The mental health of populations directly and indirectly exposed to violent conflict in Indonesia

The objective was to examine the hypothesis of a ripple effect on the mental health consequences in populations exposed to man-made disasters in a developing country context, through a comparison of two different populations living in different proximities from the center of disaster in Mollucas.Cross-sectional longitudinal data were collected from 510 Internally Displaced Persons (IDPs) living in Ambon, who were directly exposed to the violence, and non-IDPs living in remote villages in Mollucas, Indonesia, who had never been directly exposed to violence in Mollucas. Data were collected during home visits and statistical comparisons were conducted by using chi square tests, t-test and logistic regression.There was significantly more psychological distress "caseness" in IDPs than non-IDPs. The mental health consequences of the violent conflict in Ambon supported the ripple effect hypothesis as displacement status appears to be a strong risk factor for distress, both as a main effect and interaction effect. Significantly higher percentages of IDPs experienced traumatic events than non-IDPs in all six event types reported.This study indicates that the conflict had an impact on mental health and economic conditions far beyond the area where the actual violent events took place, in a diminishing pattern in line with the hypothesis of a ripple effect.A number of factors have been identified as having an impact on the mental health of populations affected by disasters [1-3]. The geographical distance from the centre of the disaster is one of the factors that is likely to influence such an impact. This has been described as the ripple effect of a disaster, and posits that mental health problems spread outward from the center of disaster in a diminishing ripple pattern [4-6]. Disaster spatial zones describe the area at the center of disaster as "area totally destroyed", the immediate area around the disaster center as "partially destroyed area", and the area adjacent to the