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All Journal Budapest International Research and Critics Institute-Journal (BIRCI-Journal): Humanities and Social Sciences International Journal of Medicine and Health Termometer: Jurnal Ilmiah Ilmu Kesehatan Dan Kedokteran Detector: Jurnal Inovasi Riset Ilmu Kesehatan Jurnal Mahasiswa Ilmu Kesehatan Jurnal An-Najat: Jurnal Ilmu Farmasi dan Kesehatan Jurnal Anestesi: Jurnal Ilmu Kesehatan dan Kedokteran Jurnal Ventilator: Jurnal Riset Ilmu Kesehatan dan Keperawatan Jurnal Medika Nusantara Jurnal Riset Ilmu Kesehatan Umum dan Farmasi Antigen: Jurnal Kesehatan Masyarakat dan Ilmu Gizi Medical Laboratory Journal Vitamedica: Jurnal Rumpun Kesehatan Umum Corona: Jurnal Ilmu Kesehatan Umum, Psikolog, Keperawatan dan Kebidanan The Journal General Health and Pharmaceutical Sciences Research Vitalitas Medis : Jurnal Kesehatan Dan Kedokteran Observasi: Jurnal Publikasi Ilmu Psikologi Obat: Jurnal Riset Ilmu Farmasi dan Kesehatan International Journal Of Public Health International Journal of Health and Medicine Jurnal Praba: Jurnal Rumpun Kesehatan Umum
Helsa Nasution
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Religion Arts Humanities Dentistry Economics, Econometrics & Finance Health Professions Medicine & Pharmacology Nursing Physics Public Health Social Sciences Veterinary Other

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The Role of Extended Family Structure in Moderating the Impact of War Trauma in the Middle East: A Cultural Analysis M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar; Nurzahara Sihombing
Detector: Jurnal Inovasi Riset Ilmu Kesehatan Vol. 3 No. 2 (2025): Mei: Jurnal Inovasi Riset Ilmu Kesehatan
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/detector.v3i2.5033

Abstract

This meta-analysis systematically and comprehensively examines the structural and functional roles of the extended family in moderating the psychological impact of war trauma in the Middle East by compiling data from 47 independent studies involving 12,483 participants published between 2000 and 2023. An analytical approach using a random-effects model revealed that the presence and involvement of the extended family demonstrated a statistically significant moderating effect on the reduction of PTSD symptoms, anxiety, and depression, with an association strength of r = .42 (p < .001). Further meta-regression results indicated that support from the extended family contributed to a 37.8% reduction in PTSD symptoms (β = -.378, SE = .042, p < .001), a 29.4% decrease in anxiety levels (β = -.294, SE = .038, p < .001), and a 31.2% reduction in depressive symptoms (β = -.312, SE = .040, p < .001). Analysis of moderator variables showed that the protective effect of the extended family structure was more pronounced among children (r = .48) compared to the adult population (r = .38) and more salient among females (r = .45) than males (r = .39), indicating demographic sensitivity to the type of collective support received. Moreover, the high heterogeneity across studies (I² = 76.3%) indicated significant contextual and methodological diversity, though it did not obscure the core findings. These results contradict the theoretical emphasis advanced by Nakeyar and Frewen (2016) and Atallah (2017), who prioritized the role of the nuclear family in post-war healing contexts. In contrast, this study found that the extended family configuration has provided a more comprehensive and multidimensional form of psychological protection rooted in the distinct collectivistic values of Middle Eastern societies. Ultimately, these findings expand the conceptual horizon for understanding resilience mechanisms to trauma within non-Western cultural landscapes and open new possibilities for developing extended family-based interventions in the context of post-conflict psychosocial reconstruction.
Coordination of Mental Health Services in Humanitarian Crises : A Systematic Policy Review Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar
Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran Vol. 3 No. 3 (2025): Juli : Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/termometer.v3i3.5393

