Mental Health Sequela Resulting From Political Violence: Using Structural Equation Modeling to Examine Unique and Overlapping Experiences

Background and Purpose: Political violence has affected more than 50 countries in the last three decades (World Health Organization (WHO), 2002). While evidence of the effects of political violence on mental health is compelling (Barber, 2008; deJong, 2003; Haj-Yahia, 2008; Punamaki, 1990; Summerfield, 2000; World Health Organization (WHO), 2002), conceptualizing “political violence” is still a fundamental task. Key questions remain about what constitutes violence and whether particular acts function uniquely to disrupt mental health. Many classification schemes do not account for everyday experiences under political violence. The analysis described here is focused on understanding acts that are often not thought of as violence, but are hassles and limitations to daily life reflecting disruption of the life course (arrest, assaults from soldiers, separation from family, the need to change one's plans for schooling, proximity to structures of violence like separation walls and checkpoints, separation from family land). To aid in social work practice with populations suffering from political violence, this study attempts to isolate unique categories within political violence, including the everyday, and to examine their effects on mental health.

Methods: Study population was adult women in the West Bank. Survey respondents (N = 131) were recruited from health and community centers. Structural equation modeling was used to examine indicators of political violence (material loss, surveillance, abuse by or presence of soldiers, and separation from family) as both independent experiences and as a single, latent construct consisting of these four factors, and examining its relationship to distress, using Kessler-10 Distress Scale (Kessler et al., 2002).

Results: Initial Confirmatory Factor Analysis (CFA) showed good fit when items in our political violence index were modeled as four distinct latent constructs. Factors were material loss (loss of income, separation from family land and home demolition); surveillance (number of checkpoints passed through in last month, distance from separation wall); abuse by and presence of Israeli soldiers (strip-searches, beatings, detention/arrest, presence of army); and separation from family (separation from family, number of family members arrested or detained due to political violence). Political violence, modeled as a latent construct of these four factors, in a model testing for effects on distress showed good model fit (x2=52.5, p=.377; CFI=.988; TLI = .985; RMSEA= .20). Political conflict was positively related to distress (ß = .30, p < .05).

Conclusions and Implications: Findings suggest distinct occurrences within political violence for the study population, including separation of family members and the experiences of being under constant surveillance and control. Surprisingly, the distinct latent factors of political violence did not exhibit differential effects on distress. Rather, they seemed to work together to affect mental health. Further research is needed to establish how political violence impairs mental health for this population; what is the effect of independent acts versus an accumulation of acts of violence? In terms of practice implications, this study suggests the importance of conceptualizing political violence as a problem that may contain variegated experiences; this is an important consideration for appropriate treatment and intervention with victims of political violence.