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Hard to Forget: The Long-Lasting Impact of War on Mental Health

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  • Bratti, Massimiliano

    (Università degli Studi di Milano)

  • Mendola, Mariapia

    (University of Milan Bicocca)

  • Miranda, Alfonso

    (CIDE, Mexico City)

Abstract

War can have long-lasting effects on individual mental health through war trauma. In this paper, we explore the impact of constantly recalling painful episodes related to the 1992-1995 Bosnia and Herzegovina conflict on individual mental health in 2001 using the Center for Epidemiologic Studies Depression (CES-D) scale. Potential endogeneity and reverse causality issues are addressed using objective measures of war intensity recorded at the municipality level. We find that individuals experiencing war trauma have worse mental health six years after the end of the conflict. In particular, instrumental-variable estimates show that they score 16 points (more than 1.5 standard deviations) higher on the CES-D scale (with higher scores meaning more depression symptoms) and have a 60 percentage points higher probability of being at risk of depression. Our results are robust to a number of sensitivity checks accounting for individual geographical mobility and different treatment intensities, and suggest that the negative effects on mental health are not mainly mediated by physical health problems. Back-of-the envelope calculations show large economic costs of war-trauma.

Suggested Citation

  • Bratti, Massimiliano & Mendola, Mariapia & Miranda, Alfonso, 2015. "Hard to Forget: The Long-Lasting Impact of War on Mental Health," IZA Discussion Papers 9269, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp9269
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    1. Harold Alderman & John Hoddinott & Bill Kinsey, 2006. "Long term consequences of early childhood malnutrition," Oxford Economic Papers, Oxford University Press, vol. 58(3), pages 450-474, July.
    2. Arthur Lewbel & Yingying Dong & Thomas Tao Yang, 2012. "Comparing features of convenient estimators for binary choice models with endogenous regressors," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 45(3), pages 809-829, August.
    3. Christopher Baum & Yingying Dong & Arthur Lewbel & Tao Yang, 2012. "Binary choice models with endogenous regressors," SAN12 Stata Conference 9, Stata Users Group.
    4. Akresh, Richard & de Walque, Damien, 2008. "Armed Conflict and Schooling: Evidence from the 1994 Rwandan Genocide," IZA Discussion Papers 3516, Institute of Labor Economics (IZA).
    5. Fabian Waldinger, 2016. "Bombs, Brains, and Science: The Role of Human and Physical Capital for the Creation of Scientific Knowledge," The Review of Economics and Statistics, MIT Press, vol. 98(5), pages 811-831, December.
    6. Cesur, Resul & Sabia, Joseph J. & Tekin, Erdal, 2013. "The psychological costs of war: Military combat and mental health," Journal of Health Economics, Elsevier, vol. 32(1), pages 51-65.
    7. Akresh, Richard & Lucchetti, Leonardo & Thirumurthy, Harsha, 2012. "Wars and child health: Evidence from the Eritrean–Ethiopian conflict," Journal of Development Economics, Elsevier, vol. 99(2), pages 330-340.
    8. Francesca Cornaglia & Naomi E. Feldman & Andrew Leigh, 2014. "Crime and Mental Well-Being," Journal of Human Resources, University of Wisconsin Press, vol. 49(1), pages 110-140.
    9. Arthur Lewbel, 2007. "Estimation of Average Treatment Effects with Misclassification," Econometrica, Econometric Society, vol. 75(2), pages 537-551, March.
    10. Duncan Thomas, 2008. "Psychological Health Before, During, and After an Economic Crisis: Results from Indonesia, 1993--2000," The World Bank Economic Review, World Bank, vol. 23(1), pages 57-76, November.
    11. Andrea Ichino & Rudolf Winter-Ebmer, 2004. "The Long-Run Educational Cost of World War II," Journal of Labor Economics, University of Chicago Press, vol. 22(1), pages 57-86, January.
    12. Chiburis, Richard C. & Das, Jishnu & Lokshin, Michael, 2012. "A practical comparison of the bivariate probit and linear IV estimators," Economics Letters, Elsevier, vol. 117(3), pages 762-766.
    13. Bratti, Massimiliano & Mendola, Mariapia, 2014. "Parental health and child schooling," Journal of Health Economics, Elsevier, vol. 35(C), pages 94-108.
    14. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    15. Patricia Justino, 2009. "Poverty and Violent Conflict: A Micro-Level Perspective on the Causes and Duration of Warfare," Journal of Peace Research, Peace Research Institute Oslo, vol. 46(3), pages 315-333, May.
    16. Miguel, Edward & Roland, Gérard, 2011. "The long-run impact of bombing Vietnam," Journal of Development Economics, Elsevier, vol. 96(1), pages 1-15, September.
    17. Daniel M. Gade & Jeffrey B. Wenger, 2011. "Combat exposure and mental health: the long‐term effects among US Vietnam and Gulf war veterans," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 401-416, April.
    18. Susan L. Ettner & Richard G. Frank & Ronald C. Kessler, 1997. "The Impact of Psychiatric Disorders on Labor Market Outcomes," NBER Working Papers 5989, National Bureau of Economic Research, Inc.
    19. Steven Brakman & Harry Garretsen & Marc Schramm, 2004. "The strategic bombing of German cities during World War II and its impact on city growth," Journal of Economic Geography, Oxford University Press, vol. 4(2), pages 201-218, April.
    20. Mevlude Akbulut-Yuksel, 2014. "Children of War: The Long-Run Effects of Large-Scale Physical Destruction and Warfare on Children," Journal of Human Resources, University of Wisconsin Press, vol. 49(3), pages 634-662.
    21. Horrace, William C. & Oaxaca, Ronald L., 2006. "Results on the bias and inconsistency of ordinary least squares for the linear probability model," Economics Letters, Elsevier, vol. 90(3), pages 321-327, March.
