Perbandingan Dampak Psikologis Konflik Bersenjata Populasi Urban  vs Rural di Yaman : Suatu Systematic Review

Luthfiah Mawar; M. Agung Rahmadi; Helsa Nasution; Nurzahara Sihombing

doi:10.55606/innovation.v3i2.3622

Authors

Luthfiah Mawar Universitas Sumatera Utara
M. Agung Rahmadi Universitas Islam Negeri Syarif Hidayatullah Jakarta
Helsa Nasution Universitas Negeri Padang
Nurzahara Sihombing SD Negeri 107396 Paluh Merbau

DOI:

https://doi.org/10.55606/innovation.v3i2.3622

Keywords:

Armed Conflict, Depression, Psychological Impact, PTSD, Urban-Rural

Abstract

This study analyzes the psychological impact of the armed conflict in Yemen by comparing urban and rural populations through a systematic review and meta-analysis of 47 published studies (N=28,463) from 2015 to 2024. The analysis reveals a significantly higher prevalence of PTSD in the urban population (42.8%, 95% CI [39.2-46.4]) compared to the rural population (31.5%, 95% CI [28.1-34.9], p<.001). In addition, multilevel regression analysis indicates a strong correlation between the level of exposure to conflict and the severity of depressive symptoms (r=.68, p<.001) and anxiety (r=.72, p<.001) in both populations. Additionally, when examining specific urban risk factors, calculations indicate that population density (OR=1.86, 95% CI [1.54-2.18]) and loss of infrastructure (OR=1.73, 95% CI [1.45-2.01]) are significant. Moreover, geographic isolation (OR=1.92, 95% CI [1.67-2.17]) and limited access to mental health services (OR=2.14, 95% CI [1.89-2.39]) also demonstrate prominent risk factors, thereby emphasizing the predominance of specific urban risk factors in rural areas. These findings contrast with the research conducted by Le & Nguyen (2023) and Carpiniello (2023), which focused solely on general impacts; thus, the novelty of this research lies in its success in identifying distinct patterns of psychological trauma based on geographic characteristics. In addition, this study successfully reveals the differing mediating mechanisms of social support between urban (β=-.42, p<.001) and rural (β=-.28, p<.01) populations in mitigating the impacts of the Yemeni war trauma.

Downloads

Download data is not yet available.

References

Akresh, R., Caruso, G. D., & Thirumurthy, H. (2022). Detailed geographic information, conflict exposure, and health impacts. World Development, 155, 105890.

Alhariri, W., McNally, A., & Knuckey, S. (2021). The right to mental health in Yemen: a distressed and ignored foundation for peace. Health and Human Rights, 23(1), 43.

Al-Taiar, A., Clark, A., Longenecker, J. C., & Whitty, C. J. (2010). Physical accessibility and utilization of health services in Yemen. International Journal of Health Geographics, 9, 1–8.

Amsalem, D., Haim-Nachum, S., Lazarov, A., Levi-Belz, Y., Markowitz, J. C., Bergman, M., ... & Neria, Y. (2025). The effects of war-related experiences on mental health symptoms of individuals living in conflict zones: a longitudinal study. Scientific Reports, 15(1), 889.

Ba-Break, M., Donnelly, S., Saleh, M., Kaity, A. M., Alwaqedi, A., Badheeb, A. M., ... & Annuzaili, D. A. (2024). COVID-19 surveillance in fragile health systems, armed conflict and humanitarian crisis, the case of Yemen. International Journal of Healthcare Management, 1–13.

Bronfenbrenner, U., & Morris, P. A. (1998). The ecology of developmental processes. In W. Damon & R. M. Lerner (Eds.), Handbook of child psychology: Theoretical models of human development (5th ed., Vol. 1, pp. 993-1028). John Wiley & Sons.

Bürgin, D., Anagnostopoulos, D., Vitiello, B., Sukale, T., Schmid, M., & Fegert, J. M. (2022). Impact of war and forced displacement on children's mental health—multilevel, needs-oriented, and trauma-informed approaches. European Child & Adolescent Psychiatry, 31(6), 845-853.

