Pharmacists on the Frontline of Post-Conflict Mental Health: A Narrative Review of Community-Based and Intergenerational Approaches

"This work was conducted by the Student Research Committee of the School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences."

Abstract
Armed conflicts and humanitarian crises generate profound and long-lasting psychological impacts that extend far beyond immediate trauma, often affecting individuals, families, and communities across generations. This narrative review examines the multidimensional mental health consequences of natural disasters and wars (including post-traumatic stress disorder, depression, and anxiety) while highlighting the mechanisms through which trauma is transmitted intergenerationally. These effects are not limited to combatants but significantly impact civilians, particularly children, caregivers, and displaced populations.

In response to these challenges, the review synthesizes global evidence on community-based, scalable interventions that foster psychosocial resilience and are culturally contextualized. Case studies from Ethiopia, Ukraine, Gaza, and Pakistan illustrate the effectiveness of family-centered, culturally adapted approaches in reducing stigma and promoting stabilization. The paper places special emphasis on the role of non-specialist providers (especially pharmacists) who, despite their accessibility and trust within communities, remain underutilized in mental health systems.

Drawing on diverse crisis settings, the review argues for the strategic integration of pharmacists in mental health recovery, highlighting their contributions to medication management, psychoeducation, early screening, and logistical coordination. Despite their demonstrated impact in low- and middle-income countries, barriers such as limited psychiatric training, role ambiguity, and policy exclusion persist.

Ultimately, the article advocates for inclusive, task-shared models of mental health care that incorporate pharmacists as essential partners in rebuilding resilient and equitable post-crisis systems.

Keyword

1. Post-Conflict Mental Health
2. Community-Based Interventions
3. Pharmacist Involvement
4. Intergenerational Trauma
5. Task-Sharing Models

1. Introduction

Armed conflicts, natural disasters, and humanitarian crises result in profound disruptions to health systems and long-term psychological consequences for affected populations (1,2). Beyond the visible destruction of infrastructure and loss of life, such crises often precipitate an increase in mental health disorders, most notably post-traumatic stress disorder (PTSD), depression, anxiety, and substance use disorders(2,3). Research indicates that PTSD prevalence in some conflict-affected civilian populations can reach up to 50% (3), underscoring the scope of the mental health burden. Comparable figures have also been observed in recent emergencies, such as among civilians in Gaza and northern Ethiopia, where PTSD rates exceeded 50% and were accompanied by anxiety, depression, and psychosomatic distress linked to displacement, violence, and disrupted social networks (1,2).

Critically, these mental health effects are not confined to individuals directly involved in combat or traumatic events (2,4). Civilian populations, including displaced families, children, and caregivers, experience long-lasting psychological repercussions, which can also be transmitted across generations (2,4). This phenomenon, intergenerational trauma, raises essential considerations for post-war recovery frameworks that extend beyond individual clinical care to encompass family units and entire communities (2,5). Evidence from Liberia further illustrates how conflict-affected societies face enduring trauma exacerbated by weakened mental health systems and a lack of coordinated policy support, despite grassroots efforts and international collaboration(6).

In response to these challenges, global mental health strategies have progressively emphasized the integration of psychosocial, community-based, and multidisciplinary interventions (2,6). Among these, pharmacists have emerged as increasingly relevant yet underutilized actors (3,6). Positioned at the intersection of clinical care and community engagement, pharmacists are often the most accessible health professionals during crises (6). Their contributions span medication management, psychoeducation, early screening, and logistical support, particularly in low-resource or conflict-affected settings where mental health specialists are scarce (3). Moreover, in contexts where traditional social systems have eroded, such as in Ethiopia and Gaza, integrating frontline providers like pharmacists into mental health strategies may help reestablish trust, reduce stigma, and enhance the reach of scalable care (1,2).

This review article is structured around three thematic pillars that reflect current evidence and evolving practice in post-crisis mental health response:

• Psychological Consequences and Intergenerational Trauma – An overview of the mental health outcomes of war and crises in both civilian and military populations, including the mechanisms through which trauma is transmitted across generations.
• Community-Based and Psychosocial Interventions – A synthesis of non-clinical, scalable interventions aimed at restoring psychological well-being, with case examples from diverse conflict-affected settings.
• The Role of Pharmacists in Mental Health Recovery – A detailed exploration of how pharmacists have contributed to crisis response, with a particular focus on different countries, as well as emerging international best practices.

