Mental Health
Trauma, trust, and ties: exploring the impact of social support on mental health in Afghanistan Emma Sexton* Emma Sexton Ajmal Sabawoon Katherine M. Keyes Sabrina Hermosilla Elie Karam Viviane Kovess-Masfety
Exposure to potentially traumatic events (PTEs) is associated with increased rates of depression, anxiety, and post-traumatic stress disorder (PTSD). While social support has been shown to buffer the effect of PTEs on psychiatric outcomes, little is known about this moderation in contexts of prolonged conflict. Afghanistan, with its ethnic diversity, persistent exposure to conflict, and strong communal structures, presents a unique context to examine the buffering hypothesis of social support. Using data drawn from a nationally representative study of 4,359 adults in Afghanistan, we assessed the relationship between PTEs (measured by LEC-5), social support (OSSS-3), and mental health symptoms of depression, anxiety, and PTSD (CIDI-SF and PCL-5). Logistic regression models were stratified by social support, and interactions between PTEs and social support were examined relative to any psychiatric disorders (specifically depression, anxiety, or PTSD) and stratified by sex. Strong social support was significantly associated with being male (RRR = 1.69; 95% CI: 1.30-2.17), higher education attainment (RRR = 2.49; 95% CI: 1.58-3.93), higher income (RRR = 1.57; 95% CI: 1.25, 1.98), and rural residence (RRR = 1.75; 95% CI: 1.30-2.35). Males who experienced collective violence with strong social support had lower odds of any psychiatric disorders versus those with poor social support (OR = 0.43; 95% CI: 0.19-0.94). Females who experienced sexual violence with strong social support had lower odds of any psychiatric disorders versus those with poor social support (OR = 0.23; 95% CI: 0.06-0.89). Social support’s relationship with PTEs and psychiatric outcomes varies by sex and PTE type. These factors should be taken into consideration to ensure adequate mental health care and support is provided. Given social support’s protective effects, strengthening support systems should also be considered when planning and providing mental health services in conflict-affected areas.