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Impact of Political Violence on Health: The Case of Academics for Peace in Turkey
Abstract
This study examines the profound impact of political violence and repression on the mental and physical health of Academics for Peace (AfP) in Turkey. The research combines quantitative and qualitative data to explore the interplay between violence, stigmatization, and health outcomes among the affected academics. This study particularly focuses on the aftermath of the State of Emergency in Turkey in 2016, which led to the dismissal of thousands of academics. We employ the World Health Organization's definition of violence to understand the broad nature of violent acts, encompassing power dynamics and systemic repression. The findings highlight the extensive physical and mental health consequences faced by AfP due to political violence. The prevalence of diagnosed mental illness among respondents is notably high, indicating that exposure to trauma, threats, and repression leads to severe mental distress. Anxiety, depression, post-traumatic stress disorder, and musculoskeletal diseases are among the common health issues reported. The research underscores how political violence disrupts psychosocial pillars including safety and security, bonds and networks, justice, roles and identities, and existential meaning, and explores how these disruptions contribute to communal mental health deterioration. It also identifies the impact on well-being of economic losses, uncertainties, and isolation from social and academic networks.
In an era when authoritarian governments increasingly target academics, Turkey’s 2016 purge of more than 6,000 academics and their diminution to civic death is conspicuous in its cruelty. Although unprecedented, this is not the first time that Turkish academics have been punished en masse. By looking at the tools with which academics have been expelled from educational institutions, the public sphere, and the political body, I attempt to develop a nuanced understanding of the interconnected forms of punishment directed towards academic citizens as knowledge producers. I suggest that the 1980 coup accomplished three things: it introduced new mechanisms of punishment based on a logic of retribution instead of compensation; it changed the legal system into a regime of exception; it transformed academics into patriotic worker-citizens. The latest purges have brought an additional change in the status of academics’ citizenship, rendering them as disposable citizens forever at risk of being targeted as the ‘civic dead’.
Background:
Existing WHO estimates of the prevalence of mental disorders in emergency settings are more than a decade old and do not reflect modern methods to gather existing data and derive estimates. We sought to update WHO estimates for the prevalence of mental disorders in conflict-affected settings and calculate the burden per 1000 population.
Methods:
In this systematic review and meta-analysis, we updated a previous systematic review by searching MEDLINE (PubMed), PsycINFO, and Embase for studies published between Jan 1, 2000, and Aug 9, 2017, on the prevalence of depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, and schizophrenia. We also searched the grey literature, such as government reports, conference proceedings, and dissertations, to source additional data, and we searched datasets from existing literature reviews of the global prevalence of depression and anxiety and reference lists from the studies that were identified. We applied the Guidelines for Accurate and Transparent Health Estimates Reporting and used Bayesian meta-regression techniques that adjust for predictors of mental disorders to calculate new point prevalence estimates with 95% uncertainty intervals (UIs) in settings that had experienced conflict less than 10 years previously.
Findings:
We estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia) was 22·1% (95% UI 18·8-25·7) at any point in time in the conflict-affected populations assessed. The mean comorbidity-adjusted, age-standardised point prevalence was 13·0% (95% UI 10·3-16·2) for mild forms of depression, anxiety, and post-traumatic stress disorder and 4·0% (95% UI 2·9-5·5) for moderate forms. The mean comorbidity-adjusted, age-standardised point prevalence for severe disorders (schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder) was 5·1% (95% UI 4·0-6·5). As only two studies provided epidemiological data for psychosis in conflict-affected populations, existing Global Burden of Disease Study estimates for schizophrenia and bipolar disorder were applied in these estimates for conflict-affected populations.
Interpretation:
The burden of mental disorders is high in conflict-affected populations. Given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden.
Funding:
WHO; Queensland Department of Health, Australia; and Bill & Melinda Gates Foundation.