The following sections of this article elaborate on three core themes: the psychological and intergenerational impacts of war and crisis on affected populations; the range of effective community-based and psychosocial interventions implemented in post-crisis mental health recovery; and the current and emerging roles of pharmacists in delivering mental health services during and after humanitarian emergencies. By drawing on interdisciplinary evidence from peer-reviewed studies, this review aims to inform global mental health policy and advance a more inclusive, evidence-based understanding of pharmacist-led responses in post-crisis mental health systems.

2. Methodology

2.1 Review Design

This structured narrative review synthesized evidence on the psychological consequences of war and crises, with emphasis on collective and intergenerational trauma, post-conflict mental health, and the role of non-specialist providers (particularly pharmacists) in recovery efforts.

2.2 Search Strategy

A comprehensive search was conducted between July 2, 2025, and July 9, 2025, in PubMed, Scopus, Web of Science, and Google Scholar. Ten core keyword phrases were applied, individually and in combination, without database-specific syntax modifications:

1. “Collective trauma war”
2. “Intergenerational trauma conflict”
3. “PTSD in war-affected populations”
4. “Post-conflict psychological impact”
5. “Mental health service post-war”
6. “Community resilience war”
7. “refugee mental health pharmacist”
8. “Public awareness post-war mental health”
9. “Pharmacist and post-conflict mental health”
10. “Mental health education and postwar society”

No filters were applied for year, study design, or language during searches; however, only peer-reviewed, formally accepted articles were eligible for inclusion. Priority was ultimately given to more recent studies. Google Scholar results were screened sequentially until no new relevant studies appeared.

Backward citation tracking of selected articles yielded two additional eligible studies. No forward citation tracking or grey literature searches were undertaken.

2.3 Eligibility Criteria

Studies were included if they following criteria:

• Population: Pharmacists and populations affected in post-crisis contexts, including those impacted by armed conflict or natural disasters.
• Focus: Identification of mental health problems in these populations,  intergenerational trauma transmission, or the involvement of non-specialist providers (particularly pharmacists) in post-crisis care.
• Type: Primary research, case reports, or review articles.

Studies were excluded if they:

• Examined only specialist-led post-crisis teams.
• Addressed non-specialist roles or mental health without a defined crisis context.
• They were non-peer-reviewed or unpublished.

While the primary focus was on studies addressing pharmacists’ roles in post-crisis mental health care, a small number of included studies examined the global role of pharmacists in general (not limited to mental health) or described the broader phases of crisis response. These studies were retained when their content offered contextual insights or conceptual frameworks relevant to understanding pharmacists’ potential contributions in post-conflict settings.

2.4 Study Selection

References were managed in Zotero, with duplicates removed automatically and manually verified.

The selection process involved two main phases:

1. Initial screening (titles and abstracts):
   Each of the three reviewers assessed only the studies retrieved via their assigned keyword groups. Potentially relevant studies were retained, yielding 70 articles.
2. Full-text review with AI-assisted extraction:
   The abstracts of all 70 articles were processed using ChatGPT (GPT-4o, OpenAI; web interface; July 2025) to extract structured key points using a predefined set of fields (see Section 2.5). Based on these outputs, 30 studies were selected for full-text review by ChatGPT (see Section 2.6). Each full text was read in detail by one reviewer, with any uncertainties referred to another reviewer for resolution. Following consensus discussions, 17 studies met all inclusion criteria, including two identified through backward citation tracking.

2.5 Data Extraction from Abstracts

Extraction parameters included:

• Bibliographic details (title, authors, year, journal, country)
• Study design (quantitative, qualitative, mixed-methods, case study, review, experimental, longitudinal, cross-sectional)
• Population characteristics (type, size, demographics, location)
• Objectives
• Key findings by thematic domain (mental health, social, economic, cultural/identity)
• Methodological details (data collection tools, analysis methods)
• Interventions/recommendations
• Study limitations
• Relevance to review aims

ChatGPT produced the initial extraction from abstracts, which human reviewers validated and, when necessary, corrected against the full texts. Each reviewer checked the subset of studies assigned to them during the initial allocation.

