Abstract

Exploring an expansive range of psychological impacts before, during, and after war, this research discusses pre-war stress, government propaganda, acculturative stress, isolation, anxiety and depression, survivor’s guilt, general trauma, and economic impacts. Anxiety and depression typically affect around 40-50% of a population experiencing war, with anxiety often being more common than depression. This statistic significantly decreases in populations only months after a war ends, and it continues to decrease over time gradually; lifelong anxiety and/or depression is more common among war veterans in comparison to civilians. Refugees face significant challenges adapting to new cultures post-war, impacting their mental well-being and integration into society. Conflicts like the Russia-Ukraine war result in substantial gross domestic product (GDP) loss and widespread job displacement, exacerbating economic instability in affected regions. Governments’ depiction of war is influenced by evolving dynamics and employs tactics like propaganda, shaping public perception and potentially fostering resistance to alternative viewpoints. Further explicating about the many challenges of war, one can observe the inevitable separation from friends and family. Throughout a conflict, separation manifests in a wide range of psychological issues. When observing pre-war times, stress caused by the uncertainty and ambiguity of the future of loved ones is evident. Similarly, when in the midst of war, the loss of support systems such as familial connections, larger networks, and religion can heighten psychological burdens. Cultural and physical dislocation may create a barrier for communication between individuals in war-torn spaces, which further exacerbates disillusionment and stress. Finally, the aftermath of war may manifest in experiences of survivor’s guilt and ongoing difficulties in processing lived experiences of trauma. Both post traumatic stress disorder (PTSD) and intergenerational trauma have significant negative impacts on the everyday lives of those affected, whether military personnel or civilians. While some manifestations of war have known treatments, others like intergenerational trauma still require additional research to assess the magnitude of impact before proposing potential comprehensive solutions.

Introduction

Throughout history, war has been a recurrent phenomenon that leaves a sizable effect on individuals and society as a whole. To be able to assess the effects of conflict and generate treatment programmes and prevention interventions, further research is necessary. From ancient conflicts described in historical texts, to modern-day conflicts depicted in forthcoming scholarly analyses, the burdens of war have become a common characteristic of human civilization. Recent research has begun to explore psychological perspectives of war, focusing on the psyche of affected individuals and community members. The profound psychological trauma in the wake of the civil war among civilians and combatants revealed by the research of Regnoli et al. (2023) and Thabet et al. (2016) justifies the need for a system of comprehensive support measures and mental health interventions. Likewise, the frequency of research on the socio-economic consequences of warfare has increased. Storonyanska and Benovska (2023) examine this issue from various perspectives, moving from the destruction of trade networks to decreased infrastructure and human capital. An economic ‘costs of war’ analysis functions as a measure of producing effective policies and plans for post-war reconstruction and development. This paper aims to provide an account of the intersectional nature of war, stretching across history, psychology, sociology, and economics.

CALM BEFORE THE STORM: A PRELUDE TO WAR

NAVIGATING THE STRESS OF UNCERTAINTY

In the face of impending political conflict, one often questions the unknown and finds themselves grappling with uncertainty and apprehension. When the next day’s bread and water are not guaranteed and one’s own safety is questioned, obvious anxiety builds up. Regnoli et al. (2023) suggest that this fear is often multifaceted, manifesting as both physiological and experiential dimensions of fear. Focusing on the heightened stress and anxiety levels of Italian adolescents in the wake of the Russo-Ukrainian war of 2022, Regnoli et al. (2023) explicate trauma’s versatile nature by displaying how teenagers, despite not sharing similar cultures, countries, or experiences, face similar impacts of impending war. 

Living in a generation that entrusts its smooth workings to the hands of various media and technology ‘experts,’ distinctions across political and social issues are often opinions that society tends to internalise. Without a simple and trustworthy mechanism for verifying information, individuals are susceptible to disinformation as well as misinformation. The concept of “motivated reasoning” corroborates this ideology, stating that people often gravitate towards information that conforms to their pre-existing beliefs and rejects any contradictory information (Mazepus et al., 2023). This selective bias is a key factor in the spread of misinformation by the media being so widely accepted (Mazepus et al., 2023). In moments of mass hysteria and panic, it is even easier to believe the misinformation being circulated. This insidious tactic of deliberately causing mental stress, anxiety and fear in innocent civilians or the “weaponization of public opinion” is often implemented in international conflicts, but seldom considered (Bernal et al., 2020).

