War

Dose–Response Gradients

The most typical developmental pattern following war exposure is a dose–response gradient, whereby higher severity of exposure to war or exposure to great numbers of war-related events directly relates to poorer functioning in the individual or across the system. Cumulative risk scores index the extent of war exposure and may include witnessing injuries or deaths of loved ones (death tolls); being injured, raped, or tortured oneself; and duration of exposure. Dose of exposure is often prolonged and includes experiences of hiding or being held hostage, home and community invasions by armed soldiers, and temporary or permanent resettlement. Conditions of refugee camps, often in low-income regions, may be further retraumatizing if displaced individuals experience violence, rape, or deprivation. In terrorist attacks, [Page 2312]dose of exposure is often measured as physical proximity to targeted locations themselves as well as indirect exposure via loved ones’ involvement or injury. For children, the extent of their caregivers’ exposure is often a form of dose in itself.

Response patterns are typically operationalized as the impact on the individual. Post-traumatic stress disorder, as well as internalizing symptoms (e.g., depression, anxiety) and externalizing symptoms (e.g., general and interpersonal aggression), are the most typically measured psychopathological outcomes corresponding to dose of exposure. Well-replicated findings show that psychopathology tends to be greatest in the acute aftermath, with symptoms gradually decreasing over time, depending on the duration of exposure. Research studies generally converge on findings that male victims tend to experience more externalizing problems, and female victims experience more internalizing symptoms. However, complexities involving the characteristics of the dose, the developmental stage of victims, and the extent of protective systems in place may qualify these findings.

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