The Role of Extended Family Structure in Moderating the Impact of War Trauma in the Middle East: A Cultural Analysis

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

doi:10.55606/detector.v3i2.5033

Authors

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

DOI:

https://doi.org/10.55606/detector.v3i2.5033

Keywords:

Extended Family, Meta-Analysis, Middle East, PTSD, War Trauma

Abstract

This meta-analysis systematically and comprehensively examines the structural and functional roles of the extended family in moderating the psychological impact of war trauma in the Middle East by compiling data from 47 independent studies involving 12,483 participants published between 2000 and 2023. An analytical approach using a random-effects model revealed that the presence and involvement of the extended family demonstrated a statistically significant moderating effect on the reduction of PTSD symptoms, anxiety, and depression, with an association strength of r = .42 (p < .001). Further meta-regression results indicated that support from the extended family contributed to a 37.8% reduction in PTSD symptoms (β = -.378, SE = .042, p < .001), a 29.4% decrease in anxiety levels (β = -.294, SE = .038, p < .001), and a 31.2% reduction in depressive symptoms (β = -.312, SE = .040, p < .001). Analysis of moderator variables showed that the protective effect of the extended family structure was more pronounced among children (r = .48) compared to the adult population (r = .38) and more salient among females (r = .45) than males (r = .39), indicating demographic sensitivity to the type of collective support received. Moreover, the high heterogeneity across studies (I² = 76.3%) indicated significant contextual and methodological diversity, though it did not obscure the core findings. These results contradict the theoretical emphasis advanced by Nakeyar and Frewen (2016) and Atallah (2017), who prioritized the role of the nuclear family in post-war healing contexts. In contrast, this study found that the extended family configuration has provided a more comprehensive and multidimensional form of psychological protection rooted in the distinct collectivistic values of Middle Eastern societies. Ultimately, these findings expand the conceptual horizon for understanding resilience mechanisms to trauma within non-Western cultural landscapes and open new possibilities for developing extended family-based interventions in the context of post-conflict psychosocial reconstruction.

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References

Abuhadra, B. D., Doi, S., & Fujiwara, T. (2023). The prevalence of post-traumatic stress disorder, depression, and anxiety in Libya: A systematic review. Middle East Current Psychiatry, 30, 49.

Ahmad, I., & Smetana, J. (2021). Palestinian refugee youth in Jordan: Parental practices, neighborhood cohesion and assistance, and adolescent well-being. International Journal of Environmental Research and Public Health, 18(7), 3649.

Almeida, M., Al-Hamdani, R., & Knuppe, A. J. (2023). Understanding community resilience in Yemen: How parallel institutions meet essential needs in the absence of the state. British Journal of Middle Eastern Studies, 1–21.

Alshabani, N., Speight, S. L., Soto, S. I., Koskey, K. L., & Behrman, C. (2023). Socioecological perspectives of resilience among Arab and Middle Eastern migrants. The Counseling Psychologist, 51(8), 1096–1127.

Atallah, D. G. (2017). A community-based qualitative study of intergenerational resilience with Palestinian refugee families facing structural violence and historical trauma. Transcultural Psychiatry, 54(3), 357–383.

Atari-Khan, R., Alshabani, N., Rabgay, S. D., Elhedk, F. R., Clifford, A., Gomariz, S., & Sahib, W. (2024). Understanding intergenerational trauma among Arab, Middle Eastern, and North African (Arab/MENA) Americans. Qualitative Psychology.

Atari-Khan, R., Covington, A. H., Gerstein, L. H., Herz, H. A., Varner, B. R., Brasfield, C., ... & Deogracias-Schleich, A. (2021). Concepts of resilience among trauma-exposed Syrian refugees. The Counseling Psychologist, 49(2), 233–268.

Betancourt, T. S., Meyers-Ohki, S. E., Charrow, A. P., & Tol, W. A. (2013). Interventions for children affected by war: An ecological perspective on psychosocial support and mental health care. Harvard Review of Psychiatry, 21(2), 70–91.

Chapin, M. (2012). Family resilience and the fortunes of war. In Advances in Social Work Practice with the Military (pp. 148–163). Routledge.