IMPACTS OF PROJECTED REALITIES ON OUR PERSPECTIVES

The government’s projection of war is a complex and challenging task. The dynamic nature of war is difficult to define clearly, as most of the defining circumstances influence change in completely different ways (Johnson, 2014). Interpretation is essential to the process of getting information in wartime, which aids the government in navigating the clutter of information which mostly is ambiguous. 

Propaganda is one of the main tools wielded by governments to create disinformation in war and conflict. There are also other ways of such manipulations. The government also employs strategic narratives to create an alternative representation of events and discourse (Crilley & Chatterjee-Doody, 2021). In the course of wartime communications, governments may use historical methods of propaganda to influence public opinion and keep loyalty up by invoking remembrance of the ‘humanity’ of war. During the Iraq War, the government not only applied strategies of abstraction but also allowed their subordinates to employ journalists, stage briefings, and broadcast to television to link to the public on a person-to-person basis. These tactics aimed to increase the empathetic response of the general public, invoking sympathy with the conflict by highlighting human narratives at the forefront that underscored efforts being made toward peace (Hiebert, 2003). Furthermore, “attitude inoculation,” which involves prolonged exposure to propaganda messages, might cause rejection of opposing ideas. This suggests a powerful influence of repeated exposure on shaping attitudes and beliefs.

IN THE TRENCHES: COPING WITH LIFE DURING WAR

ACCULTURATIVE STRESS

Acculturative stress post-war is a complex challenge faced by individuals as they try to adapt to a new culture or society after going through a traumatic ordeal (Smith, 2023). Such struggle is determined by several variable factors such as intercultural interactions, efforts toward preserving one’s cultural identity, coping with accepted societal values, adapting to a lack of familial support, and acquiring fluency in the new language. Particularly vulnerable to acculturative stress are refugees, asylum seekers, and irregular migrants as they often face relocation issues, trauma, and struggles regarding finding their families (Hasanović et al., 2020). Additionally, refugees may often endure life-threatening attacks, the violent deaths of loved ones, and the perpetual danger of living in war zones. These traumas can have lasting effects and also shape the lives of these refugees (Richter et al., 2015; Jesuthasan et al., 2018). 

According to the research of Kartal and Kiropoulos (2016), acculturative stress is a threat to mental health causing stress disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety. In a longitudinal study carried out by Yun et al. (2021), Iraqi refugee women settled in San Diego, California (USA) revealed that they had high levels of chronic stress with approximately 45.6% of women experiencing anxiety and 55.3% experiencing depression. The assessment showed a strong link between acculturative stress and mental health, with each 1-point increment on the stress scale increasing the odds of depression by 1.056 and that of anxiety by 1.076. Accordingly, it is necessary to take into consideration both psychological and social stressors that affect the mental health of refugees, as well as the impact of the host culture as they begin to integrate into the new culture. 

The concept of reacculturation, which implies that individuals return to their original culture, is a useful concept for understanding the challenges of identity and belongingness for refugees and is critical for improved health interventions and the prevention of suicides (Bhugra and Becker, 2005). Through interventions and improved services that specifically target acculturative stress experienced by people who experience the traumas of war, it is possible to significantly improve overall well-being and resettlement process (Catani, 2018).

COPING WITH SEPARATION AND DISCONNECTED BONDS

War gives rise to a medley of intricate emotional responses. Beyond the immediate physical danger, there is a more imminent fear of losing family. The feeling of this loss surpasses the understanding achieved through diagnostic psychology to a more compelling realisation of one day having to face such horrors. For individuals living in a situation where loss is imminent, the feeling is evermore overpowering. Survivors of war lament not only the agony of death and violence, but also not being able to save the ones they hold most dear (Luster et al., 2008). In Stouffer et al. (1949), the loss of family in the context of World War II provides insight into this topic; they claim that this loss is one of the greatest losses one can experience – the knowledge that a lack of control or power renders one helpless in preventing the suffering of loved ones (Stouffer et al., 1949). These complex emotions manifest on various occasions, highlighting the deep-rooted impact of war. 

Culture plays an important role in the identities of individuals at times when a person is stripped of autonomy; when multiple, often uncontrollable changes are occurring, it is common that cultural identity becomes increasingly important to individuals and communities. Furthermore, as war poses the imminent threat of the loss of a social support system, heightened levels of anxiety, isolation and loneliness present. As a result of both the loss of support systems and the desire to preserve cultural identity, migration is common. The variety in diversity and culture that find common ground in migration is evident when people of different cultures, faiths, and customs are forced to exist together for lengthy periods of time (Luster et al., 2008). Diversity in culture, while often positive, makes it difficult for care providers to accurately assess the conditions of patients while also following their religious customs (Bhugra and Becker, 2005).