I continue to think of revenge. But this thought of revenge, it doesn't know how to stop. And we should not have this thought or the matter will grow and keep going on and on for a long time. We should be a person who thinks and acts in accordance with dhamma. [A person who seeks revenge] only creates misery for our society. It is a germ in society. But I continue to think of revenge … The people who killed my brother, who put down his name to get into the truck, are all alive, living in my village. To this day, I still really want revenge. I keep observing them. But, I don't know what to do…. The government forbids it. - Chlat, whose brother's family was executed by Khmer Rouge There were many ways to die during Democratic Kampuchea (DK), the genocidal period of Khmer Rouge rule in Cambodia (1975-1979). Some starved to death. Others died from malnutrition and illness. Many more were executed, often en masse, in a genocide that took the lives of more than 1.7 of Cambodia's 8 million inhabitants (Kiernan, 1996) - almost a quarter of the population. Such numbers are almost incomprehensible, yet they fail to take account of the toll such death and destruction took on the survivors, who suffered the loss of friends and loved ones; struggled on in a world of privation and relentless work; tried to survive for another day in a time in which fear, terror, and trauma were omnipresent; and, after DK, attempted to piece together their fractured lives in a society that had been turned upside down.
Objective:
Sense of belonging has demonstrated significant relationships with depression and suicidal thoughts, highlighting its potential utility in refining assessment of suicide risk.
Method:
Structured clinical interviews and self-report measures were used to assess depression, suicidal behaviors, hopelessness, life stress, social support, and sense of belonging in a sample of 116 depressed psychiatric patients.
Results:
Lower sense of belonging was significantly associated with greater severity of depression, hopelessness, suicidal ideation, and history of prior suicide attempt(s). However, sense of belonging did not predict suicidal ideation and history of prior suicide attempt(s) beyond the association between suicidal behaviors and established risk factors. Sense of belonging displayed a significant relationship with depression and hopelessness and is likely to play a critical role in both the development of and recovery from depression.
Conclusions:
Sense of belonging is directly related to depression and hopelessness, while indirectly related to suicidal ideation. Low sense of belonging provides an important target for assessment and intervention in the treatment of depression. Cognitive, behavioral, and interpersonal interventions may help improve an individual's sense of belonging and decrease symptoms of depression and hopelessness.
The impact of political violence on health and health services is substantial in many parts of the world. A variety of types of political violence are discernible and may be broadly categorized as structural, repressive, reactive and combative. These different types of violence are described. Particular emphasis is given to a discussion of state repressive violence, including its aetiology and magnitude.
An agenda for research, policy and action is described arguing that health personnel have a role to play in documenting the form and impact of political violence, providing treatment and care for its victims, developing training and education packages for health workers who may deal with situations of violence and advocacy work aimed at prevention.
Political violence poses a considerable threat to the health of individuals. Protective factors, however, may help people to build resilience in the face of political violence. This study examined the influence of lifetime and past 30-day experiences of political violence on the mental and physical health of adult Palestinian women from the West Bank (N = 122). Two hypotheses were examined: (a) Reports of political violence exposure would be related to reports of poorer physical and mental health and (b) several coping variables (proactive coping; self-reliance; reliance on political, family, and religious support; and political or civic engagement) would function as moderators of the effects of political violence, buffering or weakening its effects on physical and mental health outcomes. Both lifetime and past 30-day measures of political violence were positively correlated with posttraumatic stress disorder symptoms. Proactive coping, reliance on self, and political or civic engagement significantly interacted with political violence to affect health in a counterintuitive direction; those with higher scores on these more internalized and individualistic coping strategies demonstrated worse health as political violence increased. Reliance on religious support, and, in particular, support from and participation in activities of religious institutions, emerged as a significant protective factor. Results underscore the importance of looking not only at whether political violence affects health, but also at how the relationships between political violence and health might occur, including the potential protective influence of resources within people's social environments.
Political violence is implicated in a range of mental health outcomes, including PTSD, depression, and anxiety. The social and political contexts of people's lives, however, offer considerable protection from the mental health effects of political violence. In spite of the importance of people's social and political environments for health, there is limited scholarship on how political violence compromises necessary social and political systems and inhibits individuals from participating in social and political life. Drawing on literature from multiple disciplines, including public health, anthropology, and psychology, this narrative review uses a multi-level, social ecological framework to enhance current knowledge about the ways that political violence affects health. Findings from over 50 studies were analysed and used to build a conceptual model demonstrating how political violence threatens three inter-related domains of functioning: individual functioning in relationship to their environment; community functioning and social fabric; and governmental functioning and delivery of services to populations. Results illustrate the need for multilevel frameworks that move beyond individual pathology towards more nuanced conceptualizations about how political violence affects health; findings contribute to the development of prevention programmes addressing political violence.
