Collective Trauma- Psychosocial consequences of war in northern Sri Lanka 10 years on, a mixed methods study

Individuals, families and communities in Sri Lanka, particularly in the North-East of Sri Lanka, have undergone 3 decades of war trauma. Mixed quantitative and qualitative methods with an integrated, holistic and inclusive approach using validated survey measures of trauma, collective distress and mental health, complemented by information from narratives, observations, key-informant interviews, focus group discussions and case studies were collected from the war-affected in 5 districts of Sri Lanka. Thick description was used to bring out the contours of collective trauma through exemplar quotes, summarized verbatims and collective themes. At the individual level, high levels of Post Traumatic Stress Disorder (PTSD) (46.8 %), depression (57.1 %), anxiety (60.7 %), stress (50 %), somatization (40.2 %) and functional disability (36.4 %) were found. Individual level consequences were significantly higher in districts with high trauma as compared to those with low trauma burdens. Coping intensity was correlated with anxiety, stress, PTSD and somatization. At the family level, dysfunctional families had a higher proportion of members with suicidal thoughts, mental health issues, alcohol and drug abuse, poor income, lack of essential facilities and dissatisfaction with family life. At the community level, common problems reported were use of illicit drugs (86.2 %) and alcohol (84.5 %), family problems (36.4 %), unemployment (32 %) and financial problems (26.3 %). Study villages scored very low in structural social capital. Bonding social capital was used more indicating its use as a coping strategy. This study provides evidence that trauma in a population can collectively affect the characteristics and dynamics of the group as a whole. The observed social capital and collective efficacy changes, dysfunctional family units, negative changes in the functional dynamics of the community, higher rates of coping efforts and high prevalence of individual level effects of trauma are manifestations of collective trauma. • Individual, family and community effects of a 3 decade protracted war. • Individuals manifested PTSD, depression, anxiety, stress, and somatization. • Families showed family disharmony, domestic violence, and substance abuse. • Community effects manifests as social dysfunction and collective trauma. • Measuring trauma burden based on its impact is useful in quantification.