BATTLEFIELD OF THE MIND

Anxiety and depression significantly increase during war; there have been many relevant studies on anxiety and depression during wars and all have comparatively similar results (Lim et al., 2022; Thabet et al., 2016). 

A meta-analysis on the prevalence of depression, anxiety, and post-traumatic stress in war and conflict-affected areas reveals the general magnitude of depression and anxiety of populations during war. Depression typically affects 38.7% of the population in war, while anxiety has a higher 43.4% (Lim et al., 2022). In this study, as in many others, anxiety is more common among victims of war compared to depression, correlating with many other studies. An example includes a study on the 2008-2009 war at the Israel-Gaza border, where 45.2% of adult Israeli civilians were affected by major depressive disorder (MDD), whereas 57.8% were diagnosed with generalised anxiety disorder (GAD). This study also found that both disorders were more common among women than men (Neria et al., 2010). It is important, however, to consider the possibility that women may have been more commonly diagnosed than men. 

In contrast, a study performed on Palestinian children between the ages of 6-16 found a higher prevalence of depression, which was significantly more common at 50.6% than anxiety with 21.9% of children diagnosed (Thabet et al., 2016). There was largely no difference between the percentage of males and the percentage of females that were diagnosed with either depression or anxiety, however, it is important to note that this bit of information did not align with many other similar studies that found differences among genders, such as the previously mentioned study (Neria et al., 2010). 

The difference in the prevalence of anxiety and depression individually between adults and children may suggest the importance of considering external factors. It is likely that adults were more prone to worry and anxiety because of financial, familial, and school issues etc. A study of the Russia-Ukraine War found that exacerbated financial and employment conditions often resulted in increased anxiety (Kurapov et al., 2023). Children, on the other hand, are less likely to worry about such things due to, perhaps, an ignorance of the economy or a lack of understanding regarding the consequences of violent conflict or the concept of death.

THE AFTERMATH: REBUILDING A LIFE IN THE WAKE OF WAR

ECHOES OF SURVIVOR’S GUILT

Survivors of war, often regarded as living heroes for having experienced things that seem to defy comprehension, often do not express feeling like heroes themselves. Even when active conflict ceases, survivors report carrying guilt regarding those lives cut short (Kirkpatrick, 2012). The effect of war can never truly be encompassed by mere statistics as they do not encapsulate the true suffering of the victims or survivors. Society must recognize the deep-rooted effects of war on survivors, amplifying the need for physical, emotional, financial, and social support with the goal of aiding in healing and rebuilding (Elder & Clipp, 1988). 

A CRISIS OF FAITH

For many groups experiencing violence and conflict, religion becomes a main coping mechanism; it provides solace and a sense of hope for those who have experienced the atrocities of war and helps them find meaning in their experiences (Elder & Clipp, 1988). War has a profound impact on individuals and communities before, during, and after the conflict. It shapes their identity, their relationships, and their overall well-being. Interventions that recognize the importance of religion and spirituality in the lives of war survivors can be beneficial for their mental health and overall resiliency (Elder & Clipp, 1988). Once faced with such conflict, there are often split reports of feeling more connected or disconnected from religion (Larsen et al., 2024). 

HEALING FROM THE TRAUMA

Post-traumatic stress disorder: 

Post-traumatic stress disorder (PTSD) is considered to be one of the most common and well-known after-effects of war, both in military personnel and civilians. Around 9-25% of war veterans develop PTSD in the first two years after the traumatic experience (Arbanas, 2010). Causes for PTSD vary from directly witnessing a death to hearing about traumatic experiences from close contact. PTSD impacts the everyday life of those affected by it, and according to the DSM criteria (Exhibit 1.3-4 DSM-5) for diagnosis, symptoms include re-experiencing the event in forms such as having nightmares, intrusive thoughts, or being psychologically distressed when reminded of the experience. Other symptoms may include avoidance of certain places or people, emotional detachment, decreased interest in meaningful activities, anxiety, and sleep problems. 

Currently, there are many treatments for PTSD. One of the most effective treatments is considered to be exposure therapy through cognitive behavioural therapy (CBT). During an event, a person’s brain associates a traumatic stimulus with its meaning for the individual, which is unpleasant at the very least, creating a “trigger structure” (Foa & Kozak, 1986). When an individual with PTSD is reminded of the situation, it causes distress to the person and leads to the avoidance of the trigger, which in turn prevents the formation of new meaningful correlations that could decrease anxiety. Exposure therapy involves re-exposing an individual to traumatic triggers in a safe and controlled environment, activating the “trigger structure” and facilitating the differentiation between the trigger and the distressed state.