Carpiniello, B. (2023). The mental health costs of armed conflicts—a review of systematic reviews conducted on refugees, asylum-seekers and people living in war zones. International Journal of Environmental Research and Public Health, 20(4), 2840.

David, A. S., Farrin, L., Hull, L., Unwin, C., Wessely, S., & Wykes, T. (2002). Cognitive functioning and disturbances of mood in UK veterans of the Persian Gulf War: a comparative study. Psychological Medicine, 32(8), 1357–1370.

Edeh, A. N., Uwakwe, R., Obindo, T. J., Agbir, M. T., & Akanni, O. O. (2023). A comparative study of posttraumatic stress disorder in two post-conflict communities in Benue state Nigeria. Dialogues in Health, 2, 100105.

Elayah, M., Al-Sameai, N., Khodr, H., & Gamar, S. (2024). Community-based initiatives and public services delivery in a fragile context: The case of Yemen. Nonprofit and Voluntary Sector Quarterly, 53(1), 5-28.

Elnakib, S., Elaraby, S., Othman, F., BaSaleem, H., AlShawafi, N. A. A., Al-Gawfi, I. A. S., ... & Tappis, H. (2021). Providing care under extreme adversity: the impact of the Yemen conflict on the personal and professional lives of health workers. Social Science & Medicine, 272, 113751.

Ennis, N., Sijercic, I., & Monson, C. M. (2021). Trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder under ongoing threat: A systematic review. Clinical Psychology Review, 88, 102049.

Eytan, A., Munyandamutsa, N., Mahoro Nkubamugisha, P., & Gex-Fabry, M. (2015). Long-term mental health outcome in post-conflict settings: Similarities and differences between Kosovo and Rwanda. International Journal of Social Psychiatry, 61(4), 363-372.

Findley, P. A., Halpern, J., Rodriguez, R., & Vermeulen, K. (2016). Psychological first aid: A tool for mitigating conflict in the Middle East. In A. Okasha, L. Mezzich, & I. Galal (Eds.), Mental health and addiction care in the Middle East (pp. 155-170). Springer.

Garber, K., Fox, C., Abdalla, M., Tatem, A., Qirbi, N., Lloyd-Braff, L., ... & Hassen, K. (2020). Estimating access to health care in Yemen, a complex humanitarian emergency setting: a descriptive applied geospatial analysis. The Lancet Global Health, 8(11), e1435-e1443.

Garry, S., & Checchi, F. (2020). Armed conflict and public health: into the 21st century. Journal of Public Health, 42(3), e287-e298.

Gizelis, T. I., Pickering, S., & Urdal, H. (2021). Conflict on the urban fringe: Urbanization, environmental stress, and urban unrest in Africa. Political Geography, 86, 102357.

Gros, A., Gard-Murray, A. S., & Bar-Yam, Y. (2015). Conflict in Yemen: From ethnic fighting to food riots. In P. Fellman, Y. Bar-Yam, & A. Minai (Eds.), Conflict and Complexity: Countering terrorism, insurgency, ethnic and regional violence (pp. 269–280). Springer.

Guest, P. C., Vasilevska, V., Al-Hamadi, A., Eder, J., Falkai, P., & Steiner, J. (2023). Digital technology and mental health during the COVID-19 pandemic: a narrative review with a focus on depression, anxiety, stress, and trauma. Frontiers in Psychiatry, 14, 1227426.

Hamadeh, A., El-Shamy, F., Billings, J., & Alyafei, A. (2024). The experiences of people from Arab countries in coping with trauma resulting from war and conflict in the Middle East: a systematic review and meta-synthesis of qualitative studies. Trauma, Violence, & Abuse, 25(2), 1278–1295.

Hamza, M. K., & Hicks, M. H. R. (2021). Implementation of mental health services in conflict and post-conflict zones: Lessons from Syria. Avicenna Journal of Medicine, 11(01), 8-14.

Hobfoll, S. E., & Shirom, A. (2000). Conservation of resources theory: Applications to stress and management in the workplace. In R. T. Golembiewski (Ed.), Handbook of organization behavior (2nd ed., pp. 57–81). Marcel Dekker.

