title: Civil conflict in Northern Ireland and the prevalence of psychiatric disturbance across the United Kingdom: a population study using the British household panel survey and the Northern Ireland household panel survey.
abstract: BACKGROUND
  To date, no large-scale cross-comparative study of psychiatric morbidity in the United Kingdom has been carried out until recently when the Northern Ireland Household Panel Survey (NIHPS) included the General Health Questionnaire (GHQ-12) in 2001. The GHQ-12 has been included in the British Household Panel Survey (BHPS) since 1991 for England and since 1999 for both Scotland and Wales. The purpose of this article is to compare rates of psychiatric morbidity across the United Kingdom, given that one region in particular, Northern Ireland, has experienced political conflict and civil strife for more than 35 years.
  
  
  OBJECTIVE
  To assess the impact of low-intensity warfare on rates of psychiatric morbidity in Northern Ireland and to compare these with psychiatric morbidity rates across England, Scotland and Wales.
  
  
  METHODS
  The sample consisted of 17,343 respondents completing the GHQ-12 across the United Kingdom. In England, 8286 respondents completed the GHQ-12 while 2729, 3165 and 3163 respondents from Wales, Scotland and Northern Ireland completed the GHQ-12 respectively. Results were then weighted according to population size.
  
  
  RESULTS
  Rates of psychiatric morbidity varied across each UK region. Wales had the highest mean GHQ-12 score (11.54), followed by Northern Ireland (11.41). English respondents had the lowest mean score (11.02). The difference in mean scores across the four regions in the UK was statistically significant (F= 5.04, df = 3, p < 0.001). Post-hoc analyses indicated that the mean scores for England differed significantly from those for Wales and Northern Ireland but not for Scotland. Region accounted for less than 1% of the variation in GHQ-12 scores.
  
  
  CONCLUSIONS
  Psychiatric morbidity rates for adults in Northern Ireland are comparable to other parts of the United Kingdom and we propose that individuals in Northern Ireland use a range of coping strategies to moderate the impact of the conflict in everyday life. These include habituation to the violence, denial and social cohesion, evidenced in the tightly knit Unionist and Nationalist communities. Particular concern was noted over GHQ-12 scores for Wales and while social and economic factors are acknowledged in our commentary, we conclude that further research appears to be crucial in understanding and preventing poorer rates of mental health in this region.
authors.affiliation: Critical Psychology Research Group, School of Psychology, University of East London, UK. h.murphy@uel.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Murphy
authors.forename: Katrina
authors.initials: K
authors.lastname: Lloyd
mesh_terms: D000223:Adaptation, Psychological; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000503:physiopathology; D009017:Morbidity; D009660:Northern Ireland / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D014857:Warfare