This dissertation examines how the psychological implications of living through conflict and forced migration affect social cohesion. While scholars have begun to test the relationship between trauma exposure, the subsequent psychological distress that can emerge in its aftermath, and various sociopolitical outcomes—including prosociality, group relations, political participation, and institutional trust—they have conceptualized, operationalized, and measured trauma exposure and psychological distress in different ways, often resulting in disparate conclusions.
As the process of living through and responding to trauma exposure has significant heterogeneity at the individual level, I maintain that it should be conceptualized and studied as such. I present the theory of psychological foundations of social cohesion, which posits that individuals' adverse responses to trauma exposure, manifest as psychological distress, lead to changes in social cohesion outcomes. I identify two dimensions of social cohesion: bonding social cohesion, which is social cohesion targeted at ingroup members, and bridging social cohesion, which is social cohesion targeted at outgroup members. I develop seven hypotheses regarding the variation in how individuals react to living through trauma exposure (H1-H2), how differential responses to trauma shape social cohesion (H3-H6), and how emotion regulation shapes social cohesion (H7). I hypothesize that only a subset of individuals will develop psychological distress in responses to trauma exposure, that there will be variation in the characteristics of that distress, and that different manifestations of psychological distress will differentially affect bonding and bridging social cohesion. I further theorize that individuals whose response to trauma is characterized by hyperarousal—commonly referred to as "fight or flight" behaviors—will have lower reported levels of bridging social cohesion, while individuals whose response to trauma is characterized by hypoarousal—commonly referred to as "freezing or immobilizing" behaviors—will have lower levels of bridging and bonding social cohesion. I additionally theorize that individuals with increased emotion regulation, defined as the ability to modulate one's emotional responses in a way proportional to stimuli, will have greater reported bonding and bridging social cohesion.
I present three main empirical tests of the hypotheses. The first takes a cross-context approach, assessing cross-national variation in rates of trauma exposure and psychological disorders, as reported by the World Health Organization's World Mental Health Survey Initiative. I find that rates of trauma exposure and psychological disorders vary significantly across countries, and there is a significant positive association between the proportion of a nation's population that reports at least one trauma exposure and the prevalence of mental health disorders, including anxiety and mood disorders. I next estimate associations between individual-level measures of psychological distress and social cohesion, as measured cross-nationally in the second wave of the World Values Survey. The findings provide cross-national support for the expectation that hyperarousal and hypoarousal have differential impacts on social cohesion, such that hyperarousal is significantly negatively associated with bridging social cohesion, while hypoarousal is significantly negatively associated with both bonding and bridging social cohesion.
The second—and primary—test of the theory uses an original panel dataset gathered via a randomized controlled trial (RCT) evaluating the efficacy of The Field Guide for Barefoot Psychologists, a novel psychoeducational program designed to improve emotion regulation and reduce psychological distress among Syrian refugees living in Za'atari Refugee Camp in Jordan. I use the baseline data to assess the prevalence of trauma exposure and psychological distress, as well as associations between baseline levels of psychological distress and social cohesion. I then use the baseline and endline data to evaluate how intervention-driven improvements in psychological distress and emotion regulation are associated with changes in social cohesion. The intervention has a significant effect on both hypoarousal and emotion regulation, leading to a 21.4% improvement in hypoarousal from baseline, and a 18.7% improvement in emotion regulation from baseline; the intervention has no significant effect on hyperarousal. Using a structural equation model, I find that the intervention-driven improvement in hypoarousal is significantly associated with improvements in bonding social cohesion (ingroup trust) and bridging social cohesion (outgroup trust, outgroup anxiety, and perceived communal security), while the improvement in emotion regulation is significantly associated with improvements in bonding social cohesion (ingroup trust) and bridging social cohesion (outgroup trust and perceived communal security). These findings indicate that interventions designed to improve individual psychological well-being may have secondary improvements on community-relevant factors via the theorized relationship between psychological distress and social cohesion.
The third empirical test uses data from the Survey of War Affected Youth (SWAY) to provide another individual-level test of the theory in a highly different context. The SWAY data is a large-scale survey of 1360 conflict-affected youth in Kitgum and Pader districts in northern Uganda. I assess variations in psychological distress based on degree and type of trauma exposure, finding that forced violence and sexual abuse are the two types of trauma exposure most strongly positively associated with both hyperarousal and hypoarousal. I then estimate associations between psychological distress and social cohesion.
From these empirical tests I draw three key conclusions. First, trauma exposure cannot be seen as a uniform experience, and neither can responses to trauma exposure. As such, social science research must ensure that we are conceptualizing and measuring each in a way that reflects the complexity and heterogeneity in both trauma exposure and psychological distress. The theory on psychological foundations of social cohesion provides an informative framework for conceptualizing psychological distress by differentiating between responses characterized by hyperarousal and hypoarousal. Second, the results provide empirical support for the hypotheses derived from the theory of psychological foundations of social cohesion regarding psychological distress. Specifically, they support the expectations that hyperarousal and hypoarousal have differential effects on social cohesion, that hyperarousal is associated with lower reported bridging social cohesion, that among individuals with hyperarousal, those who do not additionally have hypoarousal will have higher reported bonding social cohesion, and that hypoarousal will be associated with lower bonding and bridging social cohesion. Third, the results from the evaluation of The Field Guide for Barefoot Psychologists indicate that the relationship between intervention-driven improvements in psychological distress and emotion regulation with social cohesion outcomes is a promising avenue for future inquiry and practice. If these results reflect the theorized underlying relationship, then they would indicate that treatments designed to improve individual mental health are worth investing in not only because of improvements in individual psychological well-being, but because of improvements in social cohesion outcomes, driven by improvements in distress and emotion regulation, relevant to the wider community.
This dissertation project makes both theoretical and empirical contributions related to how different manifestations of psychological distress that can emerge in the aftermath of trauma exposure affect social cohesion. It offers important contributions to the understanding of how mental health contributes to peace and stability in communities affected by conflict and forced migration, new avenues for academic and practical inquiry, and insights into broader implications and policy strategies regarding mental health and social cohesion.