Abstract

This study examines the effectiveness of coordination mechanisms within mental health service delivery during humanitarian crises through a systematic review of 127 policies from 43 countries issued between 2010 and 2023. The analysis reveals that only 37.8% of policies containing coordination mechanisms can be classified as structured, while the effective implementation rate reaches 28.3% (χ²=24.67, p<.001). A subsequent meta-analysis demonstrates a significant correlation between the existence of integrated coordination systems and improved access to mental health services (r=0.73, p<.001), as well as a reduction in the severity of psychological disorders (d=0.82, 95% CI [0.76, 0.88]). Regression findings identify four primary determinants contributing to the success of coordination: centralized and directive leadership (β=0.45, p<.001), the use of integrated and real-time information systems (β=0.38, p<.001), systematically designed resource allocation strategies (β=0.35, p<.01), and the active engagement of stakeholders across sectors (β=0.31, p<.01). This study expands upon key findings by Van Long et al. (2005) concerning service fragmentation, and Martinez (2016) regarding coordination barriers, by presenting an empirically grounded model that integrates technical elements and sociocultural dimensions into the structure of coordination. Coordination effectiveness increases by up to 43% when policies adopt an adaptive and contextual approach, marking a substantial departure from conventional coordination models traditionally dominated by bureaucratic and rigid frameworks. The conceptual novelty of this study lies in developing a dynamic coordination framework that explicitly considers system complexity and the heterogeneity of crisis contexts across different global regions.
A Comprehensive Evaluation of PTSD Measurement Tools for Arab Populations : An Analysis of Validity Helsa Nasution; M. Agung Rahmadi; Luthfiah Mawar; Nurzahara Sihombing
Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran Vol. 3 No. 3 (2025): Juli : Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/termometer.v3i3.5396

Abstract

This study presents a highly comprehensive meta-analysis of the validity of various Post-Traumatic Stress Disorder (PTSD) measurement instruments that have been implemented within the context of Arab populations. By synthesizing data from 47 studies involving 12,384 participants published between 2000 and 2023, this review employed a multilevel meta-analytic approach based on a random-effects model to ensure estimation accuracy that accounts for cultural and methodological heterogeneity. The main findings indicate that PTSD instruments adapted into Arabic generally exhibit an adequate level of internal reliability (α = 0.88, 95% CI [0.85, 0.91]), although construct validity demonstrates significant variability (r = 0.72, 95% CI [0.67, 0.77]). Among the instruments analyzed, the Post-traumatic Diagnostic Scale (PDS) was found to have the highest level of validity (r = 0.83, p < 0.001), followed by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) with r = 0.79 (p < 0.001), and the PTSD Checklist for DSM-5 (PCL-5) with r = 0.76 (p < 0.001). Moderator analysis revealed significant contributions from the translation strategies employed (Q = 18.42, p < 0.001), as well as demographic and psychosocial characteristics of the sample (Q = 15.67, p < 0.01), to fluctuations in instrument validity. When compared to the findings of Alqahtani et al. (2021), which highlighted the low validity of several Arabic-language psychological instruments due to a lack of cultural sensitivity in the adaptation process, and the study by Alhalal et al. (2017), which reported construct validity for the five-factor model of the Arabic version of the PCL-C, the present research successfully identifies a substantial overall increase in validity, particularly in instruments that integrate a deep cultural adaptation approach. Furthermore, one of the distinctive contributions of this study lies in its identification of specific patterns in PTSD symptom manifestation unique to Arab populations, significantly characterized by a tendency toward somatization (β = 0.45, p < 0.001) and the expression of distress in collective forms (β = 0.38, p < 0.001), as two dimensions that have been previously underexplored in cross-cultural psychometric validation studies.
Standardization of Research Methodology on War Trauma in the Middle Eastern Context Luthfiah Mawar; M. Agung Rahmadi; Helsa Nasution; Nurzahara Sihombing
Jurnal Praba : Jurnal Rumpun Kesehatan Umum Vol. 3 No. 2 (2025): Juni : Jurnal Praba : Jurnal Rumpun Kesehatan Umum
Publisher : STIKES Columbia Asia Medan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62027/praba.v3i2.373

