Elsevier

Social Science & Medicine

Volume 200, March 2018, Pages 19-26
Social Science & Medicine

Pathways linking war and displacement to parenting and child adjustment: A qualitative study with Syrian refugees in Lebanon

https://doi.org/10.1016/j.socscimed.2018.01.009Get rights and content

Highlights

  • Qualitative study with Syrian refugee parents and children in Lebanon.

  • Analysis of parenting and child adjustment in war and displacement.

  • Daily stressors impair parenting behavior via distinct and interrelated pathways.

  • Argues for structural interventions alongside psychosocial and parenting support.

Abstract

Forcibly displaced children are at risk of a range of negative outcomes, yet little is known about how to support war-affected caregivers in promoting children's psychosocial resilience. The current study uses qualitative methods to examine the mechanisms underlying the effects of war and displacement on parenting and child adjustment in order to inform intervention development. In April and November 2016, group and individual interviews were conducted with 39 Syrian parents and 15 children in partnership with a humanitarian organization in Lebanon. Interviews were transcribed and analyzed using a grounded theory approach. Results show three interrelated pathways linking daily displacement stressors to various dimensions of parenting: (1) economic hardship prevents parents from meeting their children's basic needs and forces adaptation strategies that impair positive parent-child interactions; (2) parental psychological distress contributes to harsh parenting; and (3) perceptions and experiences of insecurity in the community results in increased parental control. Greater economic resources and social support emerged as potential protective factors for maintaining positive parenting despite exposure to war and displacement-related adversity. Our findings suggest that implementation of policies and programs to remove structural barriers to refugees' physical and economic security can have tangible impacts on parental mental health, parenting quality, and child psychosocial outcomes. Future research priorities include a stronger focus on the effects of war and displacement on family processes, taking into account interactions with the broader social, economic and political context.

Introduction

Forced displacement affects an estimated 28 million children across the world, yet research is limited on how to support war-affected caregivers in promoting children's psychosocial resilience (UNICEF, 2016). The importance of stable, nurturing parenting for positive child developmental outcomes has been established across diverse social, economic, and cultural contexts (Putnick et al., 2015). For refugee children, who have likely been exposed to potentially traumatic events and whose extended support structures have been disrupted, strong family relationships may be even more crucial as a source of protection and resilience (Masten and Narayan, 2012, Qouta et al., 2008, Betancourt et al., 2010, Sriskandarajah et al., 2015). Prospective, longitudinal studies in Sierra Leone, Afghanistan, and Pakistan demonstrate the “intergenerational impact of war,” in which caregiver and family variables such as parental mental health, family acceptance, and domestic violence have cascading effects on the next generation, predicting child mental health outcomes over and above individual predictors including trauma exposure (Betancourt et al., 2015, p. 1101; Panter-Brick et al., 2014). These studies reflect a recent shift away from the historical emphasis on the individual child's direct exposure to war events, towards a more integrated family perspective in which parenting and other family variables mediate the effects of armed conflict on child psychosocial outcomes (Timshel et al., 2017).

Qualitative studies in conflict-affected areas have found that the problems induced or exacerbated by war and persistent social and economic inequality have knock-on effects on parenting and family relationships. In Afghanistan, poverty and overcrowded housing led to frustration and anger among men and women, which in turn contributed to intimate partner violence and child maltreatment (Eggerman and Panter-Brick, 2010). The same study also found, however, that family unity and harmony were sources of strength and perseverance amidst unrelenting economic and social suffering. Similarly, in post-conflict Rwanda, family unity and good parenting were protective constructs described by HIV/AIDS-affected families as crucial to surviving difficult times (Betancourt et al., 2011). Other studies have shown how the effects of war on parenting and family dynamics are complex and multidimensional. Song et al. (2014) found that war trauma experienced by Burundian former child combatants was transmitted to the next generation via effects on parenting behavior and norms, parental psychological distress, and community stigma. In East Timor, qualitative findings suggest a “post-conflict cycle of violence” in which patriarchal values, combined with war-related psychological distress, contributed to male perpetration of intimate partner violence, which in turn increased mothers’ use of violence against children (Rees et al., 2015, p. 285).

