The 3P Model and How Conflict Breaks Civilians Down Over Time

Most frameworks for understanding mental health in conflict zones focus on the moment of attack. The explosion, the displacement, the loss. What they tend to underestimate is everything that came before, and everything that keeps grinding afterward. The 3P model, a clinical framework organizing illness into predisposing, precipitating, and perpetuating factors, offers a more honest account of how wartime conditions create, trigger, and maintain distress and disease in civilian populations (Wright et al., 2019; Sleight et al., 2022; Warren et al., 2024). Applied to civilians living under bombardment, it reframes helplessness not as a personality deficit but as a predictable outcome of layered, intersecting forces operating across time.

The first layer is what civilians bring into the war with them. Predisposing factors are the baseline vulnerabilities present before any conflict begins, including genetic predisposition, temperament, prior adversity, chronic illness, and social position (Wright et al., 2019; Warren et al., 2024). Early childhood trauma, poverty, prior maltreatment, and family mental illness all increase vulnerability to later war-related distress and disease (Isarinade et al., 2025; Calam, 2017). A civilian who enters a conflict already carrying unresolved trauma, food insecurity, or limited social support is not starting from the same position as someone with stable resources and an intact support network. The war hits everyone, but it does not hit everyone equally, and the predisposing layer is a significant reason why (Isarinade et al., 2025; Calam, 2017). In children especially, early adversity combined with war-related threat can become biologically embedded, increasing lifelong risk for chronic physical and mental illness well beyond the conflict period itself (Isarinade et al., 2025; Clarkin, 2019; Calam, 2017). This means the psychiatric consequences of war are being written into developing bodies before the bombs fall, and the war simply accelerates what vulnerability had already begun.

The second layer is the acute trigger. Precipitating factors are the events that cause the sharp onset or worsening of symptoms, and in wartime these are neither subtle nor rare (Wright et al., 2019; Sleight et al., 2022). Direct exposure to bombardment, forced displacement, family separation, food and water insecurity, and the collapse of health and sanitation systems all function as precipitating events for civilian mental and physical deterioration (Miller & Rasmussen, 2024; Isarinade et al., 2025; Mohylnyk et al., 2023; Marou et al., 2024; Goniewicz et al., 2021). Conflict dramatically increases infectious disease risk through disrupted sanitation, overcrowded shelters, collapsed healthcare infrastructure, and interrupted vaccination programs, meaning that physical illness compounds psychiatric distress in ways that are rarely addressed as a unified problem (Marou et al., 2024; Goniewicz et al., 2021; Mohylnyk et al., 2023). For civilians under multi-front bombardment, the precipitating layer is not a single event. It is a sustained accumulation of acute stressors arriving faster than any individual or community can metabolize them. Ecological models of conflict mental health have shown that both direct war violence and ongoing social-environmental stress drive distress, with daily stressors mediating much of war's long-term psychiatric impact (Miller & Rasmussen, 2024). The precipitating layer in modern urban conflict is less a discrete incident and more a continuous assault on every system a civilian depends on to survive.

The third layer is arguably the most clinically neglected. Perpetuating factors are the ongoing conditions that keep problems entrenched and prevent recovery, even after acute events have passed (Wright et al., 2019; Sleight et al., 2022; Warren et al., 2024). For civilians in conflict zones these include prolonged displacement, continued insecurity, crowded and unsanitary housing, disrupted schooling and employment, persistent infection risk, repeated trauma exposures, and the near-total absence of mental health support (Miller & Rasmussen, 2024; Isarinade et al., 2025; Mohylnyk et al., 2023; Marou et al., 2024; Clarkin, 2019; Calam, 2017). This is where the 3P model adds something that snapshot prevalence studies cannot. A survey measuring PTSD rates six months after displacement captures a moment. The 3P framework asks why those rates remain elevated at five years, at ten years, at a generation later, and the answer is almost always found in the perpetuating layer. Miller and Rasmussen (2024) followed conflict-affected populations fifteen years after active hostilities and found that ongoing daily stressors, not just war exposure history, continued to drive psychiatric symptoms. The war had ended. The perpetuating conditions had not.

The practical implications of this framework are worth stating plainly. Identifying high-risk groups with significant predisposing vulnerabilities, including very young children and those with prior trauma or chronic illness, allows for early targeted protection and monitoring before acute deterioration occurs (Isarinade et al., 2025; Calam, 2017). Rapid responses to precipitating events, restoring safety, reunifying families, and securing access to food, water, and infection control, can blunt acute psychiatric and physical impact if deployed quickly enough (Miller & Rasmussen, 2024; Mohylnyk et al., 2023; Marou et al., 2024; Goniewicz et al., 2021). Long-term programs addressing the perpetuating layer must reduce daily stressors through stable housing, employment, schooling, ongoing healthcare, and sustained psychosocial support, because without attention to perpetuating conditions, even excellent acute interventions produce short-lived gains (Miller & Rasmussen, 2024; Isarinade et al., 2025; Calam, 2017).

What the 3P model ultimately clarifies is that civilian helplessness in wartime is not a response to a single moment. It is the cumulative product of pre-existing vulnerability meeting acute catastrophe and then being held there by conditions that never allow recovery to begin. Addressing the mental health crisis of civilians in conflict zones requires responding to all three layers simultaneously, not sequentially, and not only during the period when the world is paying attention.

References

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