Understanding the Mental Health Impact of Internally Displaced Persons (IDPs) and Their Support Networks in Southeastern Myanmar Post-Military Coup: A Qualitative Study

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The internally displaced persons (IDPs) experience higher levels of psychological distress due to ongoing fears of military attacks, forced evictions, and financial hardships. As they cope with the unpredictability of their circumstances, many IDPs report experiencing persistent trauma symptoms, including nightmares, hypervigilance, and social withdrawal. This study aims to investigate the local conditions on the ground regarding the impact of displacement on the mental health of internally displaced people (IDPs) as well as the people and organizations who assist them in post-coup Myanmar. This qualitative study used a mix of purposive and snowball sampling approaches, conducting in-depth online and in-person interviews with 13 IDPs and 10 individuals from the IDP support network. Thematic analysis revealed that IDPs along with their support network described increased anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children's mental health and early warning systems for airstrikes emerged as practical coping strategies. Despite limitations in generalizability and translation bias, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Internally Displaced Persons Myanmar mental health displacement trauma conflict emotional distress Figures Figure 1 1. Introduction Following the February 1, 2021, military coup that resulted in extensive fighting, human rights violations, and mass displacement, Myanmar has been dealing with a serious humanitarian crisis. Armed conflicts and military offensives have resulted in the internal displacement of almost 3.2 million people as of 2024. ( 1 ). Numerous internally displaced people (IDPs) have had to repeatedly escape their homes, taking refuge in temporary camps, in the jungle, and in communities impacted by war, where they have little access to basic commodities, food, and medical treatment ( 2 ). Due to the military junta's severe travel restrictions and frequent assistance blockages, humanitarian groups have major obstacles while attempting to provide relief ( 3 ). The protracted nature of the situation has placed IDPs in a condition of extended uncertainty, with serious consequences for their physical and emotional well-being, despite efforts by international players to provide mental health services. Displacement has been linked globally to an increased risk of mental health conditions, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Studies on IDPs from Syria, South Sudan, and Colombia indicate that prolonged displacement, exposure to violence, and lack of access to healthcare significantly contribute to psychological distress ( 4 , 5 ). IDPs frequently experience grief due to the loss of family members, social networks, and a sense of belonging, which exacerbates feelings of isolation and hopelessness ( 6 ). Furthermore, humanitarian interventions often ignore the long-term consequences of displacement in favour of addressing urgent physical needs like food and shelter ( 7 ). IDPs are further restricted from obtaining essential psychological assistance by the stigma surrounding mental illness and the lack of culturally appropriate mental health services ( 8 ). Ethnic minorities in Myanmar who endured decades of conflict reported mental health impact due to displacement ( 9 ). The internally displaced persons (IDPs) experience higher levels of psychological distress due to ongoing fears of military attacks, forced evictions, and financial hardships ( 10 ). As they cope with the unpredictability of their circumstances, many IDPs report experiencing persistent trauma symptoms, including nightmares, hypervigilance, and social withdrawal ( 11 ). Furthermore, support networks, including community-based organisations, religious groups, and local NGOs, play a key role in providing informal psychological assistance. However, their activities are typically hindered by limited resources and security concerns ( 12 ). Existing literature predominantly focuses on broad mental health trends and provides international-based mental health services without an in-depth exploration of local the experiences of both IDPs and their support networks in navigating the crisis. This study aims to fill this gap by investigating the local conditions on the ground regarding the impact of displacement on the mental health of internally displaced people (IDPs) as well as the people and organizations who assist them in post-coup Myanmar. Unlike previous research that primarily examines IDPs in isolation, this study takes a holistic approach by investigating the psychological toll on IDPs, civil society organizations, humanitarian program designers and policymakers who are directly involved in assisting displaced populations. By using qualitative research methods, this study seeks to capture the lived experiences, coping mechanisms, and mental health challenges faced by both groups. Understanding these dynamics is essential for designing more effective, sustainable mental health interventions that address the needs of both IDPs and their support networks. The findings will provide valuable insights for policymakers, humanitarian organizations, and mental health professionals working to improve psychological resilience and well-being in conflict-affected communities in Myanmar. 2. Methodology 2.1. Study Design and Participants This qualitative study employed in-depth online and in-person interviews with internally displaced persons (IDPs) and their support networks in Mon, Kayin, Kayah, and Eastern Bago between December 2024 and March 2025. Key stakeholders were selected using a purposive sampling approach, while snowball sampling facilitated recruitment due to access challenges. Civil Society Organizations (CSOs) assisted in referrals to ensure diverse representation. Participants were briefed on the study’s objectives, procedures, and their right to withdraw at any time. Eligibility criteria included being at least 18 years old and residing in an IDP camp or working with IDPs. Only those who provided voluntary consent were interviewed. Each session, conducted in Burmese and Kayin, lasted 20–35 minutes and was audio-recorded with detailed field notes. Interviews continued until data saturation was achieved. 2.2. Data Collection and Analysis A stakeholder analysis was conducted to identify relevant participants. Recruitment involved targeted outreach with study details and informed consent procedures. Online interviews were led by the research team, while local CSOs facilitated in-person sessions by nominating trained interviewers. Standardized training was provided to ensure consistency in conducting interviews. All interviews were conducted in the Burmese and Kayin language and this study was focused on question number 4 of the qualitative interview. 2.3. Data Analysis Thematic analysis followed Braun and Clarke’s framework [14], with researchers familiarizing themselves with the data through repeated listening and note review before transcription. Transcripts were translated into English, cross-checked for accuracy, and systematically coded. The mixed method approach of inductive or deductive reasoning was used to identify 8 initial codes. The coded data were then analyzed thematically by identifying patterns and merging similar responses into overarching themes. The coded data were then analyzed to identify recurring themes. Taguette software following the NYU data services guide was used for this analysis.[15] 2.4. Ethical Considerations Ethical approval was obtained from the Community Ethics Advisory Board (CEAB). Participants provided oral consent and were assured of confidentiality. To protect anonymity, identifying details such as names, locations, and participant ages were omitted. Pseudonyms were assigned for transcription, coding, and analysis. 