2.6 AI-Assisted Study Prioritization

Prior to full-text review, ChatGPT (GPT-4o; OpenAI; web interface; July 2025) was employed to assist in prioritizing studies for inclusion. The model was provided with a structured prompt outlining the review’s scope and objectives, including:

1. Examination of post-war psychological outcomes such as PTSD, collective trauma, and intergenerational trauma among survivors, refugees, and affected communities.
2. Analysis of community-based and public mental health support mechanisms in post-conflict settings, particularly in low-resource or war-affected areas.
3. Exploration of the evolving role of pharmacists in interdisciplinary mental health care, public awareness, and access to medicines for vulnerable populations after war.

The input dataset consisted of one-paragraph summaries for each candidate study. The model was instructed to:

• Prioritize studies directly examining trauma in post-war populations, with emphasis on intergenerational aspects.
• Give preference to articles evaluating or recommending community-level or public health interventions in conflict-affected or resource-limited contexts.
• Assign the highest priority to work addressing pharmacists’ contributions, pharmaceutical care, or interdisciplinary collaboration in post-war mental health recovery.
• Exclude studies with only indirect relevance (e.g., general mental health without a war context, trauma unrelated to conflict, or purely pharmacological research lacking a psychosocial dimension).

Following this process, the model selected 25 core studies judged to offer the strongest support for the review’s multi-faceted aims, and additionally recommended five supplementary studies as theoretical or contextual background sources. The human author team subsequently reviewed all AI-generated selections to confirm alignment with the inclusion criteria and research objectives before proceeding to the next screening stage.

2.7 Manuscript Drafting Process Using AI Assistance

Following data extraction and synthesis, the manuscript was drafted in a structured, stepwise manner with the assistance of ChatGPT (GPT-4o; OpenAI; web interface; July 2025). The model was provided with validated summaries of the 17 peer-reviewed studies selected for inclusion (see Section 2.8).

AI-assisted drafting proceeded in discrete stages: the model produced one manuscript section at a time, beginning with the Introduction. After each section was generated, it was reviewed in full by the human author team, who provided feedback, implemented necessary edits, and formally approved the content before instructing the model to proceed to the next section.

In-text citations were inserted during the drafting process using the reference numbers assigned in the study selection phase, ensuring consistency with the final reference list. The AI model was instructed to refrain from speculation or inclusion of information beyond that contained in the provided summaries, thereby limiting content strictly to the validated evidence base.

Quality control measures included multi-stage human review of each AI-generated section for accuracy, clarity, coherence, and adherence to the predefined structure and formal academic tone. All modifications made during human review were documented, and only the corrected and approved versions were incorporated into the final manuscript.

This approach enabled efficient drafting while maintaining full human oversight; however, it carries inherent limitations. These include the potential omission of relevant nuances not captured in the provided summaries, dependence on the completeness of the input data, and the necessity for rigorous human verification to prevent the propagation of AI-generated errors.

2.8 AI-Assisted Generation of Comprehensive Article Summaries

To prepare the evidence base for synthesis, ChatGPT (GPT-4o; OpenAI; web interface; July 2025) was used to produce structured, comprehensive summaries of the 17 studies selected for final inclusion. The model was provided with the full text of each study in sequential sections (e.g., Introduction, Methods, Results, Discussion, Conclusion). For each section, the AI was instructed to extract and concisely present the most important scientific information (emphasizing key findings, core concepts, and critical methodological or contextual details) while omitting unnecessary repetition or extraneous narrative.

This process aimed to create clear, academically styled summaries that captured the essential content of each article without retaining its original structure. These summaries served as standardized inputs for the subsequent narrative synthesis stage.

To ensure reliability, all AI-generated summaries were reviewed in full by the human author team, who verified their accuracy against the source documents and edited them as necessary to preserve meaning and precision before incorporation into the integrated review framework.

2.9 Quality Considerations

No formal critical appraisal tool was applied. Minimum quality standards required that included studies:

• Were peer-reviewed.
• Reported a clear methodology.
• Defined populations and relevant outcomes.
• Provided sufficient detail for interpretation.

Quality judgments were made by all reviewers during the full-text assessment.

