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Comparison of Evidence-Based Treatment Protocols for Complex Trauma in Middle Eastern Conflict Populations Luthfiah Mawar; M. Agung Rahmadi; Helsa Nasution; Nurzahara Sihombing
Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF) Vol. 3 No. 2 (2025): April : Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF)
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/jrikuf.v3i2.603

This meta-analysis systematically evaluates the relative effectiveness of various empirically supported therapeutic protocols designed to address complex trauma in populations affected by armed conflict in the Middle Eastern region. From 1,284 articles identified, 47 studies (N=4,832) met the inclusion criteria and were further analyzed. The primary findings indicate that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) produces the most significant therapeutic impact (g=0.83, 95% CI [0.76, 0.90], p<.001), followed by Eye Movement Desensitization and Reprocessing (EMDR; g=0.78, 95% CI [0.71, 0.85], p<.001) and Narrative Exposure Therapy (NET; g=0.71, 95% CI [0.64, 0.78], p<.001). Moderator analysis revealed that the duration of the intervention (β=0.42, p<.001), as well as the severity of trauma at the commencement of treatment (β=0.38, p<.001), significantly influence therapeutic effectiveness. Further network meta-analysis results demonstrated that TF-CBT holds the highest probability of being the most superior intervention (SUCRA=0.92), indicating its superior effectiveness in reducing symptoms of post-traumatic stress disorder (PTSD), with a significantly standardized mean difference compared to other approaches (SMD=-0.45, 95% CI [-0.52, -0.38]). Contrary to findings reported by Korn (2009) and Rahman et al. (2019), which positioned EMDR as the primary method, this study identifies the distinct superiority of TF-CBT specifically for individuals suffering from complex trauma due to prolonged conflict. These results broaden the horizon of prior scientific understanding by emphasizing the importance of trauma-specific characteristics as moderating variables that determine the success of therapeutic interventions.

Integration of Indigenous Healing Approaches and Western Psychotherapy in Addressing War Trauma Post-Arab Spring M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar; Nurzahara Sihombing
Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF) Vol. 3 No. 2 (2025): April : Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF)
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/jrikuf.v3i2.604

This study systematically evaluates the effectiveness of integrating indigenous healing approaches with Western psychotherapy in addressing psychological trauma experienced by populations affected by war in the aftermath of the Arab Spring. Utilizing a systematic review methodology, the analysis encompasses 47 independent studies involving 4,382 participants, published between 2011 and 2024. Meta-analytic results indicate that the combined application of both approaches yields a significantly higher effect size (d=0.86, 95% CI [0.72, 1.01]) compared to the individual application of either indigenous healing (d=0.51) or Western psychotherapy (d=0.63). Further moderator analysis reveals that the highest therapeutic effectiveness is achieved through interventions that integrate traditional healing rituals with Cognitive Behavioral Therapy techniques (β=0.41, p<.001) and Eye Movement Desensitization and Reprocessing (β=0.38, p<.001). Moreover, Indigenous healing demonstrates a significantly targeted contribution to the recovery of collective identity (r=0.72, p<.001) and enhancement of social reintegration capacity (r=0.68, p<.001). In contrast, Western psychotherapy proves more effective in reducing the intensity of post-traumatic stress disorder (PTSD) symptoms (r=-0.59, p<.001). These findings substantially expand upon previous research by Okasha et al. (2012) and Erickson & Al-Tamimi (2001), which primarily focused on the isolated effectiveness of each approach. The empirical evidence presented in this study supports the conclusion that an integrated therapeutic model yields more comprehensive and sustainable clinical benefits for survivors of collective trauma resulting from armed conflict. Finally, the core novelty of this research lies in its successful identification of specific mechanisms that effectively facilitate the synergy between indigenous healing and Western psychotherapy in the context of complex post-conflict mass trauma following the Arab Spring.

Impact of Displacement on Mental Health Among Elderly War Victims in Syam Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar
Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF) Vol. 3 No. 2 (2025): April : Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF)
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/jrikuf.v3i2.605

This study comprehensively evaluates the impact of displacement on the mental health of the elderly population affected by armed conflict in the Syam region through a systematic review and meta-analysis of 47 empirical studies (N=12,483) published between 2011 and 2024. The meta-analytic findings indicate an exceptionally high prevalence of severe psychological disorders within this population, with PTSD recorded at 63.8% (95% CI [59.2–68.4]), major depression at 58.2% (95% CI [54.1–62.3]), and generalized anxiety disorder at 52.4% (95% CI [48.3–56.5]). Multilevel regression analysis identified the duration of displacement (β=0.42, p<.001) and the loss of family support (β=0.38, p<.001) as the most significant determinants of the elevated prevalence of these mental health disorders. In particular, elderly individuals who experienced displacement for more than three years exhibited a 2.8-fold increased risk of developing psychological disorders compared to those displaced for less than one year (OR=2.83, 95% CI [2.41–3.25]). Findings from the meta-regression further revealed that social support (r=–0.45, p<.001) and adequate access to mental health services (r=–0.38, p<.001) served as significant protective factors. Accordingly, these results not only extend the contributions of prior studies by Peconga & Høgh Thøgersen (2020) and Chung et al. (2018) but also uncover the complex interaction between the duration of displacement and the degradation of social networks as key determinants within the mental health dynamic. Furthermore, this study makes an original contribution by identifying psychosocial adaptation patterns among elderly refugees that are structurally distinct from those of the general population while simultaneously proposing a contextually designed community-based intervention framework to address the multidimensional needs of elderly war victims.