Abstract

This meta-methodological study evaluates 127 research articles on war-induced trauma in the Middle East, published between 2000 and 2023, with the aim of developing a methodological standardization framework capable of addressing the region-specific contextual complexity. The findings reveal a marked degree of heterogeneity in the methodological approaches employed (χ² = 78.45, p < .001), with 42.5% of the studies utilizing cross-sectional designs, 28.3% employing longitudinal methods, and 29.2% adopting mixed-methods approaches. Meta-regression analysis indicates a highly significant correlation between methodological rigor and the validity of research findings (r = .78, p < .001), reinforcing the importance of consistency in study design. The evaluation of instrument reliability reveals significant variation (α = .65–.92), with instruments based on DSM-5 criteria demonstrating the highest level of internal consistency (M = .86, SD = .08). Further analysis identifies five core components as critical in the methodological structuring of trauma studies within Middle Eastern conflict zones, namely cultural validation of instruments (β = .45, p < .001), data source triangulation (OR = 2.34, 95% CI [1.87–2.81]), contextualization of traumatic experience (R² = .56), sensitivity to conflict dynamics (κ = .82), and the application of ethics tailored to the local context (ICC = .79). These findings extend the work of Bush and Duggan (2013) on methodological biases rooted in Western epistemologies. Additionally, they advance the conclusions of Patel and Hall (2021) regarding the absence of cultural validity in cross-conflict studies, as this research introduces an integrated methodological framework that systematically synthesizes local perspectives with international scientific standards. The primary contribution of this study lies in the development of the Trauma Research Standardization Index (TRSI), a newly designed instrument intended to assess methodological alignment with the specific conflict context of the Middle East. The TRSI demonstrates verified construct validity (construct = .88) and high test-retest reliability (.92), making it a potentially valuable tool in standardizing trauma research across Middle Eastern contexts.
Impact Assessment on Mental Rehabilitation Programs during the Post-Conflict Arab Spring Period M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar; Nurzahara Sihombing
Jurnal Praba : Jurnal Rumpun Kesehatan Umum Vol. 3 No. 2 (2025): Juni : Jurnal Praba : Jurnal Rumpun Kesehatan Umum
Publisher : STIKES Columbia Asia Medan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62027/praba.v3i2.393

Abstract

This study systematically evaluates the effectiveness of mental rehabilitation programs implemented for post-conflict populations in the aftermath of the Arab Spring. A meta-analytical approach was applied to 47 empirical studies encompassing 12,873 participants across five affected countries, Egypt, Tunisia, Libya, Yemen, and Syria, from 2012 to 2023. The analysis reveals a significant reduction in symptoms of Post-Traumatic Stress Disorder (PTSD) (d = -0.78, 95% CI [-0.92, -0.64], p < .001) and depression (d = -0.65, 95% CI [-0.79, -0.51], p < .001) following psychological intervention. Among the various therapeutic modalities, Cognitive Behavioral Therapy (CBT) exhibited the strongest effect (g = 0.89), followed by Narrative Exposure Therapy (g = 0.76) and Eye Movement Desensitization and Reprocessing (g = 0.71). Analysis of moderating variables demonstrated that both program duration (β = 0.31, p < .01) and family involvement (β = 0.28, p < .01) significantly contributed to enhancing the efficacy of the intervention. These findings advance the understanding beyond previous research by Bwirire et al. (2022) and Eskici et al. (2023), which were constrained to short-term outcomes. This study confirms that therapeutic gains may persist up to two years post-intervention (r = 0.67, p < .001). Moreover, the results underscore combining community-based interventions with individualized therapy yields more favorable outcomes than the one-dimensional strategies reviewed in earlier literature.
The Impact of Social Marginalization on Mental Health in Middle Eastern Conflict Zones Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar
Medical Laboratory Journal Vol. 3 No. 2 (2025): June : Medical Laboratory Journal
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/caloryjournal.v3i2.623

Abstract

This systematic review aims to comprehensively evaluate the consequences of social marginalization on the mental health conditions of populations in Middle Eastern conflict zones, utilizing data from 2015 to 2024. Through a critical examination of 47 studies that met the inclusion criteria, a markedly high prevalence of mental disorders within this population was identified, namely post-traumatic stress disorder (PTSD) at 42.8% (95% CI = 38.4–47.2), major depression at 37.6% (95% CI = 33.2–42.0), and generalized anxiety disorder at 35.3% (95% CI = 31.1–39.5). Furthermore, the results of the meta-analysis revealed a very strong and statistically significant correlation between social marginalization and the severity of mental health disorders (r = 0.73, p < 0.001), indicating that the more intensely an individual experiences various forms of social marginalization, the more severe the psychological disorders they endure. Moreover, the three most dominant determinants of social marginalization were identified as limited access to healthcare services (OR = 3.82, 95% CI = 3.14–4.50), the persistence of systemic discrimination (OR = 3.45, 95% CI = 2.87–4.03), and widespread social isolation (OR = 3.21, 95% CI = 2.66–3.76). These findings not only expand upon the prior research outcomes of Al-Krenawi and Graham (2009) and Amsalem et al. (2025), which were confined to the aspect of PTSD but also provide new empirical evidence concerning a broader spectrum of mental disorders as well as specific patterns of social marginalization within the conflict landscape of the Middle East. Finally, this study contributes significantly to the academic literature by elaborating on the complex interactive mechanisms between practices of social marginalization and mental health deterioration while offering a framework for community-based interventions that are responsive and adaptive to the socio-political conditions characteristic of Middle Eastern conflict zones.
Intersectionality of Gender, Social Class, and War Trauma in the Middle East : A Multilayer Analysis Helsa Nasution; M. Agung Rahmadi; Luthfiah Mawar; Nurzahara Sihombing
Medical Laboratory Journal Vol. 3 No. 2 (2025): June : Medical Laboratory Journal
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/caloryjournal.v3i2.656

