A new study on mental health in war-ravaged Afghanistan conducted by researchers at the Washington University in St. Louis comes to a jarring conclusion: socioeconomic indicators such as poverty and social vulnerability are more telling risk factors for mental illness than even exposure to warfare. While the study in question is centered on Afghans’ mental health outlooks in the waning years of the Afghan war, its lessons — and implications — are just as applicable to another group in the region that has been living with a decade’s worth of violent and traumatic experiences: the enlisted men and women of the United States military.
The report is quick to point out that it’s not claiming that warfare isn’t a significant contributor to mental health concerns. But as an issue of systemic public health risk, underlying socioeconomic insecurity in the Afghan people was found to be a more significant and lasting indicator of mental wellness:
“War exposure is undisputedly a factor of mental distress and anxiety, but other predictors, such as poverty and vulnerability, are stronger and probably more persistent risk factors that have not received deserved attention in policy decisions,” says Jean-Francois Trani, PhD, assistant professor at the Brown School at Washington University and lead author of a new study published in the online first edition of Transcultural Psychiatry.
“Political unrest and violence is fueled by despair and frustrations often associated with mental distress,” Trani says. “A lack of resources or inability to find work make it impossible to assume one’s social status. That, in turn, leads to distress that can conduct to young men choosing a path of violent opposition to authorities and an international presence.”
The study… shows that even in a time of war, mental health is influenced by a combination of demographic and socioeconomic characteristics linked to social exclusion mechanisms — factors that were in place before war began.
“The conflict magnifies factors that were already in place,” Trani says, “and are redefined in relation to the changing social, cultural and economic contexts.”
To state the obvious, the report was done in the context of Afghanistan, a country with a high level of unrest and generally weak institutions. But the trends outlined in the study may also resonate with Afghanistan war veterans — a group that skews younger and more racially diverse than the general population — considering the socioeconomic exclusions and insecurities that they face here in the U.S. after returning home from combat:
The National Coalition for Homeless Veterans estimates that some 1.5 million veterans are at risk of homelessness due to poverty, lack of support networks and dismal, overcrowded, living conditions. Veterans are much more likely than the population at large to suffer from homelessness, comprising 23 percent of the homeless population even though only 8 percent of the population at large can claim veteran status.
Afghanistan War veterans are particularly at risk because of their young age and their exposure to combat with its psychological effects. Some seventy percent of Iraq and Afghanistan veterans had exposure to combat. About 30,700 are expected to leave the military in each of the next four years as the military reduces its ranks. About 13 percent of homeless Afghan and Iraq war veterans are women, and almost 50 percent of all homeless veterans are African American.
While the National Coalition for Homeless Veterans implies that poverty and homelessness among veterans is a consequence of the psychological effects of warfare, the new Washington University study adds to the existing body of evidence that suggests a more accurate view might be that mental health issues and socioeconomic status have a fair amount of interplay with each other. That assertion is also supported by studies showing that, within the military, soldiers who face social exclusion are more likely to have mental health problems than those who don’t — as well as by long-standing trends demonstrating that low-income communities are disproportionately affected by mental health issues.
These disparate factors propagate a vicious cycle for American veterans returning to a bleak economic landscape — one that is made even worse by the mental scars of warfare — and taken altogether, it perhaps isn’t surprising that military suicides for Afghan and Iraq war veterans are at record highs. While Congress and the Obama Administration have taken some steps to improve benefits for veterans who need better mental health resources, the Washington University study shows that the root of the problem may actually be with the entrenched inequality of opportunity that soldiers face right here at home, and not just the missiles and bullets they encounter while entrenched abroad.