Mental Health of Combatants vs. Non-Combatants in Middle Eastern Conflicts: A Comparative Analysis Helsa Nasution; M. Agung Rahmadi; Luthfiah Mawar; Nurzahara Sihombing
Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF) Vol. 3 No. 2 (2025): April : Jurnal Riset Ilmu Kesehatan Umum dan Farmasi (JRIKUF)
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/jrikuf.v3i2.619

This study aims to comprehensively evaluate the psychological impact differences between individuals who served as combatants and those classified as non-combatants within the context of armed conflicts in the Middle East, through a meta-analysis of 47 independent studies involving a total of 28,463 participants and published between 2010 and 2024. The principal findings of this quantitative synthesis indicate that the prevalence of post-traumatic stress disorder (PTSD) is significantly higher among combatants, reaching 73.8%, compared to non-combatants, who reported a rate of 52.4%, with a large effect size (d=0.89, p<.001). Furthermore, results from multilevel regression analysis reveal that the duration of exposure to conflict is the strongest predictor of PTSD symptoms (β=0.67, p<.001), followed by the intensity of combat, which also contributes significantly (β=0.54, p<.001). In addition, major depression was documented in 64.2% of individuals within the combatant group and 48.7% among non-combatants, with an odds ratio of 2.34 and a 95% confidence interval ranging from 1.98 to 2.76. Anxiety disorders were also more prevalent among combatants, at 58.9%, compared to 41.3% in non-combatants, with a relative risk of 1.78 (p<.001). Subgroup analysis revealed significant differences in coping strategy preferences, with combatants tending to rely more heavily on avoidance mechanisms, recorded at 69.5% versus 45.2% among non-combatants. This meta-analytic finding expands upon the studies by Eltanamly et al. (2021) on war-induced trauma and by Figley & Nash (2011) regarding psychological defense mechanisms, with its distinct contribution lying in the identification of specific patterns of mental disorders influenced by individual roles within conflict dynamics. Overall, this research concludes that combatants exhibit a distinctive pattern of trauma manifestation and demonstrate a higher threshold of resistance to conventional therapeutic interventions, thus making a significant contribution to the formulation of role-based trauma treatment protocols in regions affected by armed conflict.

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

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

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.

The Impact of Social Marginalization on Mental Health in Middle Eastern Conflict Zones Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar
Calory Journal 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

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
Calory Journal 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

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
Calory Journal 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

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 Psychological Construct of Islamic Moderation Based on Tafsir Ulul Albab : A Comparative Study of Indonesia and Syria in Responding to Social Polarization Nurzahara Sihombing; M. Agung Rahmadi; Helsa Nasution; Luthfiah Mawar; Romaito Nasution; Milna Sari
Calory Journal Medical Laboratory Journal Vol. 3 No. 3 (2025): September : Medical Laboratory Journal
Publisher : LPPM STIKES KESETIAKAWANAN SOSIAL INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57213/caloryjournal.v3i3.792

This study aims to affirm the construct validity of Islamic moderation based on the tafsir of Ulul Albab through an empirical comparison between Indonesia and Syria in responding to the social polarization that divides contemporary societies. Through a comprehensive meta-analysis of 847 journal articles indexed in Scopus, Web of Science, and PsycINFO published between 2015 and 2024, the researchers examined data from 15,428 Indonesian respondents and 12,736 Syrian respondents, integrating cross-cultural quantitative findings within a rigorous statistical framework. The results of the confirmatory factor analysis demonstrated model fit (χ²/df = 2.184; CFI = 0.947; TLI = 0.932; RMSEA = 0.041), while convergent validity indicated an AVE of 0.563 in Indonesia and 0.589 in Syria, with composite reliability values of 0.891 and 0.876 respectively, underscoring the internal consistency of the instrument. Cross-national invariance testing revealed statistically significant differences (Δχ² = 47.23; p < 0.001), with the mean score of Islamic moderation in Indonesia (M = 4.12; SD = 0.67) surpassing that of Syria (M = 3.84; SD = 0.78), indicating that distinctive sociohistorical contexts influence the implementation of moderative values. Furthermore, Islamic moderation functioned as a partial mediator of the relationship between religious literacy and social tolerance (β = 0.342; p < 0.001 for Indonesia; β = 0.287; p < 0.001 for Syria), thereby enriching Pargament's (2011) findings on religious coping and Durrheim et al.'s (2016) work on intergroup prejudice. The findings reveal that Islamic moderation encompasses cognitive, affective, and behavioral dimensions that are theoretically distinct from generic notions of tolerance, affirming the importance of the Ulul Albab approach in addressing socio-religious tensions. Lastly, the novelty of this research lies in the development of a tailored instrument that synthesizes values derived from the tafsir of Ulul Albab, going beyond conventional tolerance scales and offering a more nuanced assessment of the moderative capacity of Muslims in both countries.

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