Abstract

This multilayer meta-analysis investigates the intersectionality between gender, social class, and war-related trauma in the Middle East through a systematic review of 87 studies (N = 31,459) published between 2000 and 2023. Analytical findings reveal a strong and significant correlation between gender and trauma severity (r = 0.67, p < 0.001), with women experiencing a 2.8 times higher prevalence of PTSD compared to men. Furthermore, results from hierarchical regression demonstrate that social class functions as a substantial moderator (β = 0.45, p < 0.001), with individuals from lower social class backgrounds exhibiting a 3.2 times greater risk of trauma. Further structural path analysis reveals the presence of dual mediation (CFI = 0.96, RMSEA = 0.04), with access to mental health services and social support serving as primary mediators (indirect effect = 0.38, 95% CI [0.29, 0.47]). These results expand the contributions of Al-Krenawi and Graham (2012) and Mangrio et al. (2019) by illustrating the complex interaction of the three dimensions (Gender, Social Class, and War Trauma), which had previously been examined only separately. In addition, this study identifies a new pattern termed the "spiral trauma effect," a mechanism wherein the intersectionality of gender, social class, and trauma mutually reinforce each other in a recurring cycle (effect size d = 0.89), thereby deepening the understanding of trauma dynamics in conflict zones across the Middle East. Finally, the predictive model developed in this research demonstrated an accuracy rate of 84.3% in identifying high-risk individuals. Thus, these results are considered to provide an innovative framework for the development of empirically-based trauma interventions in Middle Eastern war zones.
A Systematic Evaluation of Mental Health Policies for Middle Eastern Refugees Luthfiah Mawar; M. Agung Rahmadi; Helsa Nasution; Nurzahara Sihombing
Medical Laboratory Journal Vol. 3 No. 2 (2025): June : Medical Laboratory Journal
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/caloryjournal.v3i2.684

Abstract

This meta-review study presents a comprehensive evaluation of the effectiveness of mental health policies targeting refugees from the Middle East based on a systematic analysis of 87 policies issued across 12 refugee-hosting countries during the period from 2015 to 2023. Employing the PRISMA approach and thematic analysis, this research found that only 34.5% of all reviewed policies met the World Health Organization's minimum standards regarding mental health services for refugees. In comparison, the effective implementation rate of those policies meeting the standards reached only 28.7% (CI 95%, p<0.001). Findings from the logistic regression analysis revealed a significant correlation between the scale of mental health budget allocations and recovery rates from PTSD among refugee populations, where every 10% increase in budget allocation corresponded to a 15.3% reduction in PTSD prevalence (r=0.78, p<0.001). Furthermore, the meta-analysis results from this study demonstrated that community-based policies were 2.4 times more effective (OR=2.4, CI 95%: 1.8–3.1) than those employing institutional approaches. Hence, diverging from the conclusions posited by Turrini et al. (2019) and Sijbrandij (2017), which emphasized clinical interventions, this study has instead affirmed that integrating cultural-spiritual approaches with conventional therapy can enhance treatment success by 47.2%. Additionally, these findings expand the conceptual framework previously proposed by Watters (2001) on holistic approaches by identifying five key elements that form the foundation of effective mental health policies: universal access, cultural sensitivity, community empowerment, service integration, and program sustainability.
The Mixed-Method Approach in Research on War-Related Trauma in the Middle East Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar
The Journal General Health and Pharmaceutical Sciences Research Vol. 3 No. 2 (2025): The Journal General Health and Pharmaceutical Sciences Research
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/tjghpsr.v3i2.668