    22. de Mel, Suresh & McKenzie, David & Woodruff, Christopher, 2008. "Mental health recovery and economic recovery after the tsunami: High-frequency longitudinal evidence from Sri Lankan small business owners," Social Science & Medicine, Elsevier, vol. 66(3), pages 582-595, February.
    23. Do, Quy-Toan & Iyer, Lakshmi, 2009. "Mental health in the aftermath of conflict," Policy Research Working Paper Series 5132, The World Bank.
    24. Bellows, John & Miguel, Edward, 2009. "War and local collective action in Sierra Leone," Journal of Public Economics, Elsevier, vol. 93(11-12), pages 1144-1157, December.
    25. Richard Akresh & Sonia Bhalotra & Marinella Leone & Una Okonkwo Osili, 2012. "War and Stature: Growing Up during the Nigerian Civil War," American Economic Review, American Economic Association, vol. 102(3), pages 273-277, May.
    26. Patricia Justino & Marinella Leone & Paola Salardi, 2014. "Short- and Long-Term Impact of Violence on Education: The Case of Timor Leste," The World Bank Economic Review, World Bank, vol. 28(2), pages 320-353.
    27. Eva Deuchert & Martin Huber, 2017. "A Cautionary Tale About Control Variables in IV Estimation," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 79(3), pages 411-425, June.
    28. Patricia Justino & Tilman Br�ck & Philip Verwimp, 2013. "Research and policy implications from a micro-level perspective on the dynamics of conflict, violence and development," HiCN Working Papers 139, Households in Conflict Network.
    29. Gianmarco León, 2012. "Civil Conflict and Human Capital Accumulation: The Long-term Effects of Political Violence in Perú," Journal of Human Resources, University of Wisconsin Press, vol. 47(4), pages 991-1022.
    30. Iris Kesternich & Bettina Siflinger & James P. Smith & Joachim K. Winter, 2014. "The Effects of World War II on Economic and Health Outcomes across Europe," The Review of Economics and Statistics, MIT Press, vol. 96(1), pages 103-118, March.
    31. Garfinkel, Michelle R. & Skaperdas, Stergios (ed.), 2012. "The Oxford Handbook of the Economics of Peace and Conflict," OUP Catalogue, Oxford University Press, number 9780195392777.
    32. Kelleher, K. & Chaffin, M. & Hollenberg, J. & Fischer, E., 1994. "Alcohol and drug disorders among physically abusive and neglectful parents in a community-based sample," American Journal of Public Health, American Public Health Association, vol. 84(10), pages 1586-1590.
    33. Richard Akresh & Philip Verwimp & Tom Bundervoet, 2011. "Civil War, Crop Failure, and Child Stunting in Rwanda," Economic Development and Cultural Change, University of Chicago Press, vol. 59(4), pages 777-810.
    34. Neuner, Frank, 2010. "Assisting war-torn populations - Should we prioritize reducing daily stressors to improve mental health? Comment on Miller and Rasmussen (2010)," Social Science & Medicine, Elsevier, vol. 71(8), pages 1381-1384, October.
    35. Tom Bundervoet & Philip Verwimp & Richard Akresh, 2009. "Health and Civil War in Rural Burundi," Journal of Human Resources, University of Wisconsin Press, vol. 44(2).
    36. Patricia Justino, 2010. "War and Poverty," HiCN Working Papers 81, Households in Conflict Network.
    37. Alesina, Alberto & La Ferrara, Eliana, 2002. "Who trusts others?," Journal of Public Economics, Elsevier, vol. 85(2), pages 207-234, August.
    38. Susan L. Ettner & Richard G. Frank & Ronald C. Kessler, 1997. "The Impact of Psychiatric Disorders on Labor Market Outcomes," ILR Review, Cornell University, ILR School, vol. 51(1), pages 64-81, October.
    39. Patrick Ball & Ewa Tabeau & Philip Verwimp, 2007. "The Bosnian Book of Dead: Assessment of the Database (Full Report)," HiCN Research Design Notes 5, Households in Conflict Network.
    40. Jishnu Das & Quy-Toan Do & Jed Friedman & David McKenzie, 2008. "Mental Health Patterns and Consequences: Results from Survey Data in Five Developing Countries," The World Bank Economic Review, World Bank, vol. 23(1), pages 31-55, August.
    41. Christopher Blattman & Edward Miguel, 2010. "Civil War," Journal of Economic Literature, American Economic Association, vol. 48(1), pages 3-57, March.
    42. Swee, Eik Leong, 2015. "On war intensity and schooling attainment: The case of Bosnia and Herzegovina," European Journal of Political Economy, Elsevier, vol. 40(PA), pages 158-172.
    43. Murphy, Anthony, 2007. "Score tests of normality in bivariate probit models," Economics Letters, Elsevier, vol. 95(3), pages 374-379, June.
    44. Donald R. Davis & David E. Weinstein, 2002. "Bones, Bombs, and Break Points: The Geography of Economic Activity," American Economic Review, American Economic Association, vol. 92(5), pages 1269-1289, December.
    45. 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.
    46. Arthur Lewbel & Yingying Dong & Thomas Tao Yang, 2012. "Viewpoint: Comparing features of convenient estimators for binary choice models with endogenous regressors," Canadian Journal of Economics, Canadian Economics Association, vol. 45(3), pages 809-829, August.
    47. Justino, Patricia & Bruck, Tilman & Verwimp, Philip (ed.), 2013. "A Micro-Level Perspective on the Dynamics of Conflict, Violence, and Development," OUP Catalogue, Oxford University Press, number 9780199664597.
    48. Eik Leong Swee, 2009. "On War and Schooling Attainment: The Case of Bosnia and Herzegovina," HiCN Working Papers 57, Households in Conflict Network.
    49. Bartel, Ann & Taubman, Paul, 1986. "Some Economic and Demographic Consequences of Mental Illness," Journal of Labor Economics, University of Chicago Press, vol. 4(2), pages 243-256, April.
    50. Miller, Kenneth E. & Rasmussen, Andrew, 2010. "War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks," Social Science & Medicine, Elsevier, vol. 70(1), pages 7-16, January.
    51. Kondylis, Florence, 2010. "Conflict displacement and labor market outcomes in post-war Bosnia and Herzegovina," Journal of Development Economics, Elsevier, vol. 93(2), pages 235-248, November.
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    Cited by:

