-much-more-widespread-than-we-thought
- Van Vugt, M., De Cremer, D., & Janssen, D. P. (2007). Gender Differences in Cooperation and Competition: The Male-Warrior Hypothesis. Psychological Science 18(1), 19–23. https://doi.org/10.1111/j.1467-9280.2007.01842.x
- Vasileiou, K., Barnett, J., Thorpe, S., & Young, T. (2018). Characterizing and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC medical research methodology, 18(1), 148. https://doi.org/10.1186/s12874-018-0594-7
- Vieira, R. F., Lima, R. C. de, & Mizubuti, E. S. G. (2019). How to write the discussion section of a scientific article. Acta Scientiarum. Agronomy, 41(0), e42621. https://doi.org/10.4025/actasciagron.v41i1.42621
- Walton, C. C., Gwyther, K., Gao, C. X., Purcell, R., & Rice, S. M. (2022). Evidence of gender imbalance across samples in sport and exercise psychology. International Review of Sport and Exercise Psychology. Advance online publication. https://doi.org/10.1080/1750984X.2022.2150981
- Xu, M., Fralick, D., Zheng, J. Z., Wang, B., Tu, X. M., & Feng, C. (2017). The Differences and Similarities between two-sample t-test and Paired t-test. Shanghai Archives of Psychiatry, 29(3), 184–188. https://doi.org/10.11919/j.issn.1002-0829.217070
- Zaki, C., Alhelo, A., & Suliman, K. (2023, November). Trade, food security, and the war in Ukraine: The cases of Egypt and Sudan. Economic Research Forum Working Paper, 1659. Retrieved from https://erf.org.eg/app/uploads/2023/11/1699801532_109_906188_1659.pdf