Dalgaard, N. T., Diab, S. Y., Montgomery, E., Qouta, S. R., & Punamäki, R. L. (2019). Is silence about trauma harmful for children? Transgenerational communication in Palestinian families. Transcultural Psychiatry, 56(2), 398–427.

Dansie, R. (2006). Cultural perspective of healing trauma. In Responses to Traumatized Children (pp. 162–185). Palgrave Macmillan UK.

Denov, M., Fennig, M., Rabiau, M. A., & Shevell, M. C. (2020). Intergenerational resilience in families affected by war, displacement, and migration: "It runs in the family." In Social Work Practice with War-Affected Children (pp. 17–45). Routledge.

Elshahat, S., & Moffat, T. (2022). Mental health triggers and protective factors among Arabic-speaking immigrants and refugees in North America: A scoping review. Journal of Immigrant and Minority Health, 24(2), 489–505.

Emam, M., Abdelazim, Y., & El-Keshky, M. (2017). Grandparents in the Middle East and North Africa: Changes in identity and trajectory. In Grandparents in Cultural Context (pp. 223–244). Routledge.

Ennis, N., Shorer, S., Shoval‐Zuckerman, Y., Freedman, S., Monson, C. M., & Dekel, R. (2020). Treating post-traumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma‐focused cognitive behavioral therapies. Journal of Clinical Psychology, 76(4), 587–611.

Gearing, R. E., Schwalbe, C. S., MacKenzie, M. J., Brewer, K. B., Ibrahim, R. W., Olimat, H. S., ... & Al-Krenawi, A. (2013). Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation. International Journal of Social Psychiatry, 59(7), 671–681.

Grace, B. L. (2019). Family from afar? Transnationalism and refugee extended families after resettlement. Journal of Refugee Studies, 32(1), 125–143.

Haboush, K. L., & Alyan, H. (2013). "Who can you tell?" Features of Arab culture that influence conceptualization and treatment of childhood sexual abuse. Journal of Child Sexual Abuse, 22(5), 499–518.

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.

Jansen, K. (2017). Extended family relationships: How they impact the mental health of young adults. [Unpublished manuscript].

Jordan, D., Kiras, J. D., Lonsdale, D. J., Speller, I., Tuck, C., & Walton, C. D. (2016). Understanding modern warfare. Cambridge University Press.

Kheirallah, K. A., Al-Zureikat, S. H., Al-Mistarehi, A. H., Alsulaiman, J. W., AlQudah, M., Khassawneh, A. H., ... & Serlin, I. A. (2022). The association of conflict-related trauma with markers of mental health among Syrian refugee women: The role of social support and post-traumatic growth. International Journal of Women's Health, 1251–1266.

Kira, I. A., Amer, M. M., & Wrobel, N. H. (2023). Arab refugees: Trauma, resilience, and recovery. In Biopsychosocial Perspectives on Arab Americans: Culture, Development, and Health (pp. 159–184). Springer International Publishing.

Konner, M. (2007). Trauma, adaptation, and resilience: A cross-cultural and evolutionary perspective. In Understanding Trauma: Biological, Psychological and Cultural Perspectives (pp. 300–338).

Kpeno, A., Sahu, P. K., & Bagson, E. (2024). The role of family in trauma recovery: A review of the literature. Anatolian Mental Health, 1(1), 10–28.

Kraus, E. K. (2024). Beyond here and there? A description and typology of multi-transnational extended family configurations of refugees. Genus, 80(1), 23.

Landau, J. L. (2012). Family and community resilience relative to the experience of mass trauma: Connectedness to family and culture of origin as the core components of healing. In Handbook of Family Resilience (pp. 459–480). Springer.

Mak, C., & Wieling, E. (2022). A systematic review of evidence-based family interventions for trauma-affected refugees. International Journal of Environmental Research and Public Health, 19(15), 9361.

Massad, S., Stryker, R., Mansour, S., & Khammash, U. (2018). Rethinking resilience for children and youth in conflict zones: The case of Palestine. Research in Human Development, 15(3–4), 280–293.

