Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches

Coming of age in war: Early life adversity, age at menarche, and mental health

Armed conflict and forced migration (ACFM) represent a set of extreme environments that are increasingly common for children and adolescents to experience. Adolescence may constitute a sensitive period (puberty and psychoneurological maturation) through which ACFM adversity leaves a lasting mark. Adolescence has become a focal point for analysis and intervention as it relates to the effects of early life adversity on puberty, linear growth, and mental health. Research in public health and psychological science suggests early life adversity (ELA) may accelerate puberty, heightening risks for mental health disorders. However, it is not well substantiated whether ACFM-derived adversities accelerate or delay relative pubertal timing. Secondly, ACFM provides salient context through which to probe the relationships between nutritional, psychosocial, and demographic changes and their respective impact on puberty and mental health. We conducted a narrative review which 1) examined constructions of early life adversity and their proposed influence on puberty 2) reviewed empirical findings (n = 29 studies, n = 36 samples) concerning effects of ACFM ELA on age at menarche and 3) discussed proposed relationships between early life adversity, puberty, and mental ill-health. Contrary to prior research, we found war-derived early life adversity was more consistently associated with pubertal delay than acceleration and may exert counterintuitive effects on mental health. We show that ELA cannot be operationalized in the same way across contexts and populations, especially in the presence of extreme forms of human stress and resilience. We further discuss the ethics of puberty research among conflict-affected youth.

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

Prevalence and correlates of emotion dysregulation among children and adolescents in Lebanon: results from a National Survey

BACKGROUND

Data on Emotion Dysregulation among youth in Lebanon is scarce. Given that Emotion Dysregulation is associated with psychopathology and has a negative impact on youth outcomes, there is a need to better understand the prevalence, clinical and demographic correlates of Emotion Dysregulation.

METHODS

This study is a secondary analysis of the Psychopathology in Children and Adolescents in Lebanon Study which recruited 1517 youth and one parent from a nationally representative sample. Participants completed The Screen for Child Anxiety Related Emotional Disorders, Mood and Feelings Questionnaire, Strengths and Difficulties Questionnaire, Peer Relations Questionnaire, Conflict Behavior Questionnaire (CBQ).Parents completed a sociodemographic questionnaire and the General Health Questionnaire (GHQ). The Strengths and Difficulties Questionnaire-Dysregulation Profile was used to measure Emotion Dysregulation.

RESULTS

The prevalence of Emotion Dysregulation was 11.26% among children aged 5 to < 8 years, 9.40% among children aged 8 to < 12 years and 6.60% among those older than 12 years. Emotion Dysregulation was associated with psychopathology across age groups and a number of correlates were identified. In the final regression models, among children aged 5 to < 8 years; Emotion Dysregulation was associated with lower odds of father employment (OR = 0.235;CI[0.078,0.704]). For those aged 8 to < 12 years old, Emotion Dysregulation was associated with acceptable school performance (OR = 2.246,CI[1.209,4.173]) as opposed to a good school performance, having a chronic physical illness (OR = 2.962; CI [1.495,5.867)], and higher parental GHQ scores (OR = 1.034;CI [1.010,10.58)] indicating worse parental mental health. Adolescents aged 12 years and older who screened positive for Emotion Dysregulation were more likely to be younger (OR = 0.688, CI[0.527,0.899]), be a bully (OR = 2.467;CI[1.036,5.875] and to have higher parental CBQ scores (OR = 1.092;CI [1.011,1.180]), indicating worse parent-child conflict. Youth who screened positive for emotion dysregulation were more likely to seek psychiatric care than their counterparts who screen negative for emotion dysregulation.

CONCLUSION

Age, school performance, parental mental health, parental conflict, chronic physical illness and bullying emerge as important correlates of Emotion Dysregulation. Findings add to the limited data on Emotion Dysregulation in Lebanon and the region and are a first step towards developing intervention and prevention strategies.