A total of 1,196 Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem were interviewed beginning in September 2007 and again at 6- and 12-month intervals. Using structural equation modeling, we focused on the effects of exposure to political violence, psychosocial and economic resource loss, and social support on psychological distress and the association of each of these variables on subjective health. Our proposed mediation model was partially supported. Exposure to political violence, psychosocial resource loss, and social support were related to subjective health, fully mediated by their relationship with psychological distress. Female gender and being older were also directly related to poorer subjective health and partially mediated via psychological distress. Greater economic resource loss, lower income, and poorer education were directly related to poor subjective health. An alternative model exploring subjective health as a mediator of psychological distress revealed that subjective health partially mediated the relationship between resource loss and psychological distress. The associate between female gender, education, income, and age on psychological distress were fully mediated by subjective health. Social support and exposure to political violence were directly related to psychological distress. These results were discussed in terms of the importance of resource loss on both mental and physical health in regions of chronic political violence and potential intervention strategies.
This article reviews the development of international research on the relationship between discrimination and health. It provides an overview of theoretical and empirical work on stigma and prejudice and their impact on discrimination and health. It argues that the literature on these issues has drawn primarily from social psychology and has focused on the impact of attitudes associated with stigma and prejudice on discriminatory practices and consequently health outcomes. It also identifies a growing trend in recent research towards a reconceptualization of stigma, prejudice and discrimination from the perspective of social inequality and structural violence, highlighting relations of power and exclusion that reinforce vulnerability within a complex social and political process. It concludes by briefly examining the ways in which this reconceptualization of discriminatory practices has generated a growing interest in the linkages between health and human rights and renewed interest in health and social justice; two major trends in the field of global public health.
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.
Uncertainties continue about the roles that methodological factors and key risk factors, particularly torture and other potentially traumatic events (PTEs), play in the variation of reported prevalence rates of posttraumatic stress disorder (PTSD) and depression across epidemiologic surveys among postconflict populations worldwide.
To undertake a systematic review and meta-regression of the prevalence rates of PTSD and depression in the refugee and postconflict mental health field.
An initial pool of 5904 articles, identified through MEDLINE, PsycINFO and PILOTS, of surveys involving refugee, conflict-affected populations, or both, published in English-language journals between 1980 and May 2009.
Surveys were limited to those of adult populations (n > or = 50) reporting PTSD prevalence, depression prevalence, or both. Excluded surveys comprised patients, war veterans, and civilian populations (nonrefugees/asylum seekers) from high-income countries exposed to terrorist attacks or involved in distal conflicts (> or = 25 years).
Methodological factors (response rate, sample size and design, diagnostic method) and substantive factors (sociodemographics, place of survey, torture and other PTEs, Political Terror Scale score, residency status, time since conflict).
A total of 161 articles reporting results of 181 surveys comprising 81,866 refugees and other conflict-affected persons from 40 countries were identified. Rates of reported PTSD and depression showed large intersurvey variability (0%-99% and 3%-85.5%, respectively). The unadjusted weighted prevalence rate reported across all surveys for PTSD was 30.6% (95% CI, 26.3%-35.2%) and for depression was 30.8% (95% CI, 26.3%-35.6%). Methodological factors accounted for 12.9% and 27.7% PTSD and depression, respectively. Nonrandom sampling, small sample sizes, and self-report questionnaires were associated with higher rates of mental disorder. Adjusting for methodological factors, reported torture (Delta total R(2) between base methodological model and base model + substantive factor [DeltaR(2)] = 23.6%; OR, 2.01; 95% CI, 1.52-2.65) emerged as the strongest factor associated with PTSD, followed by cumulative exposure to PTEs (DeltaR(2) = 10.8%; OR, 1.52; 95% CI, 1.21-1.91), time since conflict (DeltaR(2) = 10%; OR, 0.77; 95% CI, 0.66-0.91), and assessed level of political terror (DeltaR(2) = 3.5%; OR, 1.60; 95% CI, 1.03-2.50). For depression, significant factors were number of PTEs (DeltaR(2) = 22.0%; OR, 1.64; 95% CI, 1.39-1.93), time since conflict (DeltaR(2) = 21.9%; OR, 0.80; 95% CI, 0.69-0.93), reported torture (DeltaR(2) = 11.4%; OR, 1.48; 95% CI, 1.07-2.04), and residency status (DeltaR(2) = 5.0%; OR, 1.30; 95% CI, 1.07-1.57).
