The Cost of the Troubles Study

Report on the Northern Ireland Survey:
the experience and impact of the troubles

Marie Therese Fay
Mike Morrissey
Marie Smyth
Tracy Wong

First Published 1999
by INCORE (University of Ulster & The United Nations University)
Aberfoyle House, Northland Road, Derry Londonderry, Northern Ireland
Tel +44 1504 375500

We wish to acknowledge the help of the following people:

Gwen Ford, Sarah Gakes, Mark Mulligan, Catherine Sharkey; Lyn Moffett; Dr Brian Tipping, Research Services Ireland; Patricia McGrory Dr John Yarnell, Department of Public Health Queen’s University & The Health Promotion Agency; Dr Debbie Donnelly, NISRA; John Park, Social Services Inspectorate; Tony McQuillan, Northern Ireland Housing Executive; Dr Andrew Finlay, Trinity College Dublin; The Community Information Technology Unit, Belfast; Paul O’Connor; Rosemary McCrindle; Victor Cole; Liza McCormick; Sheila Fillot; Jason Docherty; Rhona Henderson; Paul Monahan; Eileen McGonnell; Johnny Nolan; Paula Fearon; Des Reilly; Roisin Kelly; Susan Ingram; Barry Gormley; Ken Humes; Janis Quinn; Caral Ni Chuilin; Anthony McIntyre; Julie Finlay, Brian Cole, Siobban Maguire, Olivia Hanna, Andy White, Aidan Molloy, Phyliss Woods, Leah Wilson, Maura McKendry, Margaret Scullion, Dermot McMahon, Geoff Wilson and Fred McIlmoyle. David Clements; Brendan Bradley; John Millar; Marie McNeice; Hazel McCready; Sandra Peake; and Sam Malcolmson

The Board of the Cost of the Troubles Study are:

David Clements; Brendan Bradley; John Millar; Marie McNeice; Hazel McCready; Sandra Peake; Sam Malcolmson; Mike Morrissey and Marie Smyth.

Table of contents

Background to the survey

• The Cost of the Troubles Study, a group of people bereaved or injured in the Troubles working with academic researchers, have conducted a survey across Northern Ireland.

• The purpose of the survey was to establish the range of experiences people had of the Troubles, and how their experiences had affected them.
• The goal of this survey is to make available to policy makers and service providers a comprehensive picture of the range of issues and needs that are prevalent in sections of the Northern Ireland population as a result of the Troubles

• To construct a sample, wards in Northern Ireland were divided in to three categories:
  
  those with a high Troubles-related death rate - high intensity areas (over 7 deaths per thousand population);
  those with a medium death rate (over 1 but under 7 per thousand population) - medium intensity areas; and
  those with a low death rate (under 1 per thousand population) - low intensity areas.
• In-depth interviews with 75 people were conducted in order to provide data on a range of experiences and effects of the Troubles. A questionnaire was designed on the basis of this interview data. A standard health instrument (SF12) was also used in the questionnaire.
• All of those individuals surveyed were first written to, and given an opportunity to refuse to participate. Publicity about the survey was organised so that the public knew who was doing the survey, and what its purpose was.
• 30 interviewers administered the questionnaire to 1,346 people from an attempted sample of 3,000 drawn randomly from the electoral registers of 30 wards.
• Interviewers were trained to give information about support services or make referrals where appropriate when they encountered people in need or distress.

• Respondents in high intensity areas reported lower incomes, higher occupancy of public sector housing, higher unemployment and more benefit dependency than either of the other two locations.

Experience of the Troubles

• Overall, respondents in high intensity areas reported more experience of the Troubles, followed by those in medium intensity areas. Those in low intensity areas reported least experience overall.
• However, those in high intensity areas, reported less experience of less extreme experiences, such as seeing news broadcasts related to the Troubles, and about the same level as the other two areas of medium range experiences such as getting stopped at a checkpoint.
• For all other intense experiences of the Troubles, those in high intensity areas reported levels of experience far in excess of medium and low intensity areas. For example, 28% of those in high intensity areas reported having their home attacked, and 10% reported having their home destroyed.

