Talking with Patients about Mental Health in Times of War: Tips for Primary Care Physicians

It is usual for people to experience a range of emotions and responses in times of war or crisis. The following are common responses, which may present differently from person to person:

• Disbelief and shock
• Fear and anxiety about the future
• Disorientation, apathy and emotional numbing
• Irritability and anger
• Sadness and depression
• Over- or under-eating
• Difficulty making decisions
• Crying for “no apparent reason”
• Headaches and stomach problems
• Difficulty sleeping
• Excessive alcohol or drug use
• Worsening of pre-existing medical conditions

  Most of these reactions, while distressing, are healthy responses to war and other crises, and will resolve themselves in time. But, if these reactions last for several weeks, they may be signs of mental health disorders. In some cases, it may be the first incidence of such a disorder. The key to identifying psychiatric distress and disorders will be the intensity and duration of these symptoms, and the disruption of the person’s ability to function in daily life.

  Which mental health issues are potential concerns?
  

  Below are some common mental health issues that develop or resurface in times of war or crisis, or after a traumatic event:

  Acute Stress Disorder: ASD may present closely following a traumatic experience or event. Symptoms of ASD include: numbness, difficulty responding to normal life events, difficulty controlling anger and suspiciousness.

  Post Traumatic Stress Disorder: PTSD may present months after a traumatic experience or event. Symptoms include repeatedly re-experiencing the ordeal in the form of flashback episodes, memories, nightmares or frightening thoughts, especially when exposed to events or objects reminiscent of the trauma. Emotional numbness and sleep disturbances are also common symptoms, as are depression, substance abuse, heightened anxiety and irritability. Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain or discomfort in other parts of the body are potential signs. People who already live with PTSD are at risk of more prominent flashbacks, anxiety and hypervigilance during times of war or crisis.

  Substance Abuse and Addictions: People may start or overuse substances, such as alcohol, food and drugs, and increase gambling and other addictive behaviors to manage their anxieties and other symptoms. The most important clue to watch for is whether the person’s usual consumption or behavior has changed.

  Depression and Anxiety: These disorders may develop or increase as a result of stress and trauma about the war or related events. It will be necessary to assess all patients whether they have been previously diagnosed or not. If patients are presently being treated for these disorders, it will be necessary to determine the appropriateness and effectiveness of current treatment. Depression and grief are separate issues, but grief can cause concern when it lasts for an extended period of time.

  Domestic Abuse: Research has shown that domestic abuse cases rise after traumatic events and during times of national crisis. Be alert for bruises and other signs of violence on adults and children.

  Tips on reducing stress and trauma reactions in your patients:
  
  • Talk to your patients about the war or traumatic events. Ask how they, their families, colleagues and friends are coping with recent events. Encourage them to express their feelings to you and/or a trusted relative, friend, social worker or clergy member.
  • Advise eating healthy foods, getting plenty of rest, exercising and drinking fluids.
  • Encourage them to spend time with their family members and close friends.
  • Advise them to limit their exposure to news reports and images of the war.
  • Encourage them to participate in activities that they find relaxing and soothing.
  • Suggest that they get back to their usual routine as soon as possible.