Intergenerational trauma: 

Generational trauma, also known as intergenerational or transgenerational trauma, is a cycle effect of a traumatic experience that gets passed down, usually from parents to children, influencing the lives of those who were not directly exposed to the traumatic experience themselves. More research is necessary to comprehensively understand the impacts of intergenerational trauma, however, multiple studies show that the trauma responses of parents have the capacity to negatively impact children later on. 

A study of 96 Southeast Asian refugees showed that parents who experienced trauma had a significant negative impact on their children’s mental and physical health, whereas non-traumatized adults had a significant positive impact on their children’s mental and physical health (Hoffman et al., 2023). This may result when someone with a diagnosed impact of the war, for example PTSD, experiences changes in their behaviour after the traumatic experience, potentially experiencing increased bouts of aggression, detachment, or anxiety that negatively impact their relationship with those around them. 

Another study conducted in 2019 by Castro-Vale et al. (2019) evaluated 46 veteran families in which fathers have been officially diagnosed with PTSD. The results implied that children were not only impacted solely by the fact that their parents experienced trauma and had a PTSD diagnosis, but rather by the severity of the trauma. In families where fathers had a more intense traumatic experience, the children were more negatively influenced. More severe PTSD symptoms may make it difficult for parents to employ consistently gentle parenting techniques, disrupting family dynamics and transmitting negative coping skills. While having a parent diagnosed with PTSD is not always connected with undesirable impacts on children, there is potential for untreated parental trauma to impact children’s well-being, both directly and indirectly.

COSTS OF CONFLICT AND HOW WAR IMPACTS THE ECONOMY

During periods of conflict, regions face significant economic challenges stemming from disruptions to investment, credit activities, and overall development. Storonyanska and Benovska (2023) shed light on the harsh economic realities of conflict, from plunging Gross Domestic Product (GDP) to logistical supply and demand problems, to the depletion of both the workforce and their productivity levels. During the Russia-Ukraine War, for all of 2022, gross domestic product losses amounted to between $81 billion and $104 billion (International Organization for Migration, 2022). 

Additionally, war also causes the loss of jobs and increases the rate of unemployment. The International Organization for Migration found that 60% of Ukrainians displaced due to the ongoing war lost their jobs; furthermore, due to the war, the inflation rate in Ukraine has soared to over 20% (2022). The cost of everyday goods like food, clothing, and medicine has become harder for people to afford. According to the International Labour Organization (ILO), about 24% of employment in the West Bank had been lost in 2019 – equivalent to 208,000 jobs (2019). 

Moreover, the erosion of infrastructure and trade networks exacerbates economic downturns in conflict zones (Bluszcz & Valente, 2020). As of September 1, 2023, the total documented direct damage to Ukraine’s infrastructure caused by a full-scale Russian invasion has reached $151.2 billion; compared to June 2023, damages have increased by over $700 million, from $150.5 billion to $151.2 billion (Kulish, 2023). 

Consequently, entrepreneurship and economic growth are severely stunted in these regions (Audretsch et al., 2023). Armed conflicts lead to multifaceted economic crises, profoundly impacting regions through disruptions in investment, trade, and infrastructure. In 2021, with a sales volume reaching $176.7 billion, the retail industry accounted for 14% of Ukraine’s gross domestic product (GDP). It is one of the most war-affected industries. 

Logistical issues and staff shortages dominated in the initial war period, while liquidity gaps, changes in consumer demand and the closure of outlets are currently affecting the industry. According to the Swiss Confederation, the Association of Retailers of Ukraine had almost 30% of outlets closed or destroyed with e-commerce, jewellery, entertainment and fashion segments suffering the highest amount of losses; online orders dropped fivefold and 85% of jewellery outlets closed (2022). In contrast, food, pharmaceutics and gas stations had a stable performance – more than 80% of them continue operating.

ANXIETY AND DEPRESSION

The percentage of people affected by anxiety and depression significantly decreases over time after a war ends (Neria et al., 2010; Lim et al., 2022; Zeidner & Ben-Zur, 1994; Karam et al., 2014). 