Hoffman, S. J., Vukovich, M. M., Fulkerson, J., Gewirtz, A., Robertson, C. L., Fredkove, W. M., & Gaugler, J. (2023). The impact of parent torture and family functioning on youth adjustment in war-affected families: a path analysis describing intergenerational trauma and the family system. Journal of Family Nursing, 29(3), 288-300.

Huynh, B. Q., & Basu, S. (2020). Forecasting internally displaced population migration patterns in Syria and Yemen. Disaster Medicine and Public Health Preparedness, 14(3), 302-307.

Issa, S., & Al Daia, R. (2015). Resilience at an individual level: geographic variation in degrees of empowerment. In I. Jomaa & C. Nagel (Eds.), Conflict and environment in North Lebanon: vulnerability and resilience from a multi-disciplinary perspective (pp. 193-217). University of Twente.

Kadir, A., Shenoda, S., & Goldhagen, J. (2019). Effects of armed conflict on child health and development: a systematic review. PLoS One, 14(1), e0210071.

Kamali, M., Munyuzangabo, M., Siddiqui, F. J., Gaffey, M. F., Meteke, S., Als, D., ... & Bhutta, Z. A. (2020). Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review. BMJ Global Health, 5(3), e002014.

Karadzhov, D. (2015). Assessing resilience in war-affected children and adolescents: A critical review. Journal of European Psychology Students, 6(3), 1-13.

Le, K., & Nguyen, M. (2023). The impacts of armed conflict on child health: Evidence from 56 developing countries. Journal of Peace Research, 60(2), 243-257.

Lim, A. G., Stock, L., Shwe Oo, E. K., & Jutte, D. P. (2013). Trauma and mental health of medics in eastern Myanmar's conflict zones: a cross-sectional and mixed methods investigation. Conflict and Health, 7, 1–13.

Lim, I. C. Z., Tam, W. W., Chudzicka-Czupała, A., McIntyre, R. S., Teopiz, K. M., Ho, R. C., & Ho, C. S. (2022). Prevalence of depression, anxiety and post-traumatic stress in war-and conflict-afflicted areas: A meta-analysis. Frontiers in Psychiatry, 13, 978703.

Mawar, L., Rahmadi, M. A., Nasution, H., Dewi, I. S., Nasution, R., & Sari, M. (2024). Efek Stres terhadap Pengobatan Asthma. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 86-112.

Mawar, L., Rahmadi, M. A., Nasution, H., Sihombing, N., Nasution, R., & Sari, M. (2024). Peran kecerdasan emosional dalam pengobatan cystic fibrosis. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 60-90.

McCall-Hosenfeld, J. S., Mukherjee, S., & Lehman, E. B. (2014). The prevalence and correlates of lifetime psychiatric disorders and trauma exposures in urban and rural settings: results from the national comorbidity survey replication (NCS-R). PLoS One, 9(11), e112416.

McDonald, L. (2010). Psychosocial rehabilitation of civilians in conflict-affected settings. In E. Martz (Ed.), Trauma rehabilitation after war and conflict: Community and individual perspectives (pp. 215–245). Springer.

Mesa-Vieira, C., Haas, A. D., Buitrago-Garcia, D., Roa-Diaz, Z. M., Minder, B., Gamba, M., ... & Franco, O. H. (2022). Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis. The Lancet Public Health, 7(5), e469-e481.

Moelker, R., Andres, M., & Poot, G. J. A. (2006). Supporting Military Families–A Comparative study in social support arrangements for military families (theoretical dimensions & empirical comparison between countries). Human Dimensions in Military Operations–Military Leaders' Strategies for Addressing Stress and Psychological Support, 18-1.

Munthe, J., Usmawadi, U., & Idris, A. (2023). Perlindungan terhadap Hak-Hak Warga Sipil dalam Konflik Bersenjata: Studi Kasus Perang Saudara di Yaman [Undergraduate Thesis]. Universitas Sriwijaya.

Nasser, R., & Brown, J. (2021). [Note: This entry appears incomplete in the original document]

Nasution, H., Rahmadi, M. A., Mawar, L., Dewi, I. S., Nasution, R., & Sari, M. (2024). Peran Kepuasan Hidup dalam Pengelolaan Penyakit Systemic Sclerosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 195-224.

