The Psychobiological Toll of Chronic Conflict: Posttraumatic Stress Symptoms, Emotion Dysregulation, and Physiology in a Conflict-Exposed Community in South Sudan.

Background: Mass conflict and related displacement in South Sudan has created a significant mental health need, however extant research on the impact of conflict is limited among South Sudanese people and has predominantly relied on Western-developed self report measures. Method: A total of 195 South Sudanese adults who work in both civil society and government leadership positions participated in a psychophysiological assessment of heart rate variability (HRV) and self-reported PTSD and emotion dysregulation symptoms to participation in the Trauma-Informed Community Empowerment (TICE) Framework, developed and implemented by the Global Trauma Project (GTP). We utilized measures of heart rate variability to determine parasympathetic activity, which may be associated with difficulties responding to stressors as well as long-term physical health morbidity and mortality. Results: Findings suggest pervasive difficulties in emotion regulation abilities among all participants and, consistent with the existing literature on PTSD in South Sudan, over a third of participants meet the clinical cut-off for PTSD. The majority of participants' physiological profiles indicate unexpected levels of parasympathetic nervous system activity given age and gender norms, demonstrating a sample with serious health risk. HRV did not correspond to self-reported PTSD symptoms, but did correlate with emotion dysregulation variables. Conclusions: These results demonstrate the feasibility and utility of using a multimethod approach to assessment in a community-based environment and highlight the psychophysiological burden of chronic socio-political strife.