War Trauma, Psychological Distress, and Coping Among Afghan Civilians Seeking Primary Health Care

The present study examined the relationship between war trauma and distress and the potential moderating role of emotion and social, avoidant, and religious coping among 81 participants seeking medical services at a primary care clinic in Kabul. Local Afghan researchers administered the Afghan Symptom Checklist, Afghan War Experiences Scale, a brief scale of other non-war-related traumatic experiences, two subscales of the COPE, an Avoidant Coping Scale, and a demographics questionnaire, and conducted a brief semistructured interview. Results revealed a significant contribution of war-related traumatic events (11%) to symptoms of distress and an additional contribution of nonwar-related trauma (7%) to distress (p's ≤ .01). Emotion and social coping and avoidant coping were positively correlated with distress (r = .23, and .60, respectively) and did not moderate the relationship between war trauma and distress. Qualitative responses were also recorded regarding various coping strategies and shed light on specific ways in which participants dealt with trauma. Demographics revealed that women reported higher symptom levels than men (p < .05), and age was positively correlated with symptoms, while education showed a negative relation with symptoms (r = .46 and −.22, respectively). While traumatic events were positively associated with distress, adaptive coping strategies that mitigated this distress were not identified by the quantitative analyses. Qualitative data suggested that religious practices, staying busy, and seeking help from others were the most frequently reported coping strategies. It is important to continue to explore these factors and others that may help mitigate the impact of traumatic events in this culture.