• Over a third of respondents in wards of highest intensity reported painful memories compared to a fifth in the middle intensity group:
• Over a quarter in wards of highest intensity reported dreams
• and nightmares compared to an eighth in the middle intensity group;
• A third in wards of highest intensity reported involuntary recall compared to an eighth in the middle intensity group;
• 30 per cent in wards of highest intensity felt some form of guilt at surviving compared to 11 per cent in the middle intensity group;
• Almost a quarter in wards of highest intensity had taken some form of medication for such effects compared to just under an eighth in middle intensity wards;
• 22 per cent in wards of highest intensity reported an increase in alcohol consumption related to the Troubles compared to just over four per cent in middle intensity wards;
• those in high intensity wards had more severe experiences and reported more severe effects of the Troubles than those in the other two wards;
• those in high intensity wards also reported more health problems than those in the other two areas.

Help and support with the effects of the Troubles

• Those in high intensity wards sought help more frequently than those in other wards;
• In all cases, help was sought primarily from friends and immediate family although some differences emerged in help sought outside the family between the three locations;
• Those in high intensity areas were less likely to seek help from their minister or priest, solicitor, psychiatrist, counsellor or community nurse than those in the other two areas;
• Over 40 per cent of those who sought help in high intensity wards were unable to find satisfactory help, compared to 29 per cent in medium intensity and 29 per cent in low intensity wards;
• Over 83 per cent in high intensity wards believed that nothing could help them, compared to just over 4 per cent in medium intensity and just over 12 per cent in low intensity wards;
• Over 23 per cent had taken medication in high intensity wards compared to almost 12 per cent in medium wards and just over 9 per cent in low intensity wards;
• Of those who used medication, over 52 per cent of those in high intensity wards were on medication permanently, compared to 9 per cent in medium intensity and 35 per cent for low intensity wards;

• Those using medication in high intensity wards were likely to be using it for sleep disturbance, sedation or anti-depressive purposes, whereas those in low intensity wards used them for pain control rather than for anti-depressive purposes.

• Those in the wards least affected tended to blame Loyalist and Republican paramilitaries for the Troubles, whereas those in the wards most affected tended to blame Loyalist but not Republican paramilitaries and the police and army.

• Differences between areas were analysed via cross-tabulation. Chi-Square was used as a significance test of these differences. Given the very large number of cross-tabulations generated, difference was tested at the .005 level.
• There is wide variation amongst people in Northern Ireland in terms of both their experience of the Troubles and the effect on them. Above all, location - whether a high, medium or low intensity area is the best predictor of the extent of experience of the Troubles, and of the effect of the Troubles.
• Males were more likely to report being involved in physical fights whereas females reported more disrupted schooling and more often felt blamed for the Troubles.
• Catholics in all three locations had more experience of the Troubles and also reported more effects of the Troubles on them. However, of the three key factors - gender, religion and location - the latter was the most important factor.

1. There is the much greater exposure to Troubles-related events both from paramilitary organisations and the security forces - a set of experiences almost unmatched in the rest of Northern Ireland (this group of wards regularly reported experience of Troubles’ related activity at twice the rate for middle wards and four times the rate for least intensity wards);
2. There are insecurities and fears in being outside one’s own area and an acute wariness of outsiders, for example reflected in efforts to conceal where one lives;
3. There is a strong pattern of segregation - over a quarter of those from highest intensity wards who were employed, worked only with members of their own community.

There is no straightforward relationship between individual experience of the Troubles and effects of the Troubles.

• 3.7% of the whole sample reported that they had a lot of experience of the Troubles and that it had completely changed their lives;
• Just over half of those with "a lot" of experience of the Troubles indicated some change in their lives, compared to a fifth who said there had been a complete change.
• Most of those who reported a lot, quite a lot or some, most commonly reported "some" change in their lives

An indicator of post-traumatic stress, loosely based on the diagnostic criteria for Post Traumatic Stress Disorder was constructed and 390 cases, about 30% of the entire sample met the criteria. Only small differences were noted between men and women, but large religious differences emerged, with Catholics reporting more stress than Protestants. Similarly, those living in the highest intensity wards reported more stress than those in medium intensity, and those in low intensity reported less stress than either of the other two cohorts.