3. Results 3.1. Demographic Characteristics of Participants The study included 23 participants, comprising internally displaced persons (IDPs), civil society organisation (CSO) representatives, local governance officials, and donor organisation members from Mon, Kayah, Kayin, and East Bago. Of these, 14 were male and 9 were female. All donor representatives were male, among IDPs, 9 were male and 5 were female. CSO participants included 3 females and 1 male, whereas local governance representatives consisted of 2 males and 1 female. Regarding age distribution, most participants (8) were between 31 and 40 years old, followed by 7 participants aged 21–30,5 participants above 50 age groups, and 3 participants aged 41–50. To ensure anonymity, participants were assigned coded identifiers based on their roles and gender: donor representatives as “Donor_M1, M2”; local governance officials as “Governance_M1, M2” or “Governance_F1, F2”; CSO representatives as “CSO_M1, M2” or “CSO_F1, F2”; and IDP participants as “IDP_M1, M2” or “IDP_F1, F2.” 3.2. Mental Health Impact Anxiety and Lack of Psychological Safety A consistent theme across interviews—including IDPs, civil society representatives, and local governance actors—was the pervasive sense of anxiety and psychological insecurity. This was particularly driven by the constant fear of airstrikes and bombardments by the Myanmar Military. These fears are especially acute among women and children living on the ground. While donor-level participants did not directly reference the psychological impact of airstrikes, it emerged as a central concern for those more directly exposed to the conflict. “….In my entire life, I haven’t had any real airstrike or missile strike experience before. I still remember when we had to rush to escape with strangers that we never knew to survive. This is still in my memories that I can’t forget. Ah…how the sound of the airstrike and missile fired have impacted me mentally is when I heard someone walking or running upstairs or even a car door slam or children playing football, I wonder whether these sounds are missile fired. Whenever I heard these sounds, I felt a tremor in my hand. When I met with strangers, I felt fear. When I hear these sounds, I cannot sleep at night and become depressed. Sometimes, I felt I didn’t want to live anymore. I was not able to mentally escape myself when I heard about the airstrikes. One of the IDP women has severe mental impact by the sound of airstrikes, whenever she hears the sound, she becomes so much more uncontrollable herself, she stands and becomes stuck like a child, and she cannot move reimaging the experience from the previous airstrike.” IDP_F5 “...Most of IDP including me are not mentally fit. When we live in our home, we are happy mentally safe and strong. But when we become IDPs who live in camps and other villages, is not the same. Before the coup, we could stay in our homes but now we have to feel unsafe of the airstrikes and large weapons. We felt very sad about the loss of the soldiers who defended our home when the military attacked. Everyone wants to live in their home, we felt unsafe to stay in war. We worry about when things will happen next, but we have a strong will to survive.” IDP_M6 “…. Another major issue is the fear caused by airstrikes. When an airstrike occurs, children and women experience intense fear—they scream, cry, and panic. These experiences create a lasting sense of insecurity, making them feel unsafe no matter where they are.” Governance_M3 Depression and Guilt Depression was another recurring concern. IDPs frequently reported emotional fatigue, helplessness, and trauma. Stakeholders involved in humanitarian support also reported emotional distress and guilt over being unable to provide adequate aid. "...Whenever I heard these sounds, I felt a tremor in my hand. When I met with strangers, I felt fear. When I hear these sounds, I cannot sleep at night and become depressed. Sometimes, I felt I didn’t want to live anymore. I was not able to mentally escape myself when I heard about the airstrikes." IDP_F5 “…. When people work, they carry fear in their minds, but they must work to survive. When we talk about depression, some people feel depressed, wondering how they will survive under the constant threat of airstrikes. This situation is not only happening in our village but probably in the entire country.” IDP_M11 “…Despite knowing how much support is needed, we are often constrained by limited resources. This gap between what we want to achieve and what we can realistically provide leads to feelings of frustration, self-doubt, and emotional exhaustion. I sometimes feel unappreciated or question whether my efforts are truly making a difference.” Governance_F2 “…Since the coup, I’ve been receiving daily news about airstrikes in townships and how many children have died from this, medics who have lost their lives while supporting communities in the field, and hospitals that have been bombed. Every morning, in the early stages of the crisis, I would wake up to this heartbreaking news. It was depressing and made me feel devastated for my country and the suffering of my society.” Donor_M1 3.3.Mental Health Coping Strategies Formal Mental Health Services Stakeholders at the governance, civil society organization (CSO), and donor levels discussed efforts to address mental health through Mental Health and Psychosocial Support (MHPSS) training. These included basic psychological first aid provided to healthcare workers which was limited to one-time interventions. However, the overall impact remains minimal due to resource constraints and the lack of sustained support. Most IDP interviewees do not report receiving or benefiting directly from these formal services. “…Unfortunately, all our support is focused on immediate needs. Although we provide some mental health support, it’s just one time. There was no long-term support specifically for mental health. There should be someone trained in the camp to support the IDPs.” CSO_F1 “…Currently, some MHPSS training is being provided to basic healthcare providers, like nurses, teaching them psychological first aid. This has increased awareness, and people are beginning to recognize mental health as an important issue. In the past, mental health struggles carried a stigma, unlike physical illnesses. Now, with education, attitudes are slowly changing. However, the number of trained professionals is still extremely low, and the gap between basic skills and the actual level of care needed is very large.” Donor_M3 Field-Level Coping Strategies At the community level, IDPs primarily rely on informal mechanisms for mental health coping. These include strong peer and family support systems, religious practices, hope for political change, and psychological adaptation to ongoing threats. Access to education was highlighted as essential for the emotional well-being of children. Additionally, early warning systems for airstrikes emerged as a practical coping tool that reduces fear and anxiety during emergencies. “…Mentally, most of us have problems. Some of us feel like dying when we see or experience something bad. When we hear the sound of missiles, my parents become terrified and don’t know where to run or how to survive. I try to calm them.” IDP_M7 “…I want to share how I overcame this. I listen to music, read books, and try to meditate—even for just one minute. Then I pray. Whatever religion you follow, reading religious texts can help. Singing loudly, praying, and living far from the airstrikes has healed me mentally.” IDP_F5 “…For children, providing educational opportunities makes a big difference. The school offers them some sense of normalcy. Since IDPs have diverse experiences, it’s difficult to address everyone’s needs with a single program. People suffer in different ways, so tailored support is important.” CSO_F2 “…We have one program—an early warning system. Not all IDP camps have it, but those that do benefit from reduced anxiety. Waiting in fear doesn’t help. We’re also planning recreation spaces in villages for IDPs to gather. These areas will serve as both community hubs and emergency shelters during airstrikes.” CSO_M4 “…Another important factor is accepting the reality of the situation. I’ve come to terms with the fact that death could come at any time, and I must face that fear. We’ve created early warning systems and civilian