Nasution, H., Rahmadi, M. A., Mawar, L., Sihombing, N., Nasution, R., & Sari, M. (2024). Hubungan dukungan sosial dalam pengobatan sklerosis multipel. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 121-151.

Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Sari, M. (2024). Hubungan antara Perasaan Bersalah dan Keberhasilan Pengobatan Lupus. An-Najat, 2(4), 179-206.

Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Sari, M. (2024). Pengaruh Intervensi Emosi Positif pada Pengobatan Fibromyalgia. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 277-302.

Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Sihombing, N., & Sari, M. (2025). Efek Kepuasan Hidup pada Pengobatan Amyotrophic Lateral Sclerosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 3(1), 67-100.

Nawsherwan, Mubarik, S., Naeem, S., Mubarak, R., Yu, C., Yan, W., & Sang, M. (2025). Health dynamics in war-torn Yemen: insights from 32 years of epidemiological data (1990–2021). Population Health Metrics, 23(1), 4.

Okasha, A., Karam, E., & Okasha, T. (2012). Mental health services in the Arab world. World Psychiatry, 11(1), 52-54.

Pandya, S. (2018). "The War Took Us Backwards": Yemeni Families and Dialectical Patriarchal Reordering. Hawwa, 16(1-3), 266-308.

Purgato, M., Gross, A. L., Betancourt, T., Bolton, P., Bonetto, C., Gastaldon, C., ... & Barbui, C. (2018). Focused psychosocial interventions for children in low-resource humanitarian settings: a systematic review and individual participant data meta-analysis. The Lancet Global Health, 6(4), e390-e400.

Qazi, R. (2024). Survivor-Centered and Trauma-Informed Approaches to Policies and Tools in the International Development Sector [Doctoral dissertation, Université d'Ottawa/University of Ottawa].

Qirbi, N., & Ismail, S. A. (2017). Health system functionality in a low-income country in the midst of conflict: the case of Yemen. Health Policy and Planning, 32(6), 911-922.

Rabbani, F., Zahidie, A., Siddiqui, A., Shah, S., Merali, Z., Saeed, K., & Afifi, M. (2024). A systematic review of mental health of women in fragile and humanitarian settings of the Eastern Mediterranean Region. East Mediterranean Health Journal, 30(5), 369.

Rahmadi, M. A., & Nasution, H. (2022). Adjusment of Students in Islamic Boarding Schools. Budapest International Research and Critics Institute-Journal (BIRCI-Journal), 5(2), 8141-8151.

Rahmadi, M. A., Al Munawar, S. A. H., Syahid, A., Shaleh, A. R., & Nasution, H. (2024). The Dynamics of Personal Adjustment in Quranic Memorization Students: A Mixed-Methods Analysis of Self-Acceptance, Objective Self-Action, and Self-Confidence in Islamic Boarding Schools. International Journal of Medicine and Health, 3(4), 24-53.

Rahmadi, M. A., Nasution, H., Mawa, L., Nasution, R., & Sari, M. (2024). Peran Harapan dalam Kepatuhan Pengobatan Kanker Kolorektal. OBAT: Jurnal Riset Ilmu Farmasi dan Kesehatan, 2(6), 38-64.

Rahmadi, M. A., Nasution, H., Mawar, L., & Sari, M. (2024). Pengaruh Kecemasan Terhadap Kepatuhan Pengobatan Kanker Payudara. Jurnal Medika Nusantara, 2(3), 325-350.

Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., Nasution, R., & Sari, M. (2024). Hubungan Motivasi terhadap Keberhasilan Pengobatan Endometriosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 225-253.

Rahmadi, M. A., Nasution, H., Mawar, L., Sihombing, N., Nasution, R., & Sari, M. (2025). Pengaruh Stigma Sosial pada Manajemen Pengobatan Kanker Kolorektal. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 3(1), 01-35.