Location and religion stand out as significant factors in both the experience and the effects of the Troubles. Other factors such as segregation and levels of deprivation seem to be related to the level of exposure to Troubles related experiences, and the degree of impact of the Troubles on people’s lives.

1. The concentration of Troubles-related violence in certain location and sub-sets of the population should be recognised by policy makers and service providers, especially in targeting social need.
2. The role of immediate families in providing support for those affected by the Troubles should be formally recognised and supported by policy makers and service providers;
3. There is a need to learn more about those who have been offering social support to those affected by the Troubles in order to offer support and recognition for work, which has been the major and most effective source of help in this field.
4. Further work is required on the role of prescribed medication and alcohol in the management of Troubles related stress, especially in the light of the poorer overall health reported in the areas worst affected by the Troubles.

Conclusion

Effects of the Troubles

• Of those reporting painful memories, over a third of respondents came from the wards with the highest intensity of violence compared to a fifth from the wards in the middle intensity group;
• An eighth of those from middle intensity wards compared to over a quarter from wards in the highest intensity group reported nightmares and dreams related to the Troubles;
• In highest intensity wards involuntary recall was reported by a third of respondents compared to an eighth of respondents in the middle intensity wards;
• 30 per cent of those from the highest intensity wards compared to just 11 per cent in the middle intensity group reported some form of guilt at surviving;
• Just over four per cent of those from middle intensity wards, whereas 22 per cent from highest intensity wards reported an increase in alcohol assumption related to the Troubles;
• More severe experience and severe effects of the Troubles were reported by those in the highest intensity wards than those in the other two locations;
• More health problems were reported by those in high intensity wards than by those in the other two locations;

• Help was sought more frequently from those in wards of highest intensity compared to those in the middle and low intensity wards;
• Respondents in all three groups reported that the primary source of help was from immediate family and friends, although, between the three locations there were differences reported in help sought outside the family network;
• Of those who did seek help, over 40 per cent in the high intensity group claimed they were unable to find adequate help, compared to 29 per cent in both middle and low intensity wards;
• The belief that nothing could help was reported by over 83 per cent in the highest intensity wards compared to over 12 per cent in the low intensity wards and just over 4 per cent in the middle intensity wards;
• When asked about medication, almost a quarter from the highest intensity wards reported that they had taken some from of medication, compared to just under an eighth in the middle intensity wards and just over 9 per cent in wards with low intensity violence;

• 52 per cent of those who used medication in highest intensity wards reported that they were on medication permanently compared to 35 per cent of those who use medication in low intensity wards and just over 9 per cent in the middle intensity group;
• In the highest intensity wards medication was used for anti-depression, sleep disturbance or sedation purposes. In the low intensity wards however medication was used for pain control rather than anti-depressive purposes;

• Those living in segregated areas were four times more likely to report ‘a lot’ of experience of the Troubles than those in non-segregated areas. Twice as many residents of segregated as opposed to non-segregated areas reported ‘quite a lot’ of experience of the Troubles;
• Over a fifth of those in segregated areas reported a complete or radical change due to the Troubles, compared to a twelfth in non-segregated areas;

• A higher proportion of men (37.5%) than women (22.3%) report ‘a lot’ or ‘quite a lot’ of experience of the Troubles with a fifth of men and a quarter of women reporting little or no experience;
• Some experiences were shared by both men and women whilst some more direct experiences - being called sectarian names, or getting into physical fights or witnessing a shooting - are more frequently encountered by men. Similar percentages reported death or injury in their immediate families;

• The percentage of Catholics reporting a lot (t8.9%) and quite a lot (22.8%) of experience of the Troubles was much higher than that of Protestants (5.25% and 13.80/0 respectively) whilst only t5% of Catholics compared to 38.9% of Protestants reported very little experience of the Troubles. We conclude that Catholic experience of the Troubles is disproportionately high;
• Of those reporting a complete change in their lives due to the Troubles, 90.9% were Catholic compared to 8.1% Protestant, and Catholics overall report having experienced more extreme effects of the Troubles, whereas Protestants report less overall change on a smaller scale;
• In spite of this, proportionately more Protestants than Catholics reported long-standing illnesses;
• Catholics reported more painful memories of the Troubles, dreams and nightmares about the Troubles, intrusive thoughts, losing interest in normal activities and feelings of insecurity and jumpiness than Protestants;