protection teams to prepare and reduce panic when threats arise.” Governance_M3 4. Discussion This study highlighted the significant psychological toll of conflict on internally displaced persons (IDPs) and stakeholders involved in humanitarian efforts in the Mon, Kayah, Kayin, and East Bago regions of Myanmar. All study participants described increased anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children's mental health and early warning systems for airstrikes emerged as practical coping strategies. The mental health impact experienced by participants can be interpreted through the lens of the Kübler-Ross model on stages of grief, commonly referred to as the five stages of grief: denial, anger, bargaining, depression, and acceptance ( 15 , 16 , 17 ), shown in Fig. 1 . Many IDPs and their support network appeared to shift between these emotional stages. Many IDPs expressed disbelief and shock at the events they experienced, reflecting the denial stage. In the anger stage, several participants especially IDPs voiced deep resentment toward the military for triggering the armed conflict, while support workers expressed frustration at their inability to provide adequate assistance due to limited resources. Feelings of guilt and despair over the loss of loved ones and communities were commonly reported by both IDPs and support actors, which aligns with the bargaining stage of grief. Nearly all participants also described emotional exhaustion, helplessness, and fear of airstrikes, along with intrusive thoughts of death hallmarks of the depression stage. Notably, some IDPs and support actors spoke of their proactive efforts to establish early warning systems and their acceptance of the constant threat of mortality, signalling movement toward the acceptance stage. While previous research emphasizes that grief is rarely linear and often complex, recognizing the mental and emotional stages individuals occupy during prolonged crises can help design more responsive and effective mental health interventions for displaced populations. ( 18 ) The findings reveal significant gaps in the accessibility and effectiveness of Myanmar’s current Mental Health and Psychosocial Support (MHPSS). To provide more effective intervention, we recommended integrating the Inter-Agency Standing Committee’s (IASC) layered intervention pyramid for mental health and psychosocial support in emergencies integrated with the identified stages of grief, shown in Fig. 1 . ( 19 , 20 ) In the context of the IDPs and their support networks, denial is often addressed by ensuring basic humanitarian services and security. The anger stage resulting from frustration can be addressed by facilitating space for peer, family community networks for emotional expression and collective healing. In the bargaining stage, marked by feelings of guilt and despair, training local facilitators and community health workers will offer culturally sensitive psychosocial support and basic counselling. During the depression stage, where emotional exhaustion and helplessness dominate, there will be a need for access to professional mental health services. While this approach may have limitations, training local staff and establishing innovative referral pathways such as through telepsychiatry can significantly improve access to essential mental health services within the community. During the stage of acceptance, there is an opportunity to reinforce existing community-based coping mechanisms such as early warning systems and educational programs for children to help address ongoing fears related to airstrikes. Future programs should align the IASC’s MHPSS intervention pyramid into a horizontal approach with the stages of grief and offer a more targeted, contextualized, and realistic framework for supporting IDPs and their support networks. This study has several limitations. First, the participants were primarily from the Kayah, Kayin and East Bago States, of Myanmar, limiting the generalizability of the findings to IDPs in other regions with different socio-political and conflict dynamics. The experiences of IDPs in other states may vary due to differences in conflict intensity, access to aid, and local support structures. Second, while in-depth interviews provided valuable insights into the psychological impact of displacement, the study relied on translations from Burmese to English, which may have introduced translation bias. Certain cultural or emotional nuances may not have been fully captured in the transcriptions, potentially affecting the interpretation of findings. Finally, the study focused on qualitative methods, which, while useful for exploring lived experiences, do not provide quantifiable measures of mental health conditions. Despite these limitations, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Future research should incorporate longitudinal approaches of study design to assess the psychological state of IDPs more comprehensively and track their coping mechanisms over time. 5. Conclusions This study's findings revealed the profound psychological impact of ongoing conflict on internally displaced persons (IDPs) and their support networks in Southeastern Myanmar, revealing a spectrum of emotions anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children's mental health and early warning systems for airstrikes emerged as practical coping strategies. Futhermore the study aligns with the stages of grief outlined in the Kübler-Ross model and IASC’s MHPSS intervention pyramid revealing critical gaps in existing mental health services and proposing a more practical, horizontal, and culturally responsive approach. Despite limitations in generalizability and translation bias, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Future research should incorporate longitudinal approaches of study design to assess the psychological state of IDPs more comprehensively and track their coping mechanisms over time. Declarations Authorship contribution statement All authors were involved in conceptualising and investigating the articles. HMT is involved in data curation, formal analysis, methodology, software, and writing the original and final manuscript. NZW, HNH, and NNNL are involved in data curation, formal analysis, review, and supervision of the final manuscript. HAR and LN are involved review and supervision of the final manuscript. Declaration of competing interest The authors affirm that they have no known financial or interpersonal conflicts that would have appeared to impact the research presented in this study. Acknowledgements The authors sincerely thank all internally displaced participants, individuals who working with internally displaced populations and individuals who assisted in interviewing and identifying potential participants for this study. Ethics Statement The paper received ethical approval from the Community Ethics Advisory Board (CEAB), Mae Tao Clinic, with reference number CEAB-2024-016 on 9th December 2024. All the participants were informed that their participation was voluntary. Oral and written informed consent was obtained from all participants before conducting the interview and audio recording, in alignment with research ethics. All the participants’ names were assigned pseudonyms. All methods were performed according to relevant guidelines and regulations. Data Availability All data generated or analysed during this study are included in this published article. The datasets generated and/or analysed during the current study are not publicly available to preserve the anonymity of study participants; however, they are available from the corresponding author upon reasonable request. 