2.10 Methodological Limitations

As a narrative review without protocol registration, this study may be subject to selection bias and lacks the reproducibility of a systematic review. Initial screening involved non-overlapping reviewer assignments, which may have increased the risk of selection bias. The use of AI in data extraction carries a risk of omission or misinterpretation; these risks were mitigated through multi-stage human verification, full-text cross-checking, and consensus decision-making.

Also, the inclusion of studies describing the global role of pharmacists or outlining general crisis phases—without a specific mental health focus—may have introduced contextual heterogeneity. However, these were considered valuable for providing transferable concepts, broadening the understanding of pharmacists’ functions in diverse crisis scenarios, and informing policy discussions.

3. Results

3.1  Section I: Psychological Consequences and Intergenerational Trauma

3.1.1  Civilian and Military Populations: Differential and Shared Psychological Burdens

While substantial research has focused on veterans and military personnel, recent evidence highlights the extensive mental health burden borne by civilian populations (2,4,6). In war-affected civilian contexts, such as Ukraine, one study found that 24.4% of parents met criteria for PTSD, while 46.7% reported clinical depression and 24.2% anxiety (4). Children in the same context also exhibited high levels of psychological distress, with over 25% showing clinically relevant symptoms (4). In comparison, veterans and ex-combatants typically experience higher levels of chronic PTSD and emotional dysregulation, often aggravated by social isolation and re-integration challenges (7,8). These findings are consistent with data from Ethiopia, where 84.4% of identified cases in a conflict-affected community met criteria for PTSD (mostly among women) and were often accompanied by grief, anxiety, and psychosomatic symptoms (1).

(3)The shared feature across both groups is the disruption of core psychological functions (affect regulation, interpersonal trust, and cognitive stability), leading to reduced daily functioning and impaired relational dynamics (2,3,8). In both contexts, untreated trauma may foster long-term psychiatric morbidity and increased reliance on maladaptive coping strategies such as substance use (3,9).

3.1.2 Intergenerational Transmission of Trauma

A growing body of literature underscores the phenomenon of intergenerational trauma, wherein children of trauma-exposed individuals demonstrate elevated risk for psychological disturbances even when not directly exposed to the triggering events (2,4). Mechanisms underlying this transmission include parental emotional unavailability, inconsistent caregiving, negative cognitive schemas, and environmental stressors such as displacement and economic instability (4,8). Neurological studies also suggest that early trauma exposure in caregivers (especially mothers) may alter the neurobiological development of infants, affecting emotion regulation and stress responses across generations (5).

In the case of ex-military fathers with PTSD, qualitative interviews revealed patterns of emotional withdrawal, heightened vigilance, and perceived inadequacy in parenting roles. These behaviors often led to weakened familial bonds and increased psychological vulnerability in children (7).

The Ukrainian civilian context similarly illustrates bidirectional psychological influence: parents' PTSD, depression, and social isolation were significantly associated with increased rates of anxiety and behavioral dysregulation in their children, particularly those aged 7 to 17 (4). These findings highlight the reciprocal nature of trauma exposure within family systems. In conflict zones such as Gaza, similar intergenerational effects have been observed, with PTSD and depression in caregivers predicting behavioral disturbances, identity disruptions, and long-term mental health problems in children (2).

3. Conceptual Frameworks for Understanding Trauma Effects

The Cognitive-Behavioral Interpersonal Theory of PTSD (C-BIT) offers a useful framework to interpret these dynamics. According to C-BIT, PTSD symptoms affect interpersonal functioning through three primary channels (8):

• Behavioral Avoidance – Withdrawal from emotionally salient interactions or avoidance of trauma-related discussions.
• Negative Cognitions – Self-perceptions of incompetence or fear of emotional harm to loved ones.
• Emotional Dysregulation – Impaired modulation of anger, guilt, or anxiety in familial interactions.

These mechanisms not only inhibit recovery but also foster environments in which trauma is indirectly transmitted and sustained (5,8). Emerging studies further emphasize how emotional dysregulation in traumatized caregivers can disrupt mother-infant bonding, neurodevelopment, and attachment security, thereby reinforcing patterns of intergenerational vulnerability (5).

3.1.3 Risk and Protective Factors in Children

Children exposed to conflict-affected environments may experience disturbances in mood, behavior, sleep, learning, and physical health (1,2,10). The severity and type of outcome are influenced by numerous factors, including age, gender, displacement status, and caregiver mental health (4). Adolescents, in particular, are at heightened risk for internalizing symptoms such as depression and suicidal ideation (4).