• The 45-64 age group had the highest percentages of people reporting ‘a lot’ of experience of the Troubles, and the 40-59 age group reported more experience of straying into areas where they did not feel safe and more experience of feeling wary in the presence of the ‘other’ community compared to other age groups;
• About a quarter of the sample had seen people killed or injured at least once, with 37.10/0 of t5-19 year olds - the highest rate for any age group - reporting this experience;

• The 25-39 age group contained the highest percentage of those reporting no change in their drinking and the highest percentage reporting an increase, with no difference emerging between the three locations in this question;
• However, over 10% of 20-24 year olds reported that their drinking had increased, and t6⁰/o said that at times they ‘drank a lot after a particular experience’ and almost half ot hose said that the period lasted for more than six months;

• About 4.5% of the sample reported that they had been injured in a bomb explosion or in shootings;

• Over a fifth of the total sample reported deterioration in their health which they attributed to a Troubles-related trauma or bereavement;
• Just less than 6% reported being given pain medication to treat conditions they suffered as a result of the effects of the Troubles on them;
• Analysis of the standard health measure (SF12) revealed remarkably little variation between the three locations. These results will he subjected to further analysis;

• A complex relationship between experience of the Troubles and the reported effects of the Troubles was found. Whilst the majority of those who reported experience of the Troubles reported ‘some change’ in their lives, whilst relatively few in all categories including those with ‘a lot’ of experience reported ‘complete change’ in their lives due to the Troubles;
• A sub-group of the sample who reported severe and very severe experiences of the Troubles were further analysed. Almost half of this group reported a significant of the Troubles on them. About a third of them reported that the Troubles had ‘completely changed my life: and a further t8% reported a radical change. This sub-group was 84% Catholic and 62% lived in high intensity wards;
• A further sub-group who reported severe impact of the Troubles were further analysed. Over half of this group lived in high intensity wards, and accounted for a quarter of the total sample from such wards. Over 80% of this group met the criteria for inclusion on the post traumatic stress indicator;

• An indicator of post traumatic stress was constructed and revealed
• minimal differences between men and women’s scores
• significant differences between Catholics and Protestants, with Catholics scoring higher on the indicator than Protestants
• significant differences between the three locations, with areas of high intensity violence scoring higher than medium intensity areas, which in turn scored higher than the low intensity areas
• those reporting complete change in their lives due to the Troubles scored higher on the indicator than any other category;

Indeed for every ‘effects’ variable, differences of this order are observable. Differential experience and effects of the Troubles would seem to be conditioned more by location than either gender or religion. These responses suggest that there have been three key dimensions to life in the areas most affected by the Troubles:

• first, there is the much greater exposure to Troubles-related events both from paramilitary organisations and the security forces - a set of experiences almost unmatched in the rest of Northern Ireland (this group of wards regularly reported experience of Troubles’ related activity at twice the rate for middle wards and four times the rate for least intensity wards);
• second, there are insecurities and fears in being outside one’s own area and an acute wariness of outsiders, for example reflected in efforts to conceal where one lives;
• third there is a strong pattern of segregation - over a quarter of those from highest intensity wards who were employed, worked only with members of their own community.

Of the five variables identified as being potentially significant in being associated with both different experiences and effects of the Troubles, location and religion stand out. Indeed these are connected, given the high degree of spatial polarisation in the form of sectarian segregation in Northern Ireland, which is exacerbated in those areas where Troubles-related violence has been most pervasive. As indicated earlier, the sampling procedure was weighted to 'over-represent' those areas where death rates were highest. Unsurprisingly, the most intensive and pervasive experiences of the Troubles occurred here. Nevertheless, like many social phenomena, the pattern of violence in Northern Ireland has been extremely uneven.

The analysis of the five variables above suggests the following set of relationships.

Recommendations

These factors should be recognised both in developing and delivering compensatory policies as part of any peace settlement. The spatial distribution of the impact of the Troubles, and its particular effects on sub-sections of the population should be part of the considerations of service planners and providers. Moreover, this concentrated experience of violence should figure in the operationalisation of New Targeting Social Need.