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Supplementary Files Supplementaryinformation.docx Cite Share Download PDF Status: Published Journal Publication published 19 Dec, 2025 Read the published version in Conflict and Health → Version 1 posted Editorial decision: Revision requested 11 Sep, 2025 Reviews received at journal 15 Jul, 2025 Reviews received at journal 10 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviews received at journal 07 Jul, 2025 Reviewers agreed at journal 17 Jun, 2025 Reviewers agreed at journal 17 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 20 Apr, 2025 Submission checks completed at journal 18 Apr, 2025 First submitted to journal 11 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6430338","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":470157998,"identity":"da3d8719-4700-49dd-ab08-6d3b0f9afe97","order_by":0,"name":"Hein Minn Tun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACfv4exsd//0jIMUgwGDAwsDGASPxAcsYZZgPeBhtj4rUYHMhhk+BtSEtsIFoLw4Gzhw0kdxxO33C7eQPDh7LDDObSDfh1MDb3JT4wPHM4d8OdYwWMM84dZrCccwC/FmaGM8YGCWxALTdyDJh52w4zGNxIwK+FjSHHTOIA2+F0A5CWv8Ro4QFqkWxsS0sAa2EkRouExBljY4YzNoYzgX452HMuncdyBgEt9ud7DB8zVEjI891u3vjgR5m1nLkEAS0o4ADYpaNgFIyCUTAKKAcA+iBJp3ndc0sAAAAASUVORK5CYII=","orcid":"","institution":"Universiti Brunei Darussalam","correspondingAuthor":true,"prefix":"","firstName":"Hein","middleName":"Minn","lastName":"Tun","suffix":""},{"id":470157999,"identity":"200c12ba-6514-4f57-a538-b510fcffcb97","order_by":1,"name":"Nay Zar Win","email":"","orcid":"","institution":"Community Partners International","correspondingAuthor":false,"prefix":"","firstName":"Nay","middleName":"Zar","lastName":"Win","suffix":""},{"id":470158000,"identity":"9a5018aa-6be9-47ad-89b3-660009b2c01e","order_by":2,"name":"Hnin Nandar Htut","email":"","orcid":"","institution":"Inspire-Asia","correspondingAuthor":false,"prefix":"","firstName":"Hnin","middleName":"Nandar","lastName":"Htut","suffix":""},{"id":470158001,"identity":"2cfb43b2-5107-495b-bedf-c2052313ae71","order_by":3,"name":"Nay Nyi Nyi Lwin","email":"","orcid":"","institution":"Inspire-Asia","correspondingAuthor":false,"prefix":"","firstName":"Nay","middleName":"Nyi Nyi","lastName":"Lwin","suffix":""},{"id":470158002,"identity":"196e7d6f-e105-4742-a437-2147732ed568","order_by":4,"name":"Lin Naing","email":"","orcid":"","institution":"Universiti Brunei Darussalam","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Naing","suffix":""},{"id":470158003,"identity":"5365ef06-778c-4e51-a99b-30d0623e1f4c","order_by":5,"name":"Hanif Abdul Rahman","email":"","orcid":"","institution":"Universiti Brunei Darussalam","correspondingAuthor":false,"prefix":"","firstName":"Hanif","middleName":"Abdul","lastName":"Rahman","suffix":""}],"badges":[],"createdAt":"2025-04-11 17:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6430338/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6430338/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13031-025-00730-9","type":"published","date":"2025-12-19T15:56:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84819838,"identity":"b5712af9-b4e1-4c7e-b05a-adc5d169b172","added_by":"auto","created_at":"2025-06-17 16:02:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":147356,"visible":true,"origin":"","legend":"\u003cp\u003eAlignment of IDPs and Support Networks’ Experiences with the Kübler-Ross Model of Grief along with recommended mental health interventions in Southeastern Myanmar\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6430338/v1/b5fdcd6d309793e7fe0246d3.png"},{"id":98813916,"identity":"2b0290ec-d503-466e-b5df-307e7e3c0574","added_by":"auto","created_at":"2025-12-22 16:07:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":692872,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6430338/v1/3a0d0b5a-3008-42ea-8169-c0ad6db7edca.pdf"},{"id":84818663,"identity":"ce9145f4-f6f3-45cd-81d5-72c4ee6d7ad7","added_by":"auto","created_at":"2025-06-17 15:53:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25359,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryinformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-6430338/v1/1575c7b1922027cd7ad53487.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding the Mental Health Impact of Internally Displaced Persons (IDPs) and Their Support Networks in Southeastern Myanmar Post-Military Coup: A Qualitative Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eFollowing the February 1, 2021, military coup that resulted in extensive fighting, human rights violations, and mass displacement, Myanmar has been dealing with a serious humanitarian crisis. Armed conflicts and military offensives have resulted in the internal displacement of almost 3.2\u0026nbsp;million people as of 2024. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Numerous internally displaced people (IDPs) have had to repeatedly escape their homes, taking refuge in temporary camps, in the jungle, and in communities impacted by war, where they have little access to basic commodities, food, and medical treatment (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Due to the military junta's severe travel restrictions and frequent assistance blockages, humanitarian groups have major obstacles while attempting to provide relief (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The protracted nature of the situation has placed IDPs in a condition of extended uncertainty, with serious consequences for their physical and emotional well-being, despite efforts by international players to provide mental health services.\u003c/p\u003e \u003cp\u003eDisplacement has been linked globally to an increased risk of mental health conditions, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Studies on IDPs from Syria, South Sudan, and Colombia indicate that prolonged displacement, exposure to violence, and lack of access to healthcare significantly contribute to psychological distress (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). IDPs frequently experience grief due to the loss of family members, social networks, and a sense of belonging, which exacerbates feelings of isolation and hopelessness (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, humanitarian interventions often ignore the long-term consequences of displacement in favour of addressing urgent physical needs like food and shelter (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). IDPs are further restricted from obtaining essential psychological assistance by the stigma surrounding mental illness and the lack of culturally appropriate mental health services (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthnic minorities in Myanmar who endured decades of conflict reported mental health impact due to displacement (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The internally displaced persons (IDPs) experience higher levels of psychological distress due to ongoing fears of military attacks, forced evictions, and financial hardships (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). As they cope with the unpredictability of their circumstances, many IDPs report experiencing persistent trauma symptoms, including nightmares, hypervigilance, and social withdrawal (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, support networks, including community-based organisations, religious groups, and local NGOs, play a key role in providing informal psychological assistance. However, their activities are typically hindered by limited resources and security concerns (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Existing literature predominantly focuses on broad mental health trends and provides international-based mental health services without an in-depth exploration of local the experiences of both IDPs and their support networks in navigating the crisis.\u003c/p\u003e \u003cp\u003eThis study aims to fill this gap by investigating the local conditions on the ground regarding the impact of displacement on the mental health of internally displaced people (IDPs) as well as the people and organizations who assist them in post-coup Myanmar. Unlike previous research that primarily examines IDPs in isolation, this study takes a holistic approach by investigating the psychological toll on IDPs, civil society organizations, humanitarian program designers and policymakers who are directly involved in assisting displaced populations. By using qualitative research methods, this study seeks to capture the lived experiences, coping mechanisms, and mental health challenges faced by both groups. Understanding these dynamics is essential for designing more effective, sustainable mental health interventions that address the needs of both IDPs and their support networks. The findings will provide valuable insights for policymakers, humanitarian organizations, and mental health professionals working to improve psychological resilience and well-being in conflict-affected communities in Myanmar.