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OBJECTIVES: Bride price is a widespread custom in many parts of the world, including in most countries in sub-Saharan Africa and parts of Asia. We hypothesised that problems relating to the obligatory ongoing remittances made by the husband and his family to the bride's family may be a source of mental disturbance (in the form of explosive anger and severe mental distress) among women. In addition, we postulated that problems arising with bride price would be associated with conflict with the spouse and family, poverty and women's preoccupations with injustice. DESIGN: A mixed-methods study comprising a total community household survey and semistructured qualitative interviews. SETTING: Two villages, one urban, the other rural, in Timor-Leste. PARTICIPANTS: 1193 married women participated in the household survey and a structured subsample of 77 women participated in qualitative interviews. RESULTS: Problems with bride price showed a consistent dose-effect relationship with sudden episodes of explosive anger, excessive anger and severe psychological distress. Women with the most severe problems with bride price had twice the poverty scores as those with no problems with the custom. Women with the most severe problems with bride price also reported a threefold increase in conflict with their spouse and a fivefold increase in conflict with family. They also reported heightened preoccupations with injustice. CONCLUSIONS: Our study is the first to show consistent associations between problems with bride price obligations and mental distress, poverty, conflict with spouse and family and preoccupations with injustice among women in a low-income, postconflict country.

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The present study examines key aspects of an emerging cycle of violence model as applied to conflict-affected countries. We focus specifically on the roles of intimate partner violence (IPV), consequent experiences of explosive anger amongst women, and associated patterns of harsh parenting. Between 2010 and 2011, we conducted a women-centred and culturally sensitive qualitative inquiry with 77 mothers drawn consecutively from a data-base of all adults residing in two villages in Timor-Leste. We over-sampled women who in the preceding whole of household survey met criteria for Intermittent Explosive Disorder (IED). Our methodology included in-depth qualitative interviews followed by a focus group with a comprehensive array of service providers. We used the NVivo software package to manage and analyse data. Our findings provide support for a link between IPV and experiences of explosive anger amongst Timorese mothers. Furthermore, women commonly reported that experiences of explosive anger were accompanied by harsh parenting directed at their children. Women identified the role of patriarchy in legitimizing and perpetuating IPV. Our findings suggest that empowering women to address IPV and poverty may allow them to overcome or manage feelings of anger in a manner that will reduce risk of associated harsh parenting. A fuller examination of the cycle of violence model will need to take into account wider contributing factors at the macro-level (historical, conflict-related, political), the meso-level (community-wide adherence to patriarchal norms affecting the rights and roles of women), and the micro-level (family interactions and gendered role expectations, individual psychological responses, and parenting). Longitudinal studies in post-conflict settings are needed to examine whether the sequence of male violence against women, mothers experience of explosive anger, and consequent harsh parenting contributes to risk of aggression and mental disorder in offspring, both in childhood and adulthood.

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INTRODUCTION: Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development. METHODS: A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice. RESULTS: Women with Intermittent Explosive Disorder (n = 184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X(2) (2) = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08-2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48-3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09-3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27-2.77); extreme poverty (OR 1.23, 95%, CI 1.08-1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35-3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger. CONCLUSIONS: Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development.

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OBJECTIVE: This paper reports on a study of the experiences of patients and carers discharged from the Townsville General Hospital into rural and remote communities in North Queensland. DESIGN: The findings presented in this paper are drawn from post-discharge in-depth, qualitative interviews of both patients and carers. RESULTS: The findings indicate the importance of examining the lived experience of both patients and carers in attempting to understand the impact of current discharge practices. CONCLUSION: We conclude that carers are providing the bulk of post-discharge care of patients - a difficult role in which the difficulties are exacerbated when the patient or the carer or both is a long way from the home community.

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