Hi Fiona. Please can you introduce yourself…

I’m Dr Fiona McEwen, and I’m the Survey and Interventions Director for the XCEPT project at King’s College London. I’m responsible for managing a large longitudinal survey and a range of associated data collection, as well as interventions, that we’re doing in Iraq, South Sudan, and Syria/Lebanon.

You’re leading our Impact of Trauma Survey. What is this, and why is it important?

We know that many people living in conflict-affected zones experience potentially traumatic events and that this can have a significant impact on their mental health. But conflict also has many other effects, such as damaging trust in institutions and decreasing social cohesion. The aim of the research we’re doing at King’s is to understand whether trauma-related mental health problems may have the potential to increase people’s propensity to seek violent, or peaceful, solutions, and how that might interact with a range of other factors. The Impact of Trauma Survey (IoTS) is a huge part of this research. It will collect data on multiple different outcome measures, such as attitudes to reconciliation or the use of political violence, and many different risk and protective factors across time to try and understand how these factors work together.

One thing which is particularly exciting about the IoTS is that it’s longitudinal. There have been lots of studies conducted in difficult contexts like this, but these are often cross-sectional, which means data is collected at a single point in time. The IoTS allows us to explore how changes in a particular factor at one point in time might influence attitudes at a later point. It’s also looking at a much wider range of factors than many studies do. We know that factors at the individual level, like people’s dispositions and personality traits, can have an impact on violent or peaceful outcomes, but conflict exposure, mental health problems, and social factors all play a role too. The IoTS will increase our understanding of the interplay between all these factors and how they feed into cycles of violence.

You talk about measuring trauma, but what do you mean by ‘trauma’?

In this context, the core aspect is that many people will have been exposed to war events, so they may have witnessed a bombing, or seen people killed, or they may have lost family members. There may be multiple other traumas in a person’s life, however, so we’ll also be looking at things like Adverse Childhood Experiences, such as abuse, neglect, and exposure to domestic violence.

We’re working on the assumption that there’s often a cumulative impact of these traumas. So, for example, someone who has had exposure to a major traumatic event during war, but otherwise benefits from protective factors like a supportive family, may not be affected by that single trauma as much as someone who also suffered maltreatment as a child. Where individuals have experienced a series of traumatic events throughout their lives, this can have an additive impact over time, and this is what we’re trying to account for, rather than assuming that, in a war-exposed population, trauma is related only to conflict.

Tell us about your background…

I originally studied biological sciences – neuroscience and veterinary medicine – but then went on to study and do research in developmental psychology and psychiatry. Most recently, I worked as the study coordinator for a programme of research centred on Syrian refugee families in Lebanon. The study was looking at mental health and resilience in these children, who were living in really challenging conditions in informal tented settlements. There were quite a few similarities between that work and the research we’re doing now on XCEPT: we used a longitudinal design to study changes in children’s mental health and behaviour over time, and delivered an intervention aimed at reducing mental health problems in children exposed to conflict and displacement. One thing we found that was really important was being alert to the fact that measures developed in one setting will not necessarily be valid in other settings.

Accounting for different contexts and cultures when carrying out data collection like this is crucial. My colleague, Dr Nafees Hamid, and I were recently in Erbil, Iraq, training the field work team who are going to be collecting the IoTS data in the country, and it was a really useful process as it allowed us to understand how our survey questions might be interpreted differently in different contexts. There can be issues with the way things have been translated or with the concepts we’re exploring. Even within one country, it’s apparent there will be different interpretations according to dialect, for example. Differing experiences across the country may also mean a question could be interpreted in a certain way, or that it may be more sensitive to the interviewees. It’s vital that we understand those differences to make sure our measures are as good as they can be. When we’re interpreting the data, we really need that local input as well to help us understand how people might have been thinking about those issues.

Why did you choose to work on XCEPT?

There are so many really exciting things about the work the King’s team is doing for the XCEPT project. It’s rare that there are research programmes doing something so large-scale, and across multiple different countries, which allows you to make comparisons across countries. I was also really keen to join a multidisciplinary research project. To date, I’ve usually been working with psychologists, psychiatrists, and biologists, so it’s been great to have an opportunity to work with people from other disciplines, including sociologists and historians. It’s exposed me to a much wider range of research and ideas than I would have been otherwise. For the team, having all these different experts and perspectives also allows us to do much more powerful research.

Another thing that really drew me to the project was the opportunity to use nested interventions – for example, psychosocial interventions that some people receive between waves of survey data collection. The advantage of this is that, once we’ve hypothesised the mechanisms by which we think something might be happening, it allows us to then manipulate that and measure the response. For example, you can try and reduce someone’s trauma-related mental health symptoms, and then measure to see if that has an impact on other outcomes you think it might be related to, like the propensity to violence. It’s rare that you have studies where you’re combining large-scale observational data with intervention data as well, and it’s great to be a part of this.

What do you hope that XCEPT will achieve?

One of the core driving questions we’re trying to explore is whether trauma-related mental health problems will have a subsequent impact on people’s behaviour or their attitudes to reconciliation. There’s an assumption that untreated trauma could act as a block on achieving stability post-conflict, but we don’t yet know if that’s true. Because our research allows us to control for lots of factors, I hope we’ll be able to get more conclusive data on whether untreated trauma itself causes a problem, or whether other factors have a bigger influence on people’s attitudes towards reconciliation.

Our work should allow us to understand more about these questions, and I hope this will result in useful policy and intervention implications. This is a very large, complicated project, and it takes a long time to prepare and build, so I’m really looking forward to seeing the data coming in, and then we can get to work running analyses across the team.