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.1. Study Design and Participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis qualitative study employed in-depth online and in-person interviews with internally displaced persons (IDPs) and their support networks in Mon, Kayin, Kayah, and Eastern Bago between December 2024 and March 2025. Key stakeholders were selected using a purposive sampling approach, while snowball sampling facilitated recruitment due to access challenges. Civil Society Organizations (CSOs) assisted in referrals to ensure diverse representation. Participants were briefed on the study’s objectives, procedures, and their right to withdraw at any time. Eligibility criteria included being at least 18 years old and residing in an IDP camp or working with IDPs. Only those who provided voluntary consent were interviewed. Each session, conducted in Burmese and Kayin, lasted 20–35 minutes and was audio-recorded with detailed field notes. Interviews continued until data saturation was achieved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.2. Data Collection and Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA stakeholder analysis was conducted to identify relevant participants. Recruitment involved targeted outreach with study details and informed consent procedures. Online interviews were led by the research team, while local CSOs facilitated in-person sessions by nominating trained interviewers. Standardized training was provided to ensure consistency in conducting interviews. \u0026nbsp;All interviews were conducted in the Burmese and Kayin language and this study was focused on question number 4 of the qualitative interview.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.3. Data Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis followed Braun and Clarke’s framework [14], with researchers familiarizing themselves with the data through repeated listening and note review before transcription. Transcripts were translated into English, cross-checked for accuracy, and systematically coded. The mixed method approach of inductive or deductive reasoning was used to identify 8 initial codes. The coded data were then analyzed thematically by identifying patterns and merging similar responses into overarching themes. The coded data were then analyzed to identify recurring themes. Taguette software following the NYU data services guide was used for this analysis.[15]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2.4. Ethical Considerations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Community Ethics Advisory Board (CEAB). Participants provided oral consent and were assured of confidentiality. To protect anonymity, identifying details such as names, locations, and participant ages were omitted. Pseudonyms were assigned for transcription, coding, and analysis.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.1. Demographic Characteristics of Participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 23 participants, comprising internally displaced persons (IDPs), civil society organisation (CSO) representatives, local governance officials, and donor organisation members from Mon, Kayah, Kayin, and East Bago. Of these, 14 were male and 9 were female. All donor representatives were male, among IDPs, 9 were male and 5 were female. CSO participants included 3 females and 1 male, whereas local governance representatives consisted of 2 males and 1 female. Regarding age distribution, most participants (8) were between 31 and 40 years old, followed by 7 participants aged 21–30,5 participants above 50 age groups, and 3 participants aged 41–50. To ensure anonymity, participants were assigned coded identifiers based on their roles and gender: donor representatives as “Donor_M1, M2”; local governance officials as “Governance_M1, M2” or “Governance_F1, F2”; CSO representatives as “CSO_M1, M2” or “CSO_F1, F2”; and IDP participants as “IDP_M1, M2” or “IDP_F1, F2.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.2. Mental Health Impact\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnxiety and Lack of Psychological Safety\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA consistent theme across interviews—including IDPs, civil society representatives, and local governance actors—was the pervasive sense of anxiety and psychological insecurity. This was particularly driven by the constant fear of airstrikes and bombardments by the Myanmar Military. These fears are especially acute among women and children living on the ground. While donor-level participants did not directly reference the psychological impact of airstrikes, it emerged as a central concern for those more directly exposed to the conflict.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“….In my entire life, I haven’t had any real airstrike or missile strike experience before. I still remember when we had to rush to escape with strangers that we never knew to survive. This is still in my memories that I can’t forget. Ah…how the sound of the airstrike and missile fired have impacted me mentally is when I heard someone walking or running upstairs or even a car door slam or children playing football, I wonder whether these sounds are missile fired. Whenever I heard these sounds, I felt a tremor in my hand. When I met with strangers, I felt fear. When I hear these sounds, I cannot sleep at night and become depressed. Sometimes, I felt I didn’t want to live anymore. I was not able to mentally escape myself when I heard about the airstrikes. One of the IDP women has severe mental impact by the sound of airstrikes, whenever she hears the sound, she becomes so much more uncontrollable herself, she stands and becomes stuck like a child, and she cannot move reimaging the experience from the previous airstrike.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIDP_F5\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“...Most of IDP including me are not mentally fit. When we live in our home, we are happy mentally safe and strong. But when we become IDPs who live in camps and other villages, is not the same. Before the coup, we could stay in our homes but now we have to feel unsafe of the airstrikes and large weapons. We felt very sad about the loss of the soldiers who defended our home when the military attacked. Everyone wants to live in their home, we felt unsafe to stay in war. We worry about when things will happen next, but we have a strong will to survive.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIDP_M6\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…. Another major issue is the fear caused by airstrikes. When an airstrike occurs, children and women experience intense fear—they scream, cry, and panic. These experiences create a lasting sense of insecurity, making them feel unsafe no matter where they are.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Governance_M3\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDepression and Guilt\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepression was another recurring concern. IDPs frequently reported emotional fatigue, helplessness, and trauma. Stakeholders involved in humanitarian support also reported emotional distress and guilt over being unable to provide adequate aid.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"...Whenever I heard these sounds, I felt a tremor in my hand. When I met with strangers, I felt fear. When I hear these sounds, I cannot sleep at night and become depressed. Sometimes, I felt I didn’t want to live anymore. I was not able to mentally escape myself when I heard about the airstrikes.\"\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIDP_F5\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…. When people work, they carry fear in their minds, but they must work to survive. When we talk about depression, some people feel depressed, wondering how they will survive under the constant threat of airstrikes. This situation is not only happening in our village but probably in the entire country.