Conversely, protective factors include stable caregiving, peer support, access to education, and community-based psychosocial programming. Importantly, when mental health services explicitly target both caregiver and child, outcomes tend to improve across generations. Multi-level interventions that address trauma simultaneously at the individual, familial, and community level have shown promise in mitigating these risks and restoring psychosocial functioning (10).

2.  Section II: The Hierarchy of Mental Health Interventions in Crisis Settings

The mental health response in emergencies typically follows a stepped-care or hierarchical model (9):

• Basic Services and Security: Access to shelter, food, protection, and safety—a prerequisite for any psychosocial stability.
• Community and Family Support: Interventions aimed at strengthening existing social structures, reestablishing routines, and facilitating peer or group support.
• Focused Non-Specialized Support: Delivery of structured psychosocial interventions by trained lay providers or paraprofessionals.
• Specialized Services: Care delivered by psychiatrists, psychologists, or psychiatric nurses for individuals with severe mental disorders.

This model allows for scalable care in low-resource settings and aligns with the Inter-Agency Standing Committee (IASC) Guidelines for mental health and psychosocial support in emergencies. Programs that follow this model have demonstrated positive outcomes in crisis settings (1,9).

1. Community- and Family-Centered Psychosocial Interventions

In post-conflict and crisis-affected settings, community-based and psychosocial interventions are recognized as critical components of the mental health response (1,6,9). These approaches are particularly relevant in low-resource settings where trauma is a shared community experience (1,3,6). They aim to stabilize individuals and communities, foster resilience, and create a foundation for more specialized mental health support if needed (1–3).

Moreover, Interventions that include both parents and children (rather than addressing them separately) are particularly effective in interrupting intergenerational trauma. Programs offering dyadic therapy, joint psychoeducation, and group counseling for displaced families have shown reductions in PTSD symptoms and behavioral issues (4). Similar outcomes were documented in Ethiopia, where group therapy and family-based psychoeducation for survivors of violence helped reduce stigma and rebuild emotional support networks (1).

Moreover, culturally adapted delivery is essential. Programs that align with local values, including traditional healing and involving community leaders, are more likely to gain acceptance. in Gaza, trauma-informed interventions embedded in religious and cultural rituals, such as collective mourning and traditional storytelling, have also been associated with higher engagement and perceived benefit (2).

2. The Role and Impact of Non-Specialist Providers in Mental Health Service Delivery during Crises

Given the shortage of psychiatrists and psychologists in many crisis-affected regions, non-specialist providers (including community health workers, teachers, and pharmacists) are essential in implementing psychosocial interventions. These providers, when appropriately trained, can deliver basic counseling, screen for distress, and facilitate referrals. Their involvement not only expands the reach of care but also increases trust within the community. In particular, research suggests that training local providers in psychological first aid and community-based trauma care can substantially reduce stigma and improve the sustainability of mental health programs (2,10).  

Multi-level interventions that incorporate school-based, family-based, and peer-group components (especially when delivered by trusted non-specialist community members) are increasingly seen as essential for achieving scalable and context-sensitive impact.

 However, evaluations also note the lack of longitudinal data to assess the sustained benefits of such programs  (10).

3.  Section III: The Role of Pharmacists in Mental Health Recovery

Among frontline responders, pharmacists have shown promise in expanding access to care (3). This section explores the expanded role of pharmacists in these settings, with a comparative view of country-specific practices and a proposed model for their systematic integration.

3.3.1 Pharmacists in the Mental Health Response Hierarchy

Within the established hierarchy of mental health interventions, pharmacists can engage meaningfully at multiple levels (3):

• Basic Service Level: Ensuring access to essential psychotropic medications; managing pharmaceutical logistics during emergencies.
• Community and Family Support Level: Conducting medication literacy sessions and addressing stigma through patient education.
• Focused Non-Specialized Support: Participating in screening for medication-related mental health symptoms (e.g., side effects, adherence issues).
• Specialized Services Support: Collaborating with psychiatrists in treatment optimization and monitoring of therapeutic outcomes.

