Abstract
War-torn children are particularly vulnerable through direct trauma exposure as well through their parents’ responses. This study thus investigated the association between trauma exposure and children’s mental health, and the contribution of parent-related factors in this association. A cross-sectional study with 263 Syrian refugee children-parent dyads was conducted in Turkey. The Stressful Life Events Questionnaire (SLE), General Health Questionnaire, Parenting Stress Inventory (PSI-SF), Impact of Events Scale for Children (CRIES-8), and Strengths and Difficulties Questionnaire were used to measure trauma exposure, parental psychopathology, parenting-related stress, children’s post-traumatic stress symptoms (PTSS), and mental health problems, respectively. Trauma exposure significantly accounted for unique variance in children’s PTSS scores. Parental psychopathology significantly contributed in predicting children’s general mental health, as well as emotional and conduct problems, after controlling for trauma variables. Interventions need to be tailored to refugee families’ mental health needs. Trauma-focused interventions should be applied with children with PTSD; whilst family-based approaches targeting parents’ mental health and parenting-related stress should be used in conjunction with individual interventions to improve children’s comorbid emotional and behavioural problems.
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References
Abidin RR (1990) Parenting Stress Index-Short Form. Pediatric Psychology Press, Charlottesville
Ahmadzadeh G, Malekian A (2004) Aggression, anxiety, and social development in adolescent children of war veterans with PTSD versus those of non-veterans. J Res Med Sci 9:231–234
Aiken LS, West SG, Reno RR (1991) Multiple regression: testing and interpreting interactions. Sage, London
Almqvist K, Brandell-Forsberg M (1997) Refugee children in Sweden: post-traumatic stress disorder in Iranian preschool children exposed to organized violence. Child Abuse Negl 21:351–366
Attanayake V, McKay R, Joffres M, Singh S, Burkle F Jr, Mills E (2009) Prevalence of mental disorders among children exposed to war: a systematic review of 7,920 children. Med Confl Surviv 25:4–19. https://doi.org/10.1080/13623690802568913
Banyard V, Williams L, Siegel J (2001) The long-term mental health consequences of child sexual abuse: an exploratory study of the impact of multiple traumas in a sample of women. J Trauma Stress 14:697–715
Bean T, Eurelings-Bontekoe E, Derluyn I, Spinhoven P (2004) Stressful life events (SLE): user’s manual. In: Centrum’45, Oegstgeest
Betancourt TS, Khan KT (2008) The mental health of children affected by armed conflict: protective processes and pathways to resilience. Int Rev Psychiatry 20:317–328. https://doi.org/10.1080/09540260802090363
Bronfenbrenner U (1977) Toward an experimental ecology of human development. Am Psychol 32:513. https://doi.org/10.1037/0003-066X.32.7.513
Chaney A, Carballedo A, Amico F, Fagan A, Skokauskas N, Meaney J, Frodl T (2014) Effect of childhood maltreatment on brain structure in adult patients with major depressive disorder and healthy participants. J Psychiatry Neurosci 39:50–59
Dalgaard N, Todd B, Daniel S, Montgomery E (2016) The transmission of trauma in refugee families: associations between intra-family trauma communication style, children’s attachment security and psychosocial adjustment. Attach Hum Dev 18:69–89
Dardas L, Ahmad M (2013) Coping strategies and mediators and moderators between stress and quality of life among parents of children with autistic disorder. Stress Health 31:5–12
Derluyn I, Broekaert E, Schuyten G (2008) Emotional and behavioural problems in migrant adolescents in Belgium. Eur Child Adolesc Psychiatry 17:54–62
Duraković-Belko E, Kulenović A, Dapić R (2003) Determinants of posttraumatic adjustment in adolescents from Sarajevo who experienced war. J Clin Psychol 59:27–40. https://doi.org/10.1002/jclp.10115
Durà-Vilà G, Klasen H, Makatini Z, Rahimi Z, Hodes M (2013) Mental health problems of young refugees: duration of settlement, risk factors and community-based interventions. Clin Child Psychol Psychiatry 18:604–623
Ellis BH, MacDonald HZ, Lincoln AK, Cabral HJ (2008) Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychol 76:184. https://doi.org/10.1037/0022-006X.76.2.184
