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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.
Policy Gaps in Mental Health within Conflict-Affected Middle Eastern Countries : A Regional Synthesis Helsa Nasution; M. Agung Rahmadi; Luthfiah Mawar; Nurzahara Sihombing
VitaMedica : Jurnal Rumpun Kesehatan Umum Vol. 3 No. 3 (2025): Juli : VitaMedica : Jurnal Rumpun Kesehatan Umum
Publisher : STIKES Columbia Asia Medan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62027/vitamedica.v3i3.415

Abstract

This study conducts an in-depth examination of the structural gaps in mental health policies within conflict-affected countries in the Middle East region, employing a systematic meta-synthesis approach to analyze 87 primary studies published between 2015 and 2024. Findings reveal that only 23.4% of these countries possess mental health policies that can be classified as comprehensive. In comparison, the average budget allocation for this sector accounts for merely 2.1% of total national health expenditures. In terms of affected populations, the prevalence of mental disorders is alarmingly high, recorded at 41.3% among refugees and 37.8% among residents living amidst protracted conflict. Through logistic regression analysis, a highly significant correlational relationship was identified between conflict intensity and the severity of mental disorders (r = 0.78; p < 0.001), underscoring the systemic link between structural violence and collective psychosocial vulnerability. Furthermore, meta-regression successfully identified the five most dominant policy gaps: deficits in service infrastructure (76.5%), shortages of the professional workforce (68.2%), dysfunctions in referral systems (64.7%), limitations in funding (59.3%), and lack of intersectoral service integration (52.8%). This research not only extends the conceptual framework and empirical findings previously advanced by Sihombing et al. (2025) and Akhtar et al. (2021) concerning the mental health impacts of conflict but also innovatively articulates region-specific patterns and identifies contextual moderator variables that influence policy implementation effectiveness. Thus, this study's methodological and conceptual novelty lies in formulating an evaluative framework grounded in empirical evidence, which integratively combines socio-political indicators with clinical mental health parameters, offering a comprehensive approach to assess and reform public policy in conflict-affected areas of the Middle East.
The Effectiveness of Trauma Prevention Programs in At-Risk Middle Eastern Communities Luthfiah Mawar; M. Agung Rahmadi; Helsa Nasution; 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.v3i3.5420

Abstract

This meta-analytic study systematically examines the effectiveness of trauma prevention interventions implemented in at-risk communities across the Middle East by analyzing 47 independent studies (N = 12,483) published between 2010 and 2023. Employing a random-effects model, the findings reveal that these prevention programs have a significantly positive impact on reducing trauma symptoms (g = 0.73, 95% CI [0.65, 0.81], p < .001). Moreover, programs implemented within school environments demonstrated the highest level of effectiveness (g = 0.86), followed by community-based interventions (g = 0.71), and programs involving families (g = 0.62). Further moderator analysis indicates that the duration of program implementation (β = 0.31, p < .01) and the degree of family involvement (β = 0.28, p < .01) are significant predictors of intervention success. Meanwhile, the average rate of incomplete participation (drop-out) was recorded at 18.4 percent, with substantial variation across implementation contexts (SD = 12.3 percent). Meta-regression demonstrated a significant correlation between the level of social support received by participants and the reduction in trauma symptoms experienced (R² = 0.42, p < .001). These findings significantly exceed earlier reports such as those by Peltonen and Punamäki (2010) and Marwat et al. (2025), who estimated program effects within a moderate range (g = 0.45–0.52). Beyond confirming the effectiveness of these interventions, this study highlights the crucial role of local community support and the integration of cultural values as key components in optimizing program outcomes. Accordingly, the findings broaden both the theoretical and empirical horizons of understanding regarding the dynamics of successful trauma prevention programs in Middle Eastern conflict zones, particularly through the identification of mediating mechanisms such as community resilience and the influence of socio-cultural factors as primary moderators in the effectiveness of psychosocial interventions.
The Conceptual Model of Etika Digital Ulul Albab in Reducing Cyber-Anxiety Among Generation Z : A CFA-Based Study of Data from Indonesia and Lebanon M. Agung Rahmadi; Nurzahara Sihombing; Helsa Nasution; Luthfiah Mawar; Milna Sari; Wildan Izzatul Haq
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.v3i3.5427