A study conducted on the mental health impacts of the 2008-2009 Israel-Gaza war on young Israeli civilians shows that the percentage of people diagnosed with major depressive disorder (MDD) dropped from 45.2% to 22.2% in the two to four months after the conclusion of the war; similarly, anxiety dropped from 57.8% to 21.5% in the two months after the war, then to an even lower 12.6% only four months after the war (Neria et al., 2010). Four months after the conclusion of the war, depression dropped from 38.7% to 29.1%, while anxiety dropped from a staggering 43.4% to 30.3% (Lim et al., 2022). Another study again shows that anxiety levels were substantially higher during the war than after (Zeidner & Ben-Zur, 1994). Women were shown to have an increased risk of symptoms of both anxiety and depression when compared to men. 

Studies on children and adolescents have provided similar results. Three weeks after the end of the war, 25.9% of the sample was found to have MDD, 16.1% with separation anxiety disorder (SAD), and 28.0% with overanxious disorder (OAD); a year after the war, the prevalence of MDD had decreased to 5.6%, SAD to 4.2% and OAD to 0%, in the same sample (Karam et al., 2014). It is critical to observe the larger decreases in disorders among children over time; this may suggest that the ongoing development of the brain helps to reduce the damage done by the war. 

Fifty years after the conclusion of the Korean War, a study of war veterans found that 31.3% suffered from anxiety, while 23.5% suffered from depression (Ikin et al., 2007). These percentages are significantly higher than those found in the previously mentioned studies that were centred around civilians. This may suggest that veterans are prone to having longer-lasting symptoms of anxiety and depression, due to a lack of structured social support (Campbell et al., 2020). Many of these studies suggested that the large decrease in anxiety and depression can be partially credited to accessible mental health support. 

DISCUSSION

War results in ongoing traumas accompanied by a range of life-changing impacts. The exploration of these impacts leads to many unanswered questions: what makes war so significant? Are the political, economic, and physical impacts the only aspects that need to be explored? 

Political aspects have long been a focus in international relations and diplomacy; we can observe that governing bodies have grown to be more sophisticated in their approaches during wars, through the use of propaganda and strategic techniques, revealing the complexities of managing war dynamics. The effectiveness of these techniques relies on the trust that the public has in the government. 

Physical and social impacts are ongoing areas of research with much to be examined. Refugees and those who have been displaced face multiple challenges associated with acculturation, which is part of the process of adapting to the new environment and changing societal norms. This stress has negative impacts on mental health. Personalised interventions as well as therapy and support services are a must for the solving of these problems and improving the lives of people affected by conflicts. 

Economic disruptions capture the attention of policymakers and large organisations like the International Monetary Fund (IMF). Conflict has the ability to stunt or spark stock values, general public investment, and trade patterns, often depending on damage to infrastructure and relations between countries. Conflict often also contributes to increases in unemployment rates. 

However, increasing attention to non-physical scars left behind by conflict, it is clear that PTSD, anxiety, and depression are among the most acknowledged mental health disorders. These psychological impacts of war have been responded to by public health and mental health professionals in the form of interventions and therapies; however, a large percentage of war veterans and civilians still suffer from these disorders as treatments may be inaccessible (Ikin et al., 2007). Future discussions must take further consideration of the ongoing need for psychological responses to war, emphasising the need for affordable, accessible mental healthcare. 

Furthermore, separation from all familiarity during situations of conflict is a psychological impact often disregarded. This separation presents itself in many different ways ranging from homesickness to grieving the loss of family left behind in war. Limited research conducted on this topic has resulted in less conversation and policy decisions on the commonly experienced significant impacts caused by separation. Future discussion international forums should examine separation as a major impact of war and conflict, allocating resources for the development of ongoing support in proposals for world peace. 

Lastly, post-traumatic stress disorder greatly impacts the lives of those diagnosed with it, elevating the difficulty of everyday tasks. Ongoing nightmares, avoidance, and emotional detachment from people and activities often lead to worse personal relationships, further complicating the experience of coping and improving. Intergenerational trauma may result as a consequence of living with PTSD. Regardless, PTSD and intergenerational trauma both have significant impacts on those who have directly experienced war and those with whom they interact. While there is a large research literature surrounding PTSD, the usage of exposure therapy and, specifically, CBT, intergenerational trauma requires future research to more comprehensively examine its direct and indirect impacts, as well as to conceptualise treatments and solutions moving forward. 

The suffering that comes with war does not end when war does. Trauma, recovery, and rebuilding are processes that dictate many lives, even years after the conflict has been resolved. Even though modern-day medical facilities and extensive academic research on war psychology have aided in equipping psychologists and psychiatrists alike in assisting patients suffering from the psychological impacts of war discussed in this paper, it is critical that we address the main causes of war to prevent additional people suffering its consequences. Perhaps, then, future research should focus more on diffusing the onset of conflict rather than preparing for the rebuilding of ruins.

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