Rahmadi, M. A., Syahid, A., Al Munawar, S. A. H., Shaleh, A. R., Nasution, H., & Mawar, L. (2024). The Construct of Emotional Support in Quranic Memorization Students: A Study on the Dynamic Influence of Reliable Relationships, Trusted Guidance, Psychological Well-being, and Quranic Memorization Achievement. International Journal of Health and Medicine, 1(4), 190-219.

Rahman, A., & Smith, J. (2021). Psychological first aid in conflict settings. Disaster Medicine and Public Health Preparedness, 15(4), 489–502.

Ramadan, M. (2021). Economic and Educational disparities in access, quality and coverage of primary healthcare services in conflict-affected fragile states: a subnational analysis of geographic proximity to organized violence and magnitude of disparities in Cameroon, Democratic Republic of Congo, Mali and Nigeria [Doctoral dissertation, Johns Hopkins University].

Roberts, B., & Fuhr, D. C. (2019). Scaling up mental health interventions in conflict zones. The Lancet Public Health, 4(10), e489-e490.

Roffman, E. (2016). Learning from the past to build for the future: Reflections on psychosocial support programs in war-torn countries. Journal of Pedagogy, Pluralism, and Practice, 8(1), 154.

Rosvold, E. L. (2023). Disaster resilience in conflict-affected areas: a review of how armed conflicts impact disaster resilience. Current Opinion in Environmental Sustainability, 65, 101381.

Saleh, M. A. B. Q., & Makki, A. M. (2008). Mental health in Yemen: Obstacles and challenges. International Psychiatry, 5(4), 90-92.

Sari, M., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Nasution, R. (2024). Hubungan antara Kepuasan Hidup dan Pengobatan Emfisema. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 113-144.

Sari, M., Rahmadi, M. A., Nasution, H., Mawar, L., Sihombing, N., & Nasution, R. (2024). Efek Kepuasan Hidup pada Pengobatan Sarcoidosis. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 91-120.

Seidi, P., & Jaff, D. (2019). Mental health in conflict settings. The Lancet, 394(10216), 2237–2238.

Shamia, N. A., Thabet, A. A. M., & Vostanis, P. (2015). Exposure to war traumatic experiences, post‐traumatic stress disorder and post‐traumatic growth among nurses in Gaza. Journal of Psychiatric and Mental Health Nursing, 22(10), 749–755.

Sihombing, N., Rahmadi, M. A., Nasution, H., & Mawar, L. (2025). Transmisi Intergenerasi Trauma Perang di Keluarga Palestina: Analisis Sistematis pada Tiga Generasi (1948-2024). Jurnal Ventilator, 3(1), 65-84.

Sihombing, N., Rahmadi, M. A., Nasution, H., Mawar, L., Nasution, R., & Sari, M. (2025). Peran Emosi Positif dalam Pengobatan Retinitis Pigmentosa. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 3(1), 36-66.

Solmi, F., & Dykxhoorn, J. (2017). Urban-rural differences in major mental health conditions. Springer.

Stark, L., Robinson, M. V., Seff, I., Hassan, W., & Allaf, C. (2020). SALaMA study protocol: a mixed methods study to explore mental health and psychosocial support for conflict-affected youth in Detroit, Michigan. BMC Public Health, 20, 1-8.

Truppa, C., Yaacoub, S., Valente, M., Celentano, G., Ragazzoni, L., & Saulnier, D. (2024). Health systems resilience in fragile and conflict-affected settings: a systematic scoping review. Conflict and Health, 18(1), 2.

Werneck, A. O., & Silva, D. R. (2020). Population density, depressive symptoms, and suicidal thoughts. Brazilian Journal of Psychiatry, 42, 105-106.

Xu, J., Wang, J., King, M., Liu, R., Yu, F., Xing, J., ... & Lu, M. (2018). Rural–urban disparities in the utilization of mental health inpatient services in China: the role of health insurance. International Journal of Health Economics and Management, 18, 377-393.

Youssef, I. A., & Wangle, K. (2022). Decades of wars in Iraq and Yemen and the protracted displacement crisis: The impact on women and children. Global Campus Human Rights Journal, 159.

Zeid, A., & Smith, J. (2022). Psychosocial interventions in conflict settings. Intervention, 20(3), 234-247.