In Jordan, community pharmacists played a vital role in delivering home-based care to Syrian refugees. Working in tandem with health professionals, pharmacists contributed to medication therapy management, significantly improving treatment adherence and symptom control (66.8% success rate) among patients with chronic conditions (11).

Following the 2005 earthquake, pharmacists were engaged in emergency logistics under WHO protocols. They also participated in mobile care units to distribute medicines and provide health education to affected communities. Their involvement in both pharmaceutical supply chain management and public health training helped bridge gaps in care access during crisis conditions (11).

This multidimensional involvement underscores that pharmacists, particularly when embedded in interdisciplinary teams and trained in trauma-informed practice, can significantly augment access, adherence, and community trust during crisis recovery.

2. Phase-Based Framework of Pharmacists’ Roles in Mental Health During Crises

• Initial Response Phase
  Pharmacists assess the immediate psychotropic medication needs of affected populations, coordinate closely with relief organizations and the World Health Organization (WHO), and ensure continuity within disrupted pharmaceutical supply chains. Their timely intervention prevents treatment interruptions and facilitates early access to essential medications (9).
• Stabilization Phase
  During this phase, pharmacists actively dispense psychiatric medications while providing psychoeducation to patients regarding adherence, potential side effects, and the importance of continued treatment. They also assist in non-specialist mental health screenings using validated tools (e.g., GAD-7, PHQ-9), facilitating early identification and referral of high-risk individuals (3).
• Recovery Phase
  Pharmacists collaborate with mental health teams in case management and ongoing monitoring of therapeutic responses. They offer culturally sensitive counseling on psychotropic use and engage families to promote medication adherence and reduce stigma. Their role helps bridge clinical care with community-level psychosocial recovery (3).
• Resilience-Building Phase
  Through mental health campaigns and integration into local planning, pharmacists play a pivotal role in building sustainable psychosocial systems. They train pharmacy staff and students in psychological first aid and integrate pharmaceutical services into broader community health planning (13).

2. Challenges to Full Integration

Despite demonstrated contributions, several obstacles hinder pharmacists from realizing their full potential in mental health care (3) :

• Limited psychiatric training in pharmacy curricula  
• Ambiguity of professional scope in interdisciplinary mental health teams
• Persistent stigma around mental illness among both patients and providers
• Policy vacuum on pharmacist engagement in psychological first aid and triage

 This limitation has been similarly highlighted in prior studies (9,11,12), which emphasize that in the absence of longitudinal supervision and well-defined task-sharing protocols, pharmacists often remain at the margins of sustainable intervention planning. To address these, training frameworks must be expanded to include psychopharmacology, mental health communication, and trauma care protocols, especially in countries with recurring humanitarian emergencies (3).

4. Discussion

Despite growing recognition of the complex psychological consequences of war and humanitarian crises, significant challenges remain in operationalizing effective and equitable mental health responses. These challenges span service delivery, workforce integration, and research gaps, particularly in low- and middle-income countries (LMICs), where crises often intersect with systemic healthcare vulnerabilities (6).

1. Structural Gaps in Mental Health Infrastructure

A recurring limitation in crisis-affected regions is the lack of scalable mental health infrastructure. This includes insufficient numbers of trained mental health professionals, limited access to psychotropic medications, and inadequate systems for early identification and long-term support (3). Even in countries with established primary care systems, the integration of mental health services remains fragmented, especially in rural areas or during large-scale emergencies (12,14).

Additionally, children and caregivers in post-war environments frequently experience psychological distress but remain underserved. In Ukraine, despite high prevalence rates of PTSD and depression, fewer than 10% of children with psychological symptoms received appropriate care. Similar disparities are seen across multiple settings due to workforce shortages, funding gaps, and societal stigma (4).

2. Fragmented Role of Pharmacists in Mental Health Systems

While pharmacists have contributed meaningfully to mental health response in various settings, their role remains inconsistently defined and unevenly implemented across countries (3,9,11). In LMICs, pharmacists are often deployed during emergencies but are rarely included in strategic mental health planning or interdisciplinary care protocols (9,14).

Challenges include:

• Educational gaps: Most pharmacy programs do not include sufficient training in psychopharmacology or trauma-informed care (9,12)
• Scope ambiguity: Without clear policy guidelines, pharmacists may be underutilized or excluded from mental health teams (14,15).
• Systemic exclusion: Pharmacists are often omitted from government-level mental health frameworks and disaster preparedness plans (9,14,15).

