The key message that emerged out of the Northern Ireland conflict through research carried out by the NICTT and the Ulster University was that there was a very high level of conflict-related trauma exposure with associated mental health implications, and major economic consequences. Key findings include:
- Approximately 40% of the Northern Ireland adult population have had one or more conflict-related traumatic experiences. The ageing population has had a particularly high incidence of trauma-related experiences associated with the conflict and a distinctive pattern of exposure to the period of major violence in the 1970s and 1980’s.
- 15% of adults who had one or more traumatic experiences subsequently met the criteria for post traumatic stress disorder (PTSD) at some point in their lives. This included adults who had such experiences in childhood.
- Among all comparable studies undertaken across the world including other areas of conflict (as part of the World Mental Health Initiative), Northern Ireland has the world’s highest the highest level of 12-month and lifetime Post-Traumatic Stress Disorder (PTSD) rates, ahead of regions affected by war and conflict, such as Israel and Lebanon.
- Findings from the series of studies show that 26% of PTSD in Northern Ireland is due to the Troubles/conflict. (The research team consider this to be an under estimate due to known limitations in the data analysis reported in a number of the reports and papers it has published.)
- The yearly cost to the Northern Ireland economy of conflict-related trauma is estimated to be £47 million, 1.4% of the entire expenditure on Health and Social Care and about one quarter of the mental health budget (2008 figures). (Northern Ireland has a population of circa 1.7 millions.)
- Individuals who experienced any conflict-related traumatic event were more likely to have had any lifetime anxiety, mood, substance or impulse-control disorder compared to those who experienced a non-conflict related traumatic experience or those who had not experienced a traumatic event at all.
- There was a significant association between having had a traumatic experience and one or more long term physical health conditions.
- Only one third of those with PTSD found help which they considered to be helpful. This is related to a combination of the personal struggle to seek help in the first place and the problem of finding (or being referred for) effective trauma therapy services. (It is recommended in the reports below that more practitioners with trauma skills and know-how are trained and supported so that trauma therapy services are readily available.)
- The average time taken for people with anxiety disorders (of which PTSD is an example) to seek help with their symptoms was 22 years. This has significant implications for the long term needs of people affected by traumatic events and stressful circumstances and therefore the provision of services in the long term.
The findings are reported upon in more detail in the following series of Reports prepared by the partnership between the Initiative for Conflict-Realted Trauma (previously the Northern Ireland Centre for Trauma & Transformation) and the Ulster University. Also, see KEY PAPERS for further papers including per reviewed journal papers.
In 2014, the Commission for Victims and Survivors (Northern Ireland) commissioned a major study into the trans-generational consequences of the Troubles in Northern Ireland. The Ulster University and the The Initiative for Conflict-Related Trauma undertook the research which led to a major publication by the Commission in March 2015, Towards A Better Future: The Trans-generational Impact of the Troubles on Mental Health. The report contains new findings drawn from the Northern Ireland dataset of the World Mental Health Survey (WMHS) Initiative and an overview of services currently in place, with recommendations for policy, services, practice and research. The conclusions include a model for understanding the cyclical transmission of the adverse consequences of traumatic events in family life and proposals as to how interventions could be made to break the cycle and build resilience.
Troubled Consequences; a report by the Ulster University and the Northern Ireland Centre for Trauma & Transformation for the Commission for Victims and Survivors (Northern Ireland) October 2010; IF YOU WANT A DETAILED ACCOUNT THIS IS THE ONE TO READ – and download full report here 2012 Dec Troubled Consequences. This report was commissioned by the Commission for Victims and Survivors for Northern Ireland (CVSNI) from the Ulster University in partnership with the Northern Ireland Centre for Trauma and Transformation and published by the Commission in November 2012.
The Commission for Victims and Survivors Northern Ireland – Comprehensive Needs Assessment; This report is the most recent Comprehensive Needs Assessment undertaken by the Commission for Victims and Survivors for Northern Ireland (published 2012) which addresses amongst other areas the health impact of the Northern Ireland conflict. The report draws significantly from the Troubled Consequences Report (see immediately above) to describe the impact of the years of violence and to make recommendations for future policy and service development.