Methodological factors and substantive population risk factors, such as exposure to torture and other PTEs, after adjusting for methodological factors account for higher rates of reported prevalence of PTSD and depression.
The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.
With negative treatment trials, the role of depression as an aetiological or prognostic factor in coronary heart disease (CHD) remains controversial. We quantified the effect of depression on CHD, assessing the extent of confounding by coronary risk factors and disease severity.
Meta-analysis of cohort studies measuring depression with follow-up for fatal CHD/incident myocardial infarction (aetiological) or all-cause mortality/fatal CHD (prognostic). We searched MEDLINE and Science Citation Index until December 2003. In 21 aetiological studies, the pooled relative risk of future CHD associated with depression was 1.81 (95% CI 1.53-2.15). Adjusted results were included for 11 studies, with adjustment reducing the crude effect marginally from 2.08 (1.69-2.55) to 1.90 (1.49-2.42). In 34 prognostic studies, the pooled relative risk was 1.80 (1.50-2.15). Results adjusted for left ventricular function result were available in only eight studies; and this attenuated the relative risk from 2.18 to 1.53 (1.11-2.10), a 48% reduction. Both aetiological and prognostic studies without adjusted results had lower unadjusted effect sizes than studies from which adjusted results were included (P<0.01).
Depression has yet to be established as an independent risk factor for CHD because of incomplete and biased availability of adjustment for conventional risk factors and severity of coronary disease.
Atherosclerotic cardiovascular diseases (ASKVD) are among the most important and preventable causes of death today. In developing countries such as our country, it is one of the important duties of family physicians to identify individuals at high risk of cardiovascular disease, to prevent the development of the disease in the early period, and to follow up high-risk individuals. Many risk factors have been identified to prevent ASPVD. Known modifiable risk factors include smoking, overweight, obesity, diabetes, hypertension, dyslipidemia, physical inactivity, and unhealthy diet. Various scoring systems have been created in order to investigate the risk factors that cause atherosclerotic cardiovascular diseases and to make their effects easier to understand. There are many risk scores such as SCORE, SCORE2, INTERHEART, PROCAM, Framingham Risk Score, Reynolds, WHO/ISH in order to identify risky individuals in the fight against cardiovascular diseases, to predict disease risk and to develop approaches for risky individuals.
Social scientists define state violence broadly, ranging from direct political violence and genocide to the redefinition of state violence as the neoliberal exit of the state from the provision of social services and the covert use of new technologies of citizen surveillance. State violence, and sometimes the state in and of itself, is clearly a social problem shaping not only the structure of governance but also citizenship and the quality of life of individuals and communities. This chapter provides a guide to the literature on state violence using the much studied case of Guatemala as a focal example. The chapter presents competing concepts on the nature of violence, analyzes the different forms of state violence (genocide, political violence, and juridical violence), and suggests emerging trends in the literature of state violence that lead us to consider structural inequalities, the changing nature of the state, and the incorporation of new technologies of violent governance.
Escalation of violence resulted with more violence in 2015 in Turkey. Two hundred and sixty-eight officially confirmed round-the-clock (all day long) and/or open-ended curfews in 11 cities and at least 47 districts of Turkey have occurred. 1,809,000 residents, and the fundamental rights of these people have been explicitly violated. On January 11, 2016, 1,128 academics signed a petition and made a declaration. Immediately after the declaration witch hunt started. This report aims to display the case of Academics for Peace Petition.
The notion that psychological states can influence physical health is hardly new, and perhaps nowhere has the mind-body connection been better studied than in cardiovascular disease (CVD). Recently, large prospective epidemiologic studies and smaller basic science studies have firmly established a connection between CVD and several psychological conditions, including depression, chronic psychological stress, posttraumatic stress disorder (PTSD), and anxiety. In addition, numerous clinical trials have been conducted to attempt to prevent or lessen the impact of these conditions on cardiovascular health. In this article, we review studies connecting depression, stress/PTSD, and anxiety to CVD, focusing on findings from the last 5 years. For each mental health condition, we first examine the epidemiologic evidence establishing a link with CVD. We then describe studies of potential underlying mechanisms and finally discuss treatment trials and directions for future research.
© Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2015. This work is written by (a) US Government employees(s) and is in the public domain in the US.
There is a growing consensus concerning the scope and components of mental health and psychosocial interventions needed to assist populations exposed to mass conflict. The Adaptation and Development after Persecution and Trauma (ADAPT) model offers a unifying, conceptual framework to underpin policy and practice in the field.
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: (a) briefly reviews definitions of discrimination, illustrated with examples from the United States; (b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; (c) concisely summarizes extant evidence--both robust and inconsistent--linking discrimination and health; and (d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
Clandestine Political Violence compares four types of clandestine political violence: Left-wing (in Italy and Germany), right-wing (in Italy), ethnonationalist (in Spain) and religious fundamentalist (in Islamist clandestine organizations). Oriented toward theory building, Della Porta develops her own definition of clandestine political violence. Building on the most recent developments in social movement studies, Della Porta proposes an original interpretative model. Using a unique research design, she singles out some common causal mechanisms at the onset, during the persistence and at the demise of clandestine political violence. The development of the phenomenon is located within the interactions among social movements, countermovements and the state. She pays particular attention to the ways different actors cognitively construct the reality they act upon. Based on original empirical research as well as existing research in many languages, this book is rich in empirical evidence on some of the most crucial cases of clandestine political violence.
Are there any commonalities between such phenomena as soccer hooliganism, sabotage by peasants of landlords' property, road rage, and even the events of September 11? With striking historical scope and command of the literature of many disciplines, this book seeks the common causes of these events in collective violence. In collective violence, social interaction immediately inflicts physical damage, involves at least two perpetrators of damage, and results in part from coordination among the persons who perform the damaging acts. Charles Tilly argues that collective violence is complicated, changeable, and unpredictable in some regards, yet also results from similar causes variously combined in different times and places. Pinpointing the causes, combinations, and settings helps to explain collective violence and also helps to identify the best ways to mitigate violence and create democracies with a minimum of damage to persons and property. Charles Tilly is the Joseph L. Buttenwieser Professor of Social Science at Columbia University. He has published more than twenty scholarly books, including twenty specialized monographs and edited volumes on political processes, inequality, population change and European history.
The gradual emergence of symptoms following exposure to traumatic events has presented a major conceptual challenge to psychiatry. The mechanism that causes the progressive escalation of symptoms with the passage of time leading to delayed onset post-traumatic stress disorder (PTSD) involves the process of sensitization and kindling. The development of traumatic memories at the time of stress exposure represents a major vulnerability through repeated environmental triggering of the increasing dysregulation of an individual's neurobiology. An increasing body of evidence demonstrates how the increased allostatic load associated with PTSD is associated with a significant body of physical morbidity in the form of chronic musculoskeletal pain, hypertension, hyperlipidaemia, obesity and cardiovascular disease. This increasing body of literature suggests that the effects of traumatic stress need to be considered as a major environmental challenge that places individual's physical and psychological health equally at risk. This broader perspective has important implications for developing treatments that address the underlying dysregulation of cortical arousal and neurohormonal abnormalities following exposure to traumatic stress.
There is increasing evidence that immigrants and traumatized individuals have elevated prevalence of medical disease. This study focuses on 459 Vietnamese, Cambodian, Somali, and Bosnian refugee psychiatric patients to determine the prevalence of hypertension and diabetes. The prevalence of hypertension was 42% and of diabetes was 15.5%. This was significantly higher than the US norms, especially in the groups younger than 65. Diabetes and hypertension were higher in the high-trauma versus low-trauma groups. However, in the subsample with body mass index (BMI) measurements subjected to logistic regression, only BMI was related to diabetes, and BMI and age were related to hypertension. Immigrant status, presence of psychiatric disorder, history of psychological trauma, and obesity probably all contributed to the high prevalence rate. With 2.5 million refugees in the country, there is a strong public health concern for cardiovascular disease in this group.
Human Rights Foundation of Turkey Publications 145
- S Tekin
- A Davas
World Health Organisation
- Etienne G Krug
- Linda L Dahlberg
- James A Mercy
- Anthony B Zwi
- Rafael Lozano
Mental Health Problems-short version
- S Kalaça