Analysis from WHO regional studies has emphasized that scalable task-sharing models, especially those including pharmacists, require not only training but also formal inclusion in national emergency response plans to ensure sustainability and legitimacy (16).

3. Underdeveloped Approaches to Intergenerational Trauma

Although studies confirm that trauma can be transmitted across generations, there remains a lack of structured interventions targeting family systems (5,17). Most programs treat children or caregivers in isolation, despite evidence that addressing both concurrently yields better Outcomes (8).

Furthermore, the literature is dominated by data from high-income countries and male-dominated military samples, leading to a gap in understanding trauma among (7,8):

• Female caregivers and veterans

• Ethnic and religious minorities

• Children with special developmental needs

Expanding inclusivity in both research and program design is crucial to ensure relevance and effectiveness across cultural contexts. These challenges underscore the need for culturally adapted and family-centered mental health interventions that are responsive to the social realities of displacement contexts.

4. Sustainability and Scalability of Interventions

While many psychosocial programs show promise during pilot phases or in response to high-profile emergencies, long-term sustainability remains a concern. Funding instability, staff burnout, and political disengagement often lead to the discontinuation of services, leaving affected populations without follow-up care (3,11). In addition, programmatic fragmentation and donor-driven priorities frequently distort mental health system-building efforts, a trend documented in several post-conflict recovery contexts, including Sri Lanka and Liberia (6).

To ensure impact, interventions must be:

• Institutionalized within national health systems
• Linked to longitudinal follow-up mechanisms
• Designed with local workforce development in mind

Task-sharing approaches (empowering non-specialist providers including pharmacists, community health workers, and educators) represent a scalable path forward, but require investment in training, supervision, and role clarity. WHO's global mental health action plan emphasizes the importance of integrated, multi-tiered systems in which pharmacists are embedded as part of frontline response teams (16).

5. Conclusion

The mental health consequences of war, disaster, and humanitarian crises extend well beyond the acute phase of conflict (2,10). They manifest in long-term psychological disorders, disrupt family systems, and perpetuate cycles of trauma across generations (5,17). This review has underscored the widespread impact on both military and civilian populations (7,8,10), the crucial role of community-based interventions in rebuilding psychosocial resilience (1,10), and the underexplored yet vital contribution of pharmacists in the mental health care continuum (3,9,11,16).

Evidence shows that intergenerational trauma is a measurable and pervasive outcome of crisis exposure affecting parenting behaviors, child development, and community cohesion. Community-based interventions, when designed to be culturally relevant and family-centered, can interrupt this cycle. Yet, the global health community continues to underutilize scalable, task-shared approaches that leverage the accessibility and trust vested in frontline providers like pharmacists. Case studies from Ethiopia, Gaza, and Sri Lanka highlight that these providers are often among the few consistent health actors in fragile settings, and their exclusion from long-term planning undermines both system resilience and equity(1,2,5,11,13).

Across multiple LMICs, pharmacists have demonstrated meaningful contributions to recovery efforts. Their roles span from medication management and education to psychosocial support and system-wide continuity of care (3,9,11). However, realizing this potential requires reform in education, policy inclusion, and interprofessional collaboration (12). As the WHO and other global bodies emphasize, embedding pharmacists into integrated, community-based care networks is both feasible and urgently needed (16).

To build resilient mental health systems in post-crisis settings, stakeholders must adopt integrated models of care that bridge pharmacologic and psychosocial domains, address systemic exclusions, and center the needs of families and communities. The future of post-war mental health recovery lies not only in clinical advancements but in the strategic engagement of all health actors, including those whose contributions have too often gone unrecognized. Empowering pharmacists and other non-specialist providers through training, inclusion, and structured collaboration offers a path toward sustainable, equitable mental health care in conflict-affected societies worldwide (3,10,11,16).