Fazel M, Reed RV, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 379:266–282. https://doi.org/10.1016/S0140-6736(11)60051-2
Field A (2013) Discovering statistics using IBM SPSS statistics. Sage, London
Goldberg D, Williams R (1988) A user’s guide to the general health questionnaire. NFER-Nelson, Windsor
Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586
Hasanović M, Sinanović O, Pavlović S (2005) Acculturation and psychological problems of adolescents from Bosnia and Herzegovina during exile and repatriation. Croat Med J 46:105–115
Heptinstall E, Sethna V, Taylor E (2004) PTSD and depression in refugee children. Eur Child Adolesc Psychiatry 13:373–380
Hjern A, Angel B (2000) Organized violence and mental health of refugee children in exile: a six-year follow-up. Acta Paediatr 89:722–727
Higgins D, McCabe M (2000) Relationships between different types of maltreatment during childhood and adjustment in adulthood. Child Maltreat 5:261–272
Hodes M, Jagdev D, Chandra N, Cunniff A (2008) Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry 49:723–732. https://doi.org/10.1111/j.1469-7610.2008.01912.x
Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218. https://doi.org/10.1097/00006842-197905000-00004
Karim K, Tischler V, Gregory P, Vostanis P (2006) Homeless children and parents: short-term mental health outcome. Int J Soc Psychiatry 52:447–458. https://doi.org/10.1177/0020764006066830
Kendler K, Kuhn J, Prescott C (2004) Childhood sexual abuse, stressful life events and risk for major depression in women. Psychol Med 34:1475–1482
Kinzie JD, Sack WH, Angell RH, Manson S, Rath B (1986) The psychiatric effects of massive trauma on Cambodian children: I. The children. J Am Acad Child Psychiatry 25:370–376. https://doi.org/10.1016/S0002-7138(09)60259-4
Kinzie J, Sack W, Angell R, Clarke G, Ben R (1989) A three-year follow-up of Cambodian young people traumatized as children. J Am Acad Child Adol Psychiatry 28:501–504
Krešić Ćorić M, Klarić M, Petrov B, Mihić N (2016) Psychological and behavioral problems in children of war veterans with post traumatic stress disorder. Eur J Psychiatry 30:219–230
Loukas A, Zucker RA, Fitzgerald HE, Krull JL (2003) Developmental trajectories of disruptive behavior problems among sons of alcoholics. J Abnorm Psychol 112:119–131. https://doi.org/10.1037/0021-843X.112.1.119
Mels C, Derluyn I, Broekaert E, Rosseel Y (2010) The psychological impact of forced displacement and related risk factors on Eastern Congolese adolescents affected by war. J Child Psychol Psychiatry 51:1096–1104
Möhlen H, Parzer P, Resch F, Brunner R (2005) Psychosocial support for war-traumatized child and adolescent refugees: evaluation of a short-term treatment program. Aust N Zeal J Psychiatry 39:81–87. https://doi.org/10.1080/j.1440-1614.2005.01513.x
Montgomery E (2010) Trauma and resilience in young refugees: a 9-year follow-up study. Dev Psychopathol 22:477–489. https://doi.org/10.1017/S0954579410000180
Ozer S, Sirin S, Oppedal B (2016) Bahcesehir study of Syrian refugee children in Turkey. Norwegian Institute of Public Health, Oslo. https://www.fhi.no/globalassets/dokumenterfiler/moba/pdf/bahcesehir-study-report3.pdf. Accessed Dec 2017
Papageorgiou V, Frangou-Garunovic A, Iordanidou R, Yule W, Smith P, Vostanis P (2000) War trauma and psychopathology in Bosnian refugee children. Eur Child Adolesc Psychiatry 9:84–90. https://doi.org/10.1007/s007870050002
Punamäki RL, Palosaari E, Diab M, Peltonen K, Qouta SR (2015) Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: trauma, family-and child-related predictors. J Affect Disord 172:133–140
Qouta S, Punamäki RL, El Sarraj E (2003) Prevalence and determinants of PTSD among Palestinian children exposed to military violence. Eur Child Adolesc Psychiatry 12:265–272. https://doi.org/10.1007/s00787-003-0328-0
Qouta S, Punamäki RL, El Sarraj E (2005) Mother-child expression of psychological distress in war trauma. Clin Child Psychol Psychiatry 10:135–156. https://doi.org/10.1177/1359104505051208
Reed RV, Fazel M, Jones L, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet 379:250–265. https://doi.org/10.1016/S0140-6736(11)60050-0
Rousseau C, Drapeau A, Corin E (1998) Risk and protective factors in Central American and Southeast Asian refugee children. J Refug Stud 11:20–37. https://doi.org/10.1093/jrs/11.1.20