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;IDP_M11\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Despite knowing how much support is needed, we are often constrained by limited resources. This gap between what we want to achieve and what we can realistically provide leads to feelings of frustration, self-doubt, and emotional exhaustion. I sometimes feel unappreciated or question whether my efforts are truly making a difference.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGovernance_F2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Since the coup, I’ve been receiving daily news about airstrikes in townships and how many children have died from this, medics who have lost their lives while supporting communities in the field, and hospitals that have been bombed. Every morning, in the early stages of the crisis, I would wake up to this heartbreaking news. It was depressing and made me feel devastated for my country and the suffering of my society.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDonor_M1\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3.3.Mental Health Coping Strategies\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFormal Mental Health Services\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStakeholders at the governance, civil society organization (CSO), and donor levels discussed efforts to address mental health through Mental Health and Psychosocial Support (MHPSS) training. These included basic psychological first aid provided to healthcare workers which was limited to one-time interventions. However, the overall impact remains minimal due to resource constraints and the lack of sustained support. Most IDP interviewees do not report receiving or benefiting directly from these formal services.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Unfortunately, all our support is focused on immediate needs. Although we provide some mental health support, it’s just one time. There was no long-term support specifically for mental health. There should be someone trained in the camp to support the IDPs.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCSO_F1\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Currently, some MHPSS training is being provided to basic healthcare providers, like nurses, teaching them psychological first aid. This has increased awareness, and people are beginning to recognize mental health as an important issue. In the past, mental health struggles carried a stigma, unlike physical illnesses. Now, with education, attitudes are slowly changing. However, the number of trained professionals is still extremely low, and the gap between basic skills and the actual level of care needed is very large.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDonor_M3\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eField-Level Coping Strategies\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the community level, IDPs primarily rely on informal mechanisms for mental health coping. These include strong peer and family support systems, religious practices, hope for political change, and psychological adaptation to ongoing threats. Access to education was highlighted as essential for the emotional well-being of children. Additionally, early warning systems for airstrikes emerged as a practical coping tool that reduces fear and anxiety during emergencies.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Mentally, most of us have problems. Some of us feel like dying when we see or experience something bad. When we hear the sound of missiles, my parents become terrified and don’t know where to run or how to survive. I try to calm them.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;IDP_M7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…I want to share how I overcame this. I listen to music, read books, and try to meditate—even for just one minute. Then I pray. Whatever religion you follow, reading religious texts can help. Singing loudly, praying, and living far from the airstrikes has healed me mentally.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIDP_F5\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…For children, providing educational opportunities makes a big difference. The school offers them some sense of normalcy. Since IDPs have diverse experiences, it’s difficult to address everyone’s needs with a single program. People suffer in different ways, so tailored support is important.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;CSO_F2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…We have one program—an early warning system. Not all IDP camps have it, but those that do benefit from reduced anxiety. Waiting in fear doesn’t help. We’re also planning recreation spaces in villages for IDPs to gather. These areas will serve as both community hubs and emergency shelters during airstrikes.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCSO_M4\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Another important factor is accepting the reality of the situation. I’ve come to terms with the fact that death could come at any time, and I must face that fear. We’ve created early warning systems and civilian protection teams to prepare and reduce panic when threats arise.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGovernance_M3\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study highlighted the significant psychological toll of conflict on internally displaced persons (IDPs) and stakeholders involved in humanitarian efforts in the Mon, Kayah, Kayin, and East Bago regions of Myanmar. All study participants described increased anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children's mental health and early warning systems for airstrikes emerged as practical coping strategies.\u003c/p\u003e \u003cp\u003eThe mental health impact experienced by participants can be interpreted through the lens of the K\u0026uuml;bler-Ross model on stages of grief, commonly referred to as the five stages of grief: denial, anger, bargaining, depression, and acceptance (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Many IDPs and their support network appeared to shift between these emotional stages. Many IDPs expressed disbelief and shock at the events they experienced, reflecting the denial stage. In the anger stage, several participants especially IDPs voiced deep resentment toward the military for triggering the armed conflict, while support workers expressed frustration at their inability to provide adequate assistance due to limited resources. Feelings of guilt and despair over the loss of loved ones and communities were commonly reported by both IDPs and support actors, which aligns with the bargaining stage of grief. Nearly all participants also described emotional exhaustion, helplessness, and fear of airstrikes, along with intrusive thoughts of death hallmarks of the depression stage. Notably, some IDPs and support actors spoke of their proactive efforts to establish early warning systems and their acceptance of the constant threat of mortality, signalling movement toward the acceptance stage. While previous research emphasizes that grief is rarely linear and often complex, recognizing the mental and emotional stages individuals occupy during prolonged crises can help design more responsive and effective mental health interventions for displaced populations. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe findings reveal significant gaps in the accessibility and effectiveness of Myanmar\u0026rsquo;s current Mental Health and Psychosocial Support (MHPSS). To provide more effective intervention, we recommended integrating the Inter-Agency Standing Committee\u0026rsquo;s (IASC) layered intervention pyramid for mental health and psychosocial support in emergencies integrated with the identified stages of grief, shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) In the context of the IDPs and their support networks, denial is often addressed by ensuring basic humanitarian services and security. The anger stage resulting from frustration can be addressed by facilitating space for peer, family community networks for emotional expression and collective healing. In the bargaining stage, marked by feelings of guilt and despair, training local facilitators and community health workers will offer culturally sensitive psychosocial support and basic counselling. During the depression stage, where emotional exhaustion and helplessness dominate, there will be a need for access to professional mental health services. While this approach may have limitations, training local staff and establishing innovative referral pathways such as through telepsychiatry can significantly improve access to essential mental health services within the community. During the stage of acceptance, there is an opportunity to reinforce existing community-based coping mechanisms such as early warning systems and educational programs for children to help address ongoing fears related to airstrikes. Future programs should align the IASC\u0026rsquo;s MHPSS intervention pyramid into a horizontal approach with the stages of grief and offer a more targeted, contextualized, and realistic framework for supporting IDPs and their support networks.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the participants were primarily from the Kayah, Kayin and East Bago States, of Myanmar, limiting the generalizability of the findings to IDPs in other regions with different socio-political and conflict dynamics. The experiences of IDPs in other states may vary due to differences in conflict intensity, access to aid, and local support structures. Second, while in-depth interviews provided valuable insights into the psychological impact of displacement, the study relied on translations from Burmese to English, which may have introduced translation bias. Certain cultural or emotional nuances may not have been fully captured in the transcriptions, potentially affecting the interpretation of findings. Finally, the study focused on qualitative methods, which, while useful for exploring lived experiences, do not provide quantifiable measures of mental health conditions. Despite these limitations, the study proposes a practical approach by aligning the IASC\u0026rsquo;s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Future research should incorporate longitudinal approaches of study design to assess the psychological state of IDPs more comprehensively and track their coping mechanisms over time.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study's findings revealed the profound psychological impact of ongoing conflict on internally displaced persons (IDPs) and their support networks in Southeastern Myanmar, revealing a spectrum of emotions anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children's mental health and early warning systems for airstrikes emerged as practical coping strategies. Futhermore the study aligns with the stages of grief outlined in the K\u0026uuml;bler-Ross model and IASC\u0026rsquo;s MHPSS intervention pyramid revealing critical gaps in existing mental health services and proposing a more practical, horizontal, and culturally responsive approach. Despite limitations in generalizability and translation bias, the study proposes a practical approach by aligning the IASC\u0026rsquo;s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network. Future research should incorporate longitudinal approaches of study design to assess the psychological state of IDPs more comprehensively and track their coping mechanisms over time.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors were involved in conceptualising and investigating the articles. HMT is involved in data curation, formal analysis, methodology, software, and writing the original and final manuscript. NZW, HNH, and NNNL are involved in data curation, formal analysis, review, and supervision of the final manuscript. HAR and LN are involved review and supervision of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that they have no known financial or interpersonal conflicts that would have appeared to impact the research presented in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank all internally displaced participants, individuals who working with internally displaced populations and individuals who assisted in interviewing and identifying potential participants for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe paper received ethical approval from the Community Ethics Advisory Board (CEAB), Mae Tao Clinic, with reference number CEAB-2024-016 on 9th December 2024. All the participants were informed that their participation was voluntary. Oral and written informed consent was obtained from all participants before conducting the interview and audio recording, in alignment with research ethics. All the participants’ names were assigned pseudonyms. All methods were performed according to relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article. The datasets generated and/or analysed during the current study are not publicly available to preserve the anonymity of study participants; however, they are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration for Consent for Publication:\u0026nbsp;\u003c/strong\u003eAll authors agree on consent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding :\u0026nbsp;\u003c/strong\u003eNo funding was received for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Office for the Coordination of Humanitarian Affairs (OCHA). \u0026ldquo;Myanmar Humanitarian Update No. 43 | Reflecting on 2024 and Preparing for 2025 | OCHA,\u0026rdquo; January 3, 2025.https://www.unocha.org/publications/report/myanmar/myanmar-humanitarian-update-no-43-reflecting-2024-and-preparing-2025\u003c/li\u003e\n\u003cli\u003eUNHCR. Myanmar Emergency Update: Internal Displacement and Protection Needs. UNHCR; 2024. Available from: https://www.unhcr.org/myanmar-crisis \u003c/li\u003e\n\u003cli\u003eInternational Crisis Group. Myanmar\u0026rsquo;s Deepening Displacement Crisis: Challenges for Humanitarian Response. 2023. Available from: https://www.crisisgroup.org/asia/southeast-asia/myanmar/myanmar-displacement-report-2023 \u003c/li\u003e\n\u003cli\u003eHassan, G., P. Ventevogel, H. Jefee-Bahloul, A. Barkil-Oteo, and L. J. Kirmayer. \u0026ldquo;Mental Health and Psychosocial Wellbeing of Syrians Affected by Armed Conflict.\u0026rdquo; Epidemiology and Psychiatric Sciences 25, no. 2 (April 2016): 129\u0026ndash;41. https://doi.org/10.1017/S2045796016000044. \u003c/li\u003e\n\u003cli\u003eRoberts, B., K. Felix Ocaka, J. Browne, T. Oyok, and E. Sondorp. \u0026ldquo;Factors Associated with the Health Status of Internally Displaced Persons in Northern Uganda.\u0026rdquo; Journal of Epidemiology and Community Health 63, no. 3 (March 2009): 227\u0026ndash;32. https://doi.org/10.1136/jech.2008.076356.\u003c/li\u003e\n\u003cli\u003eMiller, Kenneth E., and Andrew Rasmussen. \u0026ldquo;War Exposure, Daily Stressors, and Mental Health in Conflict and Post-Conflict Settings: Bridging the Divide between Trauma-Focused and Psychosocial Frameworks.\u0026rdquo; Social Science \u0026amp; Medicine (1982) 70, no. 1 (January 2010): 7\u0026ndash;16. https://doi.org/10.1016/j.socscimed.2009.09.029 \u003c/li\u003e\n\u003cli\u003eTay, A. K., and D. Silove. \u0026ldquo;The ADAPT Model: Bridging the Gap between Psychosocial and Individual Responses to Mass Violence and Refugee Trauma.\u0026rdquo; Epidemiology and Psychiatric Sciences 26, no. 2 (December 15, 2016): 142\u0026ndash;45. https://doi.org/10.1017/S2045796016000925. \u003c/li\u003e\n\u003cli\u003eVentevogel, Peter. \u0026ldquo;Integration of Mental Health into Primary Healthcare in Low-Income Countries: Avoiding Medicalization.\u0026rdquo; International Review of Psychiatry (Abingdon, England) 26, no. 6 (December 2014): 669\u0026ndash;79. https://doi.org/10.3109/09540261.2014.966067. \u003c/li\u003e\n\u003cli\u003eJolliffe, Kim, Asia Foundation (Burma) , \u0026ldquo;Ethnic Conflict and Social Services in Myanmar\u0026rsquo;s Contested Regions | Library of Congress.\u0026rdquo; Accessed March 11, 2025. https://www.loc.gov/item/2020308000/. \u003c/li\u003e\n\u003cli\u003eLopes Cardozo, Barbara, Carol Gotway Crawford, Cynthia Eriksson, Julia Zhu, Miriam Sabin, Alastair Ager, David Foy, et al. \u0026ldquo;Psychological Distress, Depression, Anxiety, and Burnout among International Humanitarian Aid Workers: A Longitudinal Study.