Miller-Graff, L. E., & Cummings, E. M. (2022). Supporting youth and families in Gaza: A randomized controlled trial of a family-based intervention program. International Journal of Environmental Research and Public Health, 19(14), 8337.

Nakeyar, C., & Frewen, P. A. (2016). Evidence-based care for Iraqi, Kurdish, and Syrian asylum seekers and refugees of the Syrian civil war: A systematic review. Canadian Psychology/Psychologie Canadienne, 57(4), 233.

Nets‐Zehngut, R. (2012). Collective self‐healing process: The Israeli Palestinian case. Conflict Resolution Quarterly, 30(2), 243–267.

Nuttman-Shwartz, O. (2023). The long-term effects of living in a shared and continuous traumatic reality: The case of Israeli families on the border with Gaza. Trauma, Violence, & Abuse, 24(3), 1387–1404.

O'Neill, L., Fraser, T., Kitchenham, A., & McDonald, V. (2018). Hidden burdens: A review of intergenerational, historical and complex trauma, implications for Indigenous families. Journal of Child & Adolescent Trauma, 11, 173–186.

Popham, C. M., McEwen, F. S., Karam, E., Fayyad, J., Karam, G., Saab, D., ... & Pluess, M. (2022). The dynamic nature of refugee children's resilience: A cohort study of Syrian refugees in Lebanon. Epidemiology and Psychiatric Sciences, 31, e41.

Pophiwa, N. (2011). The extended family is a form of informal protection for people displaced by Operation Restore Order in Zimbabwe. In The Migration Displacement Nexus: Patterns, Processes, and Policies (pp. 156–167).

Punamäki, R. L. (2010). Post-traumatic growth in Middle Eastern context: and determinants among Palestinians. In Post-traumatic Growth and Culturally Competent Practice: Lessons Learned from Around the Globe (pp. 31–48).

Punamäki, R. L., Qouta, S. R., & Peltonen, K. (2017). Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents. European Journal of Psychotraumatology, 8(sup7), 1439649.

Raghavan, S., & Sandanapitchai, P. (2024). The relationship between cultural variables and resilience to psychological trauma: A systematic review of the literature. Traumatology, 30(1), 37.

Tanga, P. T. (2013). The impact of the declining extended family support system on the education of orphans in Lesotho. African Journal of AIDS Research, 12(3), 173–183.

Thabet, A. A. M. (2017). Risk and protective factors in relation to trauma and post-traumatic stress disorders: A meta-analytic review. EC Psychology and Psychiatry, 2(4), 122–138.

Thomas, F. C., Tol, W. A., Vallipuram, A., Sivayokan, S., Jordans, M. J., Reis, R., & de Jong, J. T. (2016). Emic perspectives on the impact of armed conflict on children's mental health and psychosocial well-being: Applying a social ecological framework of resilience in northern Sri Lanka. Peace and Conflict: Journal of Peace Psychology, 22(3), 246.

Walsh, F. (2016). Family resilience: A developmental systems framework. European Journal of Developmental Psychology, 13(3), 313–324.

Wang, Y., Qiu, Y., Ren, L., Jiang, H., Chen, M., & Dong, C. (2024). Social support, family resilience and psychological resilience among maintenance hemodialysis patients: A longitudinal study. BMC Psychiatry, 24(1), 76.

Weine, S. M., Ware, N., Hakizimana, L., Tugenberg, T., Currie, M., Dahnweih, G., & Wulu, J. (2014). Fostering resilience: Protective agents, resources, and mechanisms for adolescent refugees' psychosocial well-being. Adolescent Psychiatry, 4(3), 164–176.

Wieling, E. (2018). Family interventions for populations exposed to traumatic stress related to war and violence. Journal of Marital and Family Therapy, 44(2), 189–192.

World Bank. (2022). Mental health in the West Bank and Gaza. https://documents1.worldbank.org/curated/en/099153502102330181/pdf/P17925303fca130e30936d016a378b6a1e9.pdf

Zabian, S. (2024). Building global communal resilience: Coping in the Lebanese context. [Manuscript in preparation].