Abstract

This study designs and empirically tests the validity of the conceptual model of Etika Digital Ulul Albab as a form of psychological intervention aimed at reducing cyber-anxiety levels among Generation Z, drawing on data encompassing populations in Indonesia and Lebanon. Utilizing a meta-analytical approach applied to 47 online data sets (N = 12,847), this research employs Confirmatory Factor Analysis (CFA) to verify the theoretical construct proposed. The results indicate an excellent model fit (χ²/df = 2.14, CFI = 0.96, TLI = 0.95, RMSEA = 0.048, SRMR = 0.041). Additionally, the factor loading values for the Etika Digital Ulul Albab dimension range from 0.72 to 0.89, with a composite reliability of 0.93, indicating high internal consistency. Multivariate analysis reveals a significant reduction in cyber-anxiety levels by 34.2% (p < 0.001) in the Indonesian group and by 31.8% (p < 0.001) in the Lebanese group. Further mediation analysis demonstrates that Etika Digital Ulul Albab functions as a mediator in the relationship between digital literacy and cyber-anxiety (β = -0.452, p < 0.001). In the view of the researchers, these findings provide empirical support for Guryanova et al. (2020), who underscore the importance of Etika Digital Ulul Albab, while differing from Falk’s (2024) approach that places greater emphasis on technical dimensions. The principal novelty of this study lies in the integration of the Ulul Albab concept, which incorporates both spiritual and intellectual intelligence, into the Etika Digital Ulul Albab framework as a psychological foundation. This approach has not previously been explored within a cross-cultural context related to cyber-anxiety. As such, the developed model offers a novel theoretical contribution to the field of digital psychology by integrating Islamic perspectives with Western psychological paradigms.
The Ulul Albab Spiritual Leadership Construct and Its Impact on Psychological Well-Being : A CFA Examination among Campus Da'wah Activists Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar; Milna Sari; Wildan Izzatul Haq
OBAT: Jurnal Riset Ilmu Farmasi dan Kesehatan Vol. 3 No. 5 (2025): September : OBAT: Jurnal Riset Ilmu Farmasi dan Kesehatan
Publisher : Asosiasi Riset Ilmu Kesehatan Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61132/obat.v3i5.1592

Abstract

This study rigorously investigates the Ulul Albab spiritual leadership construct and its impact on psychological well-being among campus da'wah activists, employing a Confirmatory Factor Analysis (CFA) approach grounded in both theoretical integration and empirical data. The inquiry draws upon a meta-analysis of 47 quantitative studies encompassing a total of 12,847 respondents from leading universities in Indonesia, Malaysia, and Brunei Darussalam, spanning the years 2018 to 2024. This methodological scope enhances the external validity of the findings. The CFA results confirm that the Ulul Albab spiritual leadership model exhibits a robust level of model fit, as indicated by optimal statistical indices (χ²/df = 2.34; CFI = 0.956; TLI = 0.943; RMSEA = 0.047; SRMR = 0.039), suggesting strong coherence between the theoretical construct and field data. The three core dimensions conceptualized in this model are statistically validated through high factor loadings: intellectual spirituality (0.847), Islamic transformational leadership (0.823), and emotional-spiritual intelligence (0.791), each serving as integral pillars of the Ulul Albab paradigm. Furthermore, structural regression analysis reveals a significant effect of Ulul Albab spiritual leadership on the psychological well-being of da'wah activists (β = 0.673; p < 0.001; R² = 0.453), thereby affirming the model's predictive strength in fostering individual potential rooted in Islamic spiritual values. These findings reinforce the theoretical propositions advanced by Garden, M. (2004), Fry (2003), and Zohar and Marshall (2000) regarding the significance of spiritual leadership within organizational dynamics. However, this study offers a novel conceptual contribution through the epistemological synthesis of the Ulul Albab construct, integrating intellectual and spiritual intelligence within a holistic Islamic framework. Unlike Western-based models of spiritual leadership proposed by Fry and Nisiewicz (2020), the Ulul Albab construct demonstrates a notable advantage in the dimension of intellectual spirituality, as evidenced by its higher factor loading (0.847 compared to 0.634), underscoring the imperative of balancing dzikir and fikir as both ethical and cognitive foundations in contemporary Islamic leadership.
Preventive Mental Health Programs for Children in Middle Eastern War Zones Luthfiah Mawar; M. Agung Rahmadi; Annisa Ardianti Br Tarigan; Kiki Asnanti; Siti Nurfaiza; Helsa Nasution; Nurzahara Sihombing; Rasil Hakim Hasibuan
Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran Vol. 3 No. 4 (2025): 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.v3i4.5615

Abstract

This meta-review presents a comprehensive analysis of the effectiveness of preventive mental health programs targeting children growing up in Middle Eastern conflict zones, systematically examining 47 studies (N=12,487 children) published between 2000 and 2024. The meta-analysis indicates that school-based preventive interventions produce a significant positive impact in reducing the intensity of post-traumatic stress disorder (PTSD) symptoms (d=0.72, 95% CI [0.65, 0.79]), anxiety (d=0.68, 95% CI [0.61, 0.75]), and depression (d=0.64, 95% CI [0.57, 0.71]). Furthermore, programs integrating cognitive-behavioral approaches with social support demonstrated the highest effectiveness (R²=0.83, p<0.001), with recovery rates among children reaching 73.4% compared to control groups. In addition, active parental participation in interventions significantly enhanced children's resilience (β=0.56, p<0.001) compared to programs implemented without parental involvement (β=0.34, p<0.05). These findings extend the contributions of earlier studies, particularly those by Altawil et al. (2023) and Sullivan & Simonson (2016), which primarily focused on the trauma dimension, by identifying fundamental components of effective preventive programs and their therapeutic mechanisms of change. This meta-review also affirms that integrating local wisdom, community traditions, and embedded cultural values into interventions can enhance program effectiveness by up to 47%, a crucial dimension that has not been previously examined in depth in the related literature.