\u0026rdquo; PloS One 7, no. 9 (2012): e44948. https://doi.org/10.1371/journal.pone.0044948. \u003c/li\u003e\n\u003cli\u003eKhai, T.S. Vulnerability to health and well-being of internally displaced persons (IDPs) in Myanmar post-military coup and COVID-19. Arch Public Health 81, 185 (2023). https://doi.org/10.1186/s13690-023-01204-1 \u003c/li\u003e\n\u003cli\u003eKyaw, K.W.Y., Platt, L., Bijl, M. et al. The effect of different types of migration on symptoms of anxiety or depression and experience of violence among people who use or inject drugs in Kachin State, Myanmar. Harm Reduct J 20, 45 (2023). https://doi.org/10.1186/s12954-023-00766-1 \u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/li\u003e\n\u003cli\u003eWARE, ANTHONY, and MONIQUE SKIDMORE, editors. After the Coup: Myanmar\u0026rsquo;s Political and Humanitarian Crises. 1st ed., ANU Press, 2023. JSTOR, http://www.jstor.org/stable/jj.13167839. Accessed 19 Mar. 2025. \u003c/li\u003e\n\u003cli\u003eK\u0026uuml;bler-Ross, Elisabeth. On Death and Dying. London: Routledge, 1973. https://doi.org/10.4324/9780203010495.\u003c/li\u003e\n\u003cli\u003eK\u0026uuml;bler-Ross, E., and D. Kessler. On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. Scribner, 2007. https://books.google.com.bn/books?id=YNBQYREtyS8C. \u003c/li\u003e\n\u003cli\u003eTyrrell, Patrick, Seneca Harberger, Caroline Schoo, and Waquar Siddiqui. \u0026ldquo;Kubler-Ross Stages of Dying and Subsequent Models of Grief.\u0026rdquo; In StatPearls. Treasure Island (FL): StatPearls Publishing, 2025. http://www.ncbi.nlm.nih.gov/books/NBK507885/. \u003c/li\u003e\n\u003cli\u003eGilbertine, GUEMDJO, NGUIMFACK L\u0026eacute;onard, and NOUMBISSIE Claude D\u0026eacute;sir\u0026eacute;. \u0026ldquo;Multiple Objects Lost And Complicated Grief Among Internally Displaced Persons Of The Anglophone Crisis In Cameroon\u0026rdquo; 9, no. 5 (2024). https://www.imjst.org/wp-content/uploads/2024/05/IMJSTP29121019.pdf \u003c/li\u003e\n\u003cli\u003eOmmeren, M.Van, F. Hanna, I. Weissbecker, and P. Ventevogel. \u0026ldquo;Mental Health and Psychosocial Support in Humanitarian Emergencies.\u0026rdquo; Eastern Mediterranean Health Journal 12, no. 7 (July 1, 2015): 498\u0026ndash;502. https://doi.org/10.26719/2015.21.7.498. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization(WHO), \u0026ldquo;MHPSS Interventions.\u0026rdquo; Accessed April 5, 2025. https://wkc.who.int/our-work/health-emergencies/knowledge-hub/mental-health-psychosocial-support-(mhpss)/mhpss-interventions. \u003c/li\u003e\n\u003cli\u003eShoib, Sheikh, Aishatu Yusha\u0026rsquo;u Armiya\u0026rsquo;u, Thiago Henrique Roza, Fahimeh Saeed, Sarya Swed, Nigar Arif, Chan Park, and Miyuru Chandradasa. \u0026ldquo;Telepsychiatry for Conflict-Affected Settings: Feasibility, Ethics, Barriers and Prospects.\u0026rdquo; Asian Journal of Psychiatry 75 (September 1, 2022): 103203. https://doi.org/10.1016/j.ajp.2022.103203. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"conflict-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"conf","sideBox":"Learn more about [Conflict and Health](http://conflictandhealth.biomedcentral.com/)","snPcode":"13031","submissionUrl":"https://submission.nature.com/new-submission/13031/3","title":"Conflict and Health","twitterHandle":"@Conflict_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Internally Displaced Persons, Myanmar, mental health, displacement, trauma, conflict, emotional distress","lastPublishedDoi":"10.21203/rs.3.rs-6430338/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6430338/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eArmed conflicts and military offensives after the 2021 coup in Myanmar have resulted in the internal displacement of almost 3.5 million people as of 2024. The internally displaced persons (IDPs) experience higher levels of psychological distress due to ongoing fears of military attacks, forced evictions, and financial hardships. As they cope with the unpredictability of their circumstances, many IDPs report experiencing persistent trauma symptoms, including nightmares, hypervigilance, and social withdrawal. This study aims to investigate the local conditions on the ground regarding the impact of displacement on the mental health of internally displaced people (IDPs) as well as the people and organizations who assist them in post-coup Myanmar. This qualitative study used a mix of purposive and snowball sampling approaches, conducting in-depth online and in-person interviews with 13 IDPs and 10 individuals from the IDP support network. Thematic analysis revealed that IDPs along with their support network described increased anxiety, fear, and even depression, especially concerning the prospect of airstrikes and violence. The absence of long-term mental health care added to the weight of the concern. While there are some formalized mental health and psychosocial support (MHPSS) services, they are currently limited in scope and accessibility. In contrast, IDPs resort mostly to informal coping mechanisms such as peer and family support, and a sense of positive wish for winning the revolution and the acceptance stage of the reality along with religious support. Furthermore, the grassroots recommendations also include educational opportunities for children's mental health and early warning systems for airstrikes emerged as practical coping strategies. Despite limitations in generalizability and translation bias, the study proposes a practical approach by aligning the IASC’s MHPSS intervention pyramid with the stages of grief in a horizontal framework, offering more context-sensitive and effective mental health support for displaced populations and its support network.\u003c/p\u003e","manuscriptTitle":"Understanding the Mental Health Impact of Internally Displaced Persons (IDPs) and Their Support Networks in Southeastern Myanmar Post-Military Coup: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 15:53:29","doi":"10.21203/rs.3.rs-6430338/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-11T14:40:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-15T21:06:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-10T12:15:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50017468771371236099859871591733549711","date":"2025-07-09T17:08:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18127039260470256150682823121329490305","date":"2025-07-08T13:33:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-07T10:37:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212386056465377977926079140832802431614","date":"2025-06-18T03:45:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273931042366466515967089961528299411437","date":"2025-06-17T11:40:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T05:20:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-20T18:38:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-18T14:24:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Conflict and Health","date":"2025-04-11T17:34:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"conflict-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"conf","sideBox":"Learn more about [Conflict and Health](http://conflictandhealth.biomedcentral.com/)","snPcode":"13031","submissionUrl":"https://submission.nature.com/new-submission/13031/3","title":"Conflict and Health","twitterHandle":"@Conflict_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2473f94-f18a-49ce-a631-71e6ce66e4e0","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:00:49+00:00","versionOfRecord":{"articleIdentity":"rs-6430338","link":"https://doi.org/10.1186/s13031-025-00730-9","journal":{"identity":"conflict-and-health","isVorOnly":false,"title":"Conflict and Health"},"publishedOn":"2025-12-19 15:56:56","publishedOnDateReadable":"December 19th, 2025"},"versionCreatedAt":"2025-06-17 15:53:29","video":"","vorDoi":"10.1186/s13031-025-00730-9","vorDoiUrl":"https://doi.org/10.1186/s13031-025-00730-9","workflowStages":[]},"version":"v1","identity":"rs-6430338","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6430338","identity":"rs-6430338","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}