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    2. Liu, Jenny & Modrek, Sepideh & Sieverding, Maia, 2019. "The effects of political protests on youth human capital and well-being in Egypt," Social Science & Medicine, Elsevier, vol. 243(C).
    3. Saurabh Singhal, 2018. "Early life shocks and mental health: The long-term effect of war in Vietnam," WIDER Working Paper Series 65, World Institute for Development Economic Research (UNU-WIDER).
    4. Martin Philipp Heger & Eric Neumayer, 2022. "Economic legacy effects of armed conflict: Insights from the civil war in Aceh, Indonesia," Conflict Management and Peace Science, Peace Science Society (International), vol. 39(4), pages 394-421, July.
    5. Constanze Fettnig, 2021. "The role of energy providers in tackling energy poverty," Working Paper Reihe der AK Wien - Materialien zu Wirtschaft und Gesellschaft 214, Kammer für Arbeiter und Angestellte für Wien, Abteilung Wirtschaftswissenschaft und Statistik.
    6. Aleksandar Kešeljević & Rok Spruk, 2024. "Estimating the effects of Syrian civil war," Empirical Economics, Springer, vol. 66(2), pages 671-703, February.
    7. Rebecca N. Thomson & John S. Carlson & Dylan S. T. Voris & Millie Shepherd & Kim Batsche-McKenzie, 2016. "A Dual-Factor Approach to Exploring Wraparound Outcomes in Children with Serious Emotional Disturbance within Community-Based Mental Health Settings," International Journal of Psychological Studies, Canadian Center of Science and Education, vol. 9(1), pages 107-107, March.
    8. Bharati, Tushar, 2022. "The long shadow of the Kargil War: The effect of early-life stress on education," Economics & Human Biology, Elsevier, vol. 44(C).

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    More about this item

    Keywords

    war trauma; mental health; depression; Bosnia and Herzegovina;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • O1 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development

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