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Intermittent Explosive Disorder amongst Women in Conflict Affected Timor-Leste: Associations with Human Rights Trauma, Ongoing Violence, Poverty, and Injustice

Author

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  • Susan Rees
  • Derrick Silove
  • Teresa Verdial
  • Natalino Tam
  • Elisa Savio
  • Zulmira Fonseca
  • Rosamund Thorpe
  • Belinda Liddell
  • Anthony Zwi
  • Kuowei Tay
  • Robert Brooks
  • Zachary Steel

Abstract

Introduction: Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development. Methods: A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice. Results: Women with Intermittent Explosive Disorder (n = 184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X2(2) = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08–2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48–3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09–3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27–2.77); extreme poverty (OR 1.23, 95%, CI 1.08–1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35–3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger. Conclusions: Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development.

Suggested Citation

  • Susan Rees & Derrick Silove & Teresa Verdial & Natalino Tam & Elisa Savio & Zulmira Fonseca & Rosamund Thorpe & Belinda Liddell & Anthony Zwi & Kuowei Tay & Robert Brooks & Zachary Steel, 2013. "Intermittent Explosive Disorder amongst Women in Conflict Affected Timor-Leste: Associations with Human Rights Trauma, Ongoing Violence, Poverty, and Injustice," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-7, August.
    • Handle: RePEc:plo:pone00:0069207
    DOI: 10.1371/journal.pone.0069207
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    References listed on IDEAS

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    1. Rees, Susan & Silove, Derrick, 2011. "Sakit Hati: A state of chronic mental distress related to resentment and anger amongst West Papuan refugees exposed to persecution," Social Science & Medicine, Elsevier, vol. 73(1), pages 103-110, July.
    2. Silove, Derrick & Brooks, Robert & Bateman Steel, Catherine Robina & Steel, Zachary & Hewage, Kalhari & Rodger, James & Soosay, Ian, 2009. "Explosive anger as a response to human rights violations in post-conflict Timor-Leste," Social Science & Medicine, Elsevier, vol. 69(5), pages 670-677, September.
    3. J Jaime Miranda & Vikram Patel, 2005. "Achieving the Millennium Development Goals: Does Mental Health Play a Role?," PLOS Medicine, Public Library of Science, vol. 2(10), pages 1-1, September.
    4. Kim, Jinseok, 2009. "Type-specific intergenerational transmission of neglectful and physically abusive parenting behaviors among young parents," Children and Youth Services Review, Elsevier, vol. 31(7), pages 761-767, July.
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    1. Rees, Susan & Thorpe, Rosamund & Tol, Wietse & Fonseca, Mira & Silove, Derrick, 2015. "Testing a cycle of family violence model in conflict-affected, low-income countries: A qualitative study from Timor-Leste," Social Science & Medicine, Elsevier, vol. 130(C), pages 284-291.
    2. Alvin Kuowei Tay & Susan J. Rees & Natalino Tam & Elisa Savio & Zelia Maria Da Costa & Derrick Silove, 2017. "The Role of Trauma-Related Injustice in Pathways to Posttraumatic Stress Symptoms Among Conjugal Couples: A Multilevel, Dyadic Analysis in Postconflict Timor-Leste," SAGE Open, , vol. 7(3), pages 21582440177, August.
    3. Hyunjung Choi & Sun-mi Cho, 2020. "Posttraumatic stress disorder and complicated grief in bereaved parents of the Sewol Ferry disaster exposed to injustice following the loss," International Journal of Social Psychiatry, , vol. 66(2), pages 163-170, March.
    4. Tay, Alvin Kuowei & Rees, Susan & Chan, Jack & Kareth, Moses & Silove, Derrick, 2015. "Examining the broader psychosocial effects of mass conflict on PTSD symptoms and functional impairment amongst West Papuan refugees resettled in Papua New Guinea (PNG)," Social Science & Medicine, Elsevier, vol. 132(C), pages 70-78.

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