Ageing, Health & Conflict; An investigation of the Experience and Health Impact of ‘Troubles-related’ Trauma Among Older Adults in Northern Ireland; NICTT & UU; 2012; NICTT & Ulster University with support from The Atlantic Philanthropies. This report investigates the previously observed pattern of higher levels of trauma exposure of the adult population of Northern Ireland aged 45 years and over, finding that this part of the adult population was exposed to high levels of conflict related violence with significant health consequences associated with conflict related trauma exposure. In addition, the report provides preliminary results on a more detailed follow-up investigation of the impact of fear, patterns of violence and political progress on the perceived well-being of participants. (The data obtained from the follow-up study would benefit from further investigation and the ICRT is seeking research funding to undertake further analysis.)
The Health Economic Impact of Post-Traumatic Stress Disorder in Northern Ireland; NICTT & UU; 2011; IF YOU ARE IN A HURRY – this is the best overview of the population impact of the Troubles – along with a focus on the health economics of PTSD. The study and report was completed in December 2011 by the NICTT & Ulster University with support from the Lupina Foundation of Canada. This report draws upon the full data set of the Northern Ireland Study of Health and Stress to investigate the health economic impact of PTSD in Northern Ireland and includes an update of the 2008 Report (see below) on the epidemiological findings of mental health impacts of conflict related violence. This is one of the few health economic studies of PTSD available in the scientific literature.
Trauma, Health and Conflict in Northern Ireland: A Study of the Epidemiology of Trauma Related Disorders and Investigation of the Impact of Trauma on the Individual; NICTT & UU; 2008; The first major epidemiological study of psychological trauma in Northern Ireland undertaken by the Ulster University-NICTT partnership and published in 2008 using part of the final data set which formed the basis for subsequent and updated reports (see above).
Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial; British Medical Journal BMJ 2007;334:1147 (2 June), also, doi:10.1136/bmj.39021.846852.BE (published 11 May 2007). This paper was published in 2007 in the British Medical Journal reporting on the key findings of a randomized controlled trial for trauma-focused cognitive therapy delivered by the specialist trauma focused cognitive therapy (CBT) programme developed and provided by the Northern Ireland Centre for Trauma and Transformation.
Catastrophe Mental Health; Emergency Planning, Mental health & Catastrophic Events; Policy & Practice Implications; 2005; The UK Cabinet Office and NICTT. A report of a workshop which examined the key issues to be considered in addressing the mental health consequences of major catastrophic disasters.
Community-Based Psychological Trauma Education and Treatment Project; Lessons Learned from Nepal; 2009; This study involved a two year project of health innovation delivering a psychosocial education programme through locality based partnerships to villages in two Districts of Nepal to the west of Kathmandu from 2007 to 2009. This is an example of frugal intervention and innovation aimed at enhancing the capabilities of village communities in addressing the trauma related consequences of traumatic experiences, including the experiences of civil conflict. The Northern Ireland Centre for Trauma and Transformation worked in collaboration with a local NGO, Kopila Nepal and The Development Media Workshop (www.developmentmediaworkshop.org) with support from Leprosy Mission Ireland and the Department of Foreign Affairs, Ireland.
Responding to Trauma in Newry and Mourne; A report Commissioned by the Newry and Mourne Local Health and Social Care Group; 2006; This is a report of a detailed consultation, undertaken by the Northern Ireland Centre for Trauma and Transformation and published in 2006, of public and voluntary providers of health, social and support services in a local government District in Northern Ireland which investigated psychological trauma-related needs and brought forward proposals on how trauma related need might best be addressed.
A proposal to develop a cross border Conflict Trauma Treatment, Training and Research Centre
In June 2013, ICRT submitted a concept paper to the Special EU Programmes Body [SEUPB] in which we set out the context and rationale for a major PEACE IV funded initiative, suggesting what its aims could be and how it could assist service developments for victims and survivors of the conflict in Northern Ireland, the Republic of Ireland and internationally.