title: The mental health of populations directly and indirectly exposed to violent conflict in Indonesia.
abstract: BACKGROUND
  Large disasters affect people who live both near and far from the areas in which they occur. The mental health impact is expected to be similar to a ripple effect, where the risk of mental health consequences generally decreases with increasing distance from the disaster center. However, we have not been able to identify studies of the ripple effect of man-made disaster on mental health in low-income countries.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Mental Health and Addiction, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. sherly.saragih@gmail.com.
authors.forename: Sherly S
authors.initials: SS
authors.lastname: Turnip
authors.forename: Ole
authors.initials: O
authors.lastname: Klungsøyr
authors.forename: Edvard
authors.initials: E
authors.lastname: Hauff