In this study, we aim to further elucidate the mechanisms through which parenting is impacted by exposure to mass conflict. Using qualitative interviews with Syrian refugee parents and children in Lebanon, we examine the perceived effects of war and displacement on parenting and family functioning. The United Nations has called the war and resulting exodus from Syria “the biggest humanitarian and refugee crisis of our time” (UN, 2016). More than half of Syria's 22 million pre-war population has been displaced and over half of the refugee population is comprised of children, with nearly 75 percent under the age of 12 (UNOCHA, 2017). At the time of data collection in April 2016, there were 1,048,275 Syrian refugees registered with the UNHCR, almost one-fifth of the total Lebanese population (UNHCR et al., 2015). Onerous and costly residency renewal regulations issued by the Lebanese government in 2015 have resulted in many Syrian refugees losing their legal status, which in turn contributes to restrictions on movement, work, and access to basic services (Human Rights Watch, 2016). As refugees are officially prohibited from working in Lebanon, many resort to working in the informal sector where there is a high risk of exploitation and abuse (Verme et al., 2015).

Given the still nascent evidence base on the effects of war and displacement on parenting behavior, this study uses an emic approach to develop a conceptual model of parenting in war that is rooted in the lived experiences of Syrian refugees themselves. Our ultimate aim is to inform the development of parenting and family interventions that increase caregivers' capacity to protect and promote children's psychosocial wellbeing.

We used two theoretical frameworks, each with its unique but complementary perspective on transgenerational effects of adversity, to inform the interpretation and discussion of the conceptual model resulting from this study. First, the intergenerational transmission of trauma model posits that the experience of trauma in one generation influences the developmental outcomes of successive generations, mainly via the effects of post-traumatic stress disorder (PTSD) on parenting and family dynamics (Danieli, 1998). First investigated with survivors of the Holocaust and their families, the model has since been extended to other war-affected populations (Dekel and Goldblatt, 2008, van Ee et al., 2012, Catani, 2010). For example, in northern Uganda, male caregivers' PTSD symptom severity and female caregivers’ war trauma exposure increased both parental and child reports of maltreatment (Saile et al., 2014).

A second theoretical framework used in this study is the family stress model, which theorizes that economic stress is linked to child emotional and behavioral problems via parental mental health, marital conflict, and parental rejection and hostility (Conger et al., 1994). In contrast to the previous model, which is centered on the psychosocial fallout from the dramatic events of war, the family stress model emphasizes the more mundane but no less corrosive daily struggle to “get by.” This emphasis on daily stressors is particularly relevant to refugee settings characterized by multiple environmental stressors (Miller and Rasmussen, 2010). Despite differences in etiology and emphasis, both theoretical models present parenting and family dynamics as the main mechanism through which exposure to adversity results in negative life trajectories for subsequent generations. Together they capture how past exposure to traumatic events, combined with current economic and social stress, can impair parenting quality and ultimately result in negative child psychosocial outcomes.

Section snippets

Participant recruitment and sample characteristics

The study was conducted in partnership with the International Rescue Committee (IRC), a non-governmental organization (NGO) implementing economic, psychosocial, and educational programs for refugees and host communities in Lebanon. Data collection took place in April and November 2016 in the northern district of Hermel, where the partner NGO has an established child protection program, including a parenting skills intervention. Approximately 60 percent of refugee households in Hermel rely on

Results

Results show three pathways linking war-induced displacement stressors to various dimensions of parenting behavior including parental supervision and parent-child interaction, harsh parenting, and parental control. Diminished parenting quality, combined with exposure to war and displacement, contributed to a range of emotional and behavioral difficulties in children. Results suggest that greater economic resources and social support may be important protective factors for maintaining positive,

Discussion

This study aimed to understand the pathways through which war and displacement affect parenting and ultimately child psychosocial adjustment. To our knowledge, it is among only a few studies to trace the linkages between war and parenting in an ongoing humanitarian crisis. With this study, we aim to address the need for empirical evidence to inform the development of parenting interventions for conflict-affected populations (Murphy et al., 2017). Results show three interrelated pathways that

Acknowledgements

We are immensely grateful to the parents and children who shared their experiences with us. Sincere thanks to the staff of the International Rescue Committee in Lebanon, in particular Riwa Maktabi, Joelle Wakim, Mohammad Dalloul, Sara Sakr, Ali Idriss, Batoul Soukariyeh, Badr Houjairy, Ibrahiem Salloum, Anas Adawi, Rita Mikael, and Sara Mabger. We also thank Sandra Maignant and Jeannie Annan for their ongoing support. This study was funded by UNICEF, with additional support from the Council for

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