6. Recommendations

To advance evidence-based, equitable, and integrated mental health responses in crisis contexts, we propose the following:

• Expand training programs for pharmacists in mental health care, especially in psychotropic medication management and psychological first aid (3,9).
• Develop national guidelines that clearly define pharmacist roles in disaster and post-disaster mental health systems (9,16).
• Implement integrated, family-centered models to address intergenerational trauma holistically (5).
• Enhance cross-sector partnerships to support multi-level psychosocial interventions, including schools, religious organizations, and civil society actors (1,10).
• Invest in local research to generate culturally grounded data on what works in diverse conflict-affected populations (2,6)

7. References

1.        Yigzaw N, Hailu T, Melesse M, Desalegn A, Ezezew H, Chanie T, et al. Comprehensive mental health and psychosocial support for war survivors at Chenna Kebele, Dabat woreda, North Gondar, Ethiopia. BMC Psychiatry. 2023 Mar 16;23(1):172.

2.        Aqtam I. A narrative review of mental health and psychosocial impact of the war in Gaza. East Mediterr Health J. 2025 Mar 4;31(2):89–96.

3.        Alsomali SS, Sinan RT, Eshaq MI, Almalki MN, Alzahrani FS, Alrobayee RA, Alotaibi AA, Alsofiany AA, Algabbass AA, Alqarni10 AA, Rakan GA. Mental Health Interventions by Pharmacists During Disasters and Crises. Journal of International Crisis and Risk Communication Research. 2024;7(S12):1212.

4.        Naeem A, Sikder I, Wang S, Barrett ES, Fiedler N, Ahmad M, et al. Parent-child mental health in Ukraine in relation to war trauma and drone attacks. Compr Psychiatry. 2025 May;139:152590.

5.        Perez LM. Intergenerational Dynamics of Trauma. J Infant Child Adolesc Psychother. 2009 Dec 16;8(3–4):156–68.

6.        Patterson AS, Clark MA, Rogers AV. Network power and mental health policy in post-war Liberia. Health Policy Plan. 2024 May 15;39(5):486–98.

7.        Sturgeon M, Burgess GH, Murphy D. A qualitative exploration of the parenting experiences of ex-military fathers diagnosed with post-traumatic stress disorder (PTSD). J Fam Stud. 2023 Sept 3;29(5):2408–29.

8.        Creech SK, Misca G. Parenting with PTSD: A Review of Research on the Influence of PTSD on Parent-Child Functioning in Military and Veteran Families. Front Psychol. 2017 June 30;8:1101.

9.        Rasheed H, Nawaz HA, Rao AZ, Bukhari SKS. Role of Pharmacists in Responding to Humanitarian Crisis.

10.        Betancourt TS, Meyers-Ohki SE, Charrow AP, Tol WA. Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care. Harv Rev Psychiatry. 2013;21(2):70–91.

11.        Bisher MAY, Alotaibi M, Lubbad MY, Alshamrani FA, Alotaibi M, Alharbi FM, et al. A Narrative Review of the Role of Pharmacists in Humanitarian Crises: Supporting Public Health and Ensuring Medication Access.

12.        Davis B, Qian J, Ngorsuraches S, Jeminiwa R, Garza KB. The clinical impact of pharmacist services on mental health collaborative teams: A systematic review. J Am Pharm Assoc. 2020 Sept;60(5):S44–53.

13.        Uren H, O’Mathúna D, Weinstein ES, Herbert TL. Roles, Skills, and Knowledge Requirements of Clinical Pharmacists in Disaster or Emergency Response Teams: A Scoping Review. Disaster Med Public Health Prep. 2024;18:e340.

14.        Azhar S, Hassali MA, Ibrahim MIM, Ahmad M, Masood I, Shafie AA. The role of pharmacists in developing countries: the current scenario in Pakistan. Hum Resour Health. 2009 Dec;7(1):54.

15.        Inoue Y, Takikawa M, Morita Y, Takao K, Kanamoto I, Sugibayashi K. A comparison of pharmacists’ role functions across various nations: The importance of screening. Res Soc Adm Pharm. 2016 Mar;12(2):347–54.

16.        غفاری م, چراغعلی ع, شریف نیا سا, زارعی ابرقویی سم, پورحیدری غ. تبیین نقش و جایگاه داروسازان در نظام بهداشت و درمان نیروهای مسلح ایران. طب نظامی [Internet]. 2022 Oct [cited 2025 Aug 6];23(12). Available from: https://doi.org/10.30491/JMM.23.12.925

17.        Yehuda R, Lehrner A. Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry. 2018 Oct;17(3):243–57.