Sack WH, Clarke GN, Seeley J (1996) Multiple forms of stress in Cambodian adolescent refugees. Child Dev 67:107–116. https://doi.org/10.2307/1131689
Sirin S, Rogers-Sirin L (2015) The educational and mental health needs of Syrian refugee children. Migration Policy Institute, Washington DC. https://www.researchgate.net/profile/Selcuk_Sirin/publication/287998909_The_Educational_and_Mental_Health_Needs_of_Syrian_Refugee_Children/links/567ccd6c08ae19758384e4bf.pdf. Accessed Dec 2017
Smith M (2004) Parental mental health: disruptions to parenting and outcomes for children. Child Fam Soc Work 9:3–11. https://doi.org/10.1111/j.1365-2206.2004.00312.x
Smith P, Perrin S, Yule W, Hacam B, Stuvland R (2002) War exposure among children from Bosnia–Hercegovina: psychological adjustment in a community sample. J Trauma Stress 15:147–156. https://doi.org/10.1023/A:1014812209051
Smith P, Perrin S, Yule W, Rabe-Hesketh S (2001) War exposure and maternal reactions in the psychological adjustment of children from Bosnia–Hercegovina. J Child Psychol Psychiatry 42:395–404. https://doi.org/10.1111/1469-7610.00732
Sourander A, Helstelä L, Helenius H (1999) Parent-adolescent agreement on emotional and behavioral problems. Soc Psychiatry Psychiatr Epidemiol 34:657–663
Spinhoven P, Elzinga B, Hovens J, Roelofs K, Zitman F, van Oppen P, Penninx B (2010) The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders. J Affect Disord 126:103–112
Sveaass N, Reichelt S (2001) Refugee families in therapy: from referrals to therapeutic conversations. J Fam Ther 23:119–135. https://doi.org/10.1111/1467-6427.00173
Syria Regional Refugee Response (2016) Inter-agency Information Sharing Portal. http://data.unhcr.org/syrianrefugees/regional.php. Accessed Dec 2017
Thabet AA, Ibraheem A, Shivram R, Winter E, Vostanis P (2009) Parenting support and PTSD in children of a war zone. Int J Soc Psychiatry 55:226–237. https://doi.org/10.1177/0020764008096100
Thabet AA, Tawahina AA, El Sarraj E, Vostanis P (2008) Exposure to war trauma and PTSD among parents and children in the Gaza strip. Eur Child Adolesc Psychiatry 17:191. https://doi.org/10.1007/s00787-007-0653-9
Thabet AA, Vostanis P (1999) Post-traumatic stress reactions in children of war. J Child Psychol Psychiatry 40:385–391. https://doi.org/10.1111/1469-7610.00456
United Nations High Commissioner for Refugees (UNHCR) (2017) UNHCR Syria regional refugee response. http://data.unhcr.org/syrianrefugees/country.php?id=224. Accessed 14 Nov 2017
United Nations High Commissioner for Refugees (UNHCR) (2016) Global trends: forced displacement in 2015. http://www.unhcr.org/576408cd7.pdf. Accessed Dec 2017
Vostanis P (2014) Helping children and young people who experience trauma: children of despair, Children of Hope. Radcliffe Publishing, London
Vostanis P (2014) Meeting the mental health needs of refugee and asylum seekers. Br J Psychiatry 204:176–177
Vostanis P (2016) New approaches to interventions for refugee children. World Psychiatry 15:75–77
Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J, Spahovic D, Sclove S, Pavkovi I, Feetham S, Rolland J (2008) Evaluating a multiple-family group access intervention for refugees with PTSD. J Mar Fam Ther 34:149–164
Weine SM, Raina D, Zhubi M, Delesi M, Huseni D, Feetham S, Kulauzovic Y, Melmestein R, Campbell R, Rolland J, Pakvoic I (2003) The TAFES multi-family group intervention for Kosovan refugees: a feasibility study. J Nerv Ment Disord 191:100–107
Werner EE (2012) Children and war: risk, resilience and recovery. Dev Psychopathol 24:553–558
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We are grateful to all the families who took part in the study. Our sincere thanks to the two school principals and teachers for their kind support.
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This article is part of the focused issue ‘Mental health issues in refugees’.
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Eruyar, S., Maltby, J. & Vostanis, P. Mental health problems of Syrian refugee children: the role of parental factors. Eur Child Adolesc Psychiatry 27, 401–409 (2018). https://doi.org/10.1007/s00787-017-1101-0
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DOI: https://doi.org/10.1007/s00787-017-1101-0