Abstract

This study conducts an in-depth examination of 87 mixed-method studies that address war-related trauma in the Middle East over the past two decades (2000–2023), employing a systematic methodological meta-synthesis approach to formulate a more comprehensive understanding of the impact of armed conflict on affected populations. Quantitative findings indicate an exceedingly high prevalence of post-traumatic stress disorder (PTSD), reaching 73.4% among war refugees (n = 12,456), accompanied by significant comorbidity rates in the form of depression (68.2%) and anxiety disorders (59.7%), both of which clinically exacerbate recovery prognosis. Meanwhile, the thematic qualitative analysis successfully identified five principal dimensions of recurrent traumatic experiences, namely direct exposure to violence (82.3%), the loss of family members (76.9%), forced displacement (71.4%), existential uncertainty regarding the future (68.9%), and the disintegration of social cohesion within affected communities (65.2%). A comprehensive integration of quantitative and qualitative data reveals a substantial correlation between the duration of conflict exposure and the severity of PTSD (r = 0.78, p < 0.001), indicating a linear association between the chronicity of war experiences and the intensity of psychological trauma. Through meta-regression, this study also identifies several statistically significant protective variables that reinforce both individual and collective resilience, including the presence of family support (β = 0.45, p < 0.001), the intensity of religiosity (β = 0.38, p < 0.01), and the strength of community resilience (β = 0.42, p < 0.001), all of which function as moderating factors of traumatic impact. In contrast to the narrow focus of Storozhuk et al. (2023) and Boeije et al. (2013), who emphasized individual trauma, this study advances a broadened paradigm by exploring the collective dimensions of war trauma made possible through an integrative methodological design. While Zerach and Solomon (2016) previously proposed three core categories of traumatic experience, the present study expands the conceptual spectrum by identifying two additional themes and unveiling the complex network of interrelations among trauma elements. The principal novelty of this study lies in the formulation of an integrative model of war trauma that not only theoretically unifies individual and collective dynamics but also constructs a new methodological framework that may serve as a reference point for trauma research in conflict-affected regions marked by the volatile and multidimensional sociopolitical context of the Middle East.
Cost-Effectiveness Analysis of Mental Health Programs in Middle Eastern Conflict Zones Helsa Nasution; M. Agung Rahmadi; Luthfiah Mawar; Nurzahara Sihombing
The Journal General Health and Pharmaceutical Sciences Research Vol. 3 No. 2 (2025): The Journal General Health and Pharmaceutical Sciences Research
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/tjghpsr.v3i2.669

Abstract

This meta-analysis evaluates the cost-effectiveness of mental health interventions implemented in conflict-affected regions of the Middle East between 2010 and 2023, compiling data from 47 programs across eight countries. Statistical analysis reveals substantial variation in program effectiveness levels (Cohen's d = 0.78, 95% CI [0.65, 0.91], p < 0.001), with cognitive behavioral therapy (CBT) demonstrating the highest cost-effectiveness ratio, registering an ICER of $2,340 per QALY gained. Multilevel regression findings indicate that community-based intervention approaches consistently prove more cost-efficient than those conducted in clinical settings (β = 0.67, p < 0.001), yielding an average savings of 43% per participant. Remote teletherapy programs exhibit significant potential, particularly in regions with limited access to services, with an ROI reaching 1.89 (95% CI [1.65, 2.13]). The economic burden analysis estimates that untreated mental health conditions incur an average annual cost of $4,623 per individual, whereas intervention expenses amount to approximately $1,876 per patient per year, resulting in a benefit-cost ratio of 2.47. This study expands upon prior research by Tol et al. (2011) and McBain et al. (2016), which were limited to clinical outcomes without addressing the economic dimension. In contrast to the study by Reed et al. (1994), which explored general health economics within conflict zones, this research specifically quantifies the cost-effectiveness of mental health interventions in Middle Eastern conflict areas. It reveals that cultural adaptation within intervention programs can enhance return on investment by up to 31%. Finally, this review uniquely demonstrates that community-based mental health programs integrated within conflict zones can meet the cost-effectiveness thresholds recommended by WHO-CHOICE while maintaining a high level of clinical efficacy.
Co-Authors Abdul Rahman Shaleh Achmad Syahid Aisyah Umaira Andieni Pratiwi Andine Mei Hanny Annisa Ardianti Br Tarigan Asfriyati ,MKes Ayu Anastasyah Clarisha Al Chaira Achmad Dwi Keisya Kurnia Ika Sandra Dewi Khaila Salsabila Kiki Asnanti Lathifa Nurrahmah Luthfiah Mawa Luthfiah Mawar Luthfiyah Aqilah Siagian M. Agung Rahmadi Milna Sari Naila Al Madina Nur Suci Ramadhani Nurma Handayani Nurzahara Sihombing Putri Widia Ramadhani Rambe Rahayu Lubis Rasil Hakim Hasibuan Risa Ramadhani Br Panjaitan Romaito Nasution Said Agil Husin Al Munawar Sarah Aisyah Agusti Sasa Maghfirah Siregar Saschia Amanda Siti Nurfaiza Sri Rahayu Sukirman Wildan Izzatul Haq Zahra Aliyah Verisah Zulpiani Br Sipayung