In certain areas, the experience of violence has been collective and multidimensional (local paramilitaries, paramilitaries from the ‘other side’ and the security forces have all contributed). Consequently, it makes sense to think in terms of spatially targeted programmes both to alleviate the effects and to emphasise the targeting of social and economic reconstruction. Consideration must also be given to the impact of such concentration on local cultures, expectations and attitudes. Community programmes aimed at areas worst affected which assess local need, raise expectations and provide information and support for local problem solving might offer a fruitful beginning for some of these areas.

The particular role of families and social support networks in helping those affected by the Troubles, and consideration should be given to how this can best be supported and recognised. Clearly, most people do not seek professional help for the effects of the Troubles on them, and of those who have had help, the majority report immediate family as its best and most accessible source.

Beyond the immediate family, the importance of the voluntary and community sector, and general practitioners in the provision of help from outside the family also emerges from the findings of this study. The prevalence of the use of alcohol and prescribed medication as means of coping with the Troubles, particularly amongst those worst affected also emerges, and an examination of alternatives to the use of drugs and alcohol might be a fruitful avenue for exploration by service providers.

Evaluation and Directions for future work

This survey, was part of a larger study aimed at elucidating the experience and effects of the Troubles on people in Northern Ireland. We hope it provides a useful base-line and starting point for other work in this field. We are aware of a numbre of areas for further exploration.

Although we embedded a standard health measure (SF12) in the questionnaire, we have completed only a preliminary analysis of this here, due to difficulties in finding scores for the population for analysis purposes. In some ways we regret the choice of this instrument, since it has not been widely used (or used at all) in Northern Ireland, thus rendering our task of analysis more difficult. However, we will publish further analysis on this issue in future papers.

A second regret is that, in the process of editing the questionnaire, some of the questions designed to reflect the diagnostic criteria of the DSM-IV became edited and some were omitted altogether, requiring us to use less exact questions in the constructing of our Stress Indicator.

Finally, the survey has relied on interviewees reporting their memories of their experiences of the Troubles and their own assessment of the impact on them. The issue of the reliability of memory, and the issue of denial, which has been widely used in Northern Ireland and elsewhere as a coping mechanism in times of barely tolerable stress is also worth mentioning.

This survey can only report on what respondents remember, and what they do not now deny. Perhaps assessing the experience and the impact of events as terrible as armed conflict must always be an exercise in sailing among icebergs, where the danger of collision with what is not perceived makes us constantly nervous of shipwreck. We present this study with due nervousness, in the hope that it offers some useful insights and points of departure for our own and others’ further work.

References

Bell, P., Kee, C., Loughrey, R., Roddy, R.J., and Curran, P.S. (1988) "Post Traumatic Stress in Northern Ireland." Acta Psychiatr. Scand. 77: 166-169.

Curran, P.S., Bell, P., Murray, A., Roddy, R., and Rocke, L.C. (1990) "Psychological Consequences of the Enniskillen Bombing." British Journal of Psychiatry: 156: 479-482.

Diagnostic and Statistical Manual of the American Psychiatric Association. Fourth edition.

Fay, M.T., Morrissey, M., and Smyth, M. (1998) Northern Ireland’s Troubles: The Human Costs. London: Pluto.

Fraser, R.M., (1971) "The Cost of Commotion: An Analysis of the Psychiatric Sequelae of the 1969 Belfast Riots." Brit. J. Psychiat. (1971) 11, 237-64.

Fraser, R.M., Overy, R. Russell, J. Dunlap, R. and Bourne R. (1972) "Children and Conflict." Community Forum No 2 1972. Belfast: Community Relations Commission.

Lyons, H.A.( 1974) "Terrorists’ Bombing and the Psychological Sequelae." Journal of the Irish Medical Association. January 12, 1974. Vol 67, No 1.

Sutton, NI. (1994) An Index of Deaths from the Conflict in Ireland 1969-1993. Belfast: Beyond the Pale.

World Health Organisarion: International Classification of Diseases: Tenth edition.