War exposure and changes in eating behaviours in Ukrainian school-aged children: A cross-sectional online survey

The war in Ukraine has exposed children to extremely high levels of acute and chronic stressors, which can impact their eating behaviour (EB). We aimed to determine the prevalence of war-induced, stress-related disruptions in EB of Ukrainian children. We conducted a cross-sectional online survey among parents of 5- to 17-year-old children, who had experienced the war in Ukraine in February-May 2023. Guardians reported their child's various war exposure changes in EBs using a modified version of the Child Eating Behaviour Questionnaire. We assessed associations between total and medium-term EB changes and age, sex, and war exposure using bivariate correlations and χ2 tests. Logistic regression models were fitted to explore the associations between socio-demographic factors, war exposure and frequency of EB changes. Of the 4854 children, 63% had changes in EBs during the war. The most common EB changes included food cravings (38%), food fussiness (37%), and aversion to certain foods (29%). Of the reported EB changes, 40% were medium-term, lasting over a month, and related to altered attitudes towards food. Food insecurity (adjusted OR 2.35, 95% CI: 1.76-3.14), and displacement (internally 2.01, 1.19-3.42) emerged as the most influential determinants of medium-term EB changes. The findings underscore a significant and robust association between war-related exposures and an increased risk of frequent EB changes. As healthy EBs are learned during childhood and have been shown to track into adulthood, the identified disruptions in EB may have medium-term consequences for the physical and mental health of Ukrainian children.

War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms

This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANOVA indicating a significant impact of female gender in civilians only. A hierarchical regression indicated that moral injury is a predictor of PTSD symptoms in both active-duty and civilian student groups. However, previous family trauma of genocide is associated with PTSD symptoms in active soldiers only. The findings of the current study could contribute insights for clinical practice for combatants and civilians during the current war.

Coping Mechanisms and Posttraumatic Stress Exhibited by Children in Areas of Yemen's Armed Conflict in Southern Saudi Arabia

This study is an attempt to explore war-related trauma, its stressful effects, and the coping strategies of Saudi schoolchildren. The authors hypothesized that children exposed to war-related trauma will show higher levels of PTSD, and that those with higher levels of PTSD symptoms use more maladaptive coping strategies. The study describes the correlation between traumatic events and posttraumatic stress disorder (PTSD) as well as coping strategies. Five hundred twenty-seven intermediate and high school students, 12 to 18 years old, living in the conflict zone in southern Saudi Arabia completed three standardized self-reported scales: the War Zone Traumatic Events Checklist, the Child PTSD Symptom Scale, and the Children's Coping Strategies Checklist. Each participating student was randomly chosen. Analysis was based on two groups: the high-PTSD symptoms group (182 children) and the low-PTSD symptoms group (345 children). The study was conducted between September 2020 and April 2022 while the war was ongoing as part of an ongoing larger study. Children exposed to war-related traumatic events exhibited greater prevalence rates for PTSD. The children reported high levels of PTSD symptoms and applied a variety of coping strategies to manage related stress. Participants rarely reported that psychological or educational interventions had been used to manage the war-related traumatic experiences and PTSD or to improve related coping styles. The results are discussed in the context of mental health services needed for children in the conflict zone. To bridge the gap between health care services and the needs of children with PTSD, and for better understanding and interventions, health professionals are invited to develop a biopsychosocial model that identifies the risks of PTSD related to exposure to war-related traumatic events in school-aged children and, hence, provide a multidisciplinary intervention program that educates, encourages, and supports teachers and parents in following medical recommendations and goals.

Fetal exposure to the Ukraine famine of 1932-1933 and adult type 2 diabetes mellitus

The short-term impact of famines on death and disease is well documented, but estimating their potential long-term impact is difficult. We used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the relation between prenatal famine and adult type 2 diabetes mellitus (T2DM). This ecological study included 128,225 T2DM cases diagnosed from 2000 to 2008 among 10,186,016 male and female Ukrainians born from 1930 to 1938. Individuals who were born in the first half-year of 1934, and hence exposed in early gestation to the mid-1933 peak famine period, had a greater than twofold likelihood of T2DM compared with that of unexposed controls. There was a dose-response relationship between severity of famine exposure and increase in adult T2DM risk.

A full-scale Russian invasion of Ukraine in 2022: Resilience and coping within and beyond Ukraine

The study examined the resilience and coping of samples from Ukraine and five nearby countries during the war in Ukraine. The research focused on (1) the levels of community and societal resilience of the Ukrainian respondents compared with the populations of five nearby European countries and (2) commonalities and diversities concerning coping indicators (hope, well-being, perceived threats, distress symptoms, and sense of danger) across the examined countries. A cross-sectional study was conducted, based on data collection through Internet panel samples, representing the six countries' adult populations. Ukrainian respondents reported the highest levels of community and societal resilience, hope, and distress symptoms and the lowest level of well-being, compared to the population of the five nearby European countries. Hope was the best predictor of community and societal resilience in all countries. Positive coping variables, most notably hope, but also perceived well-being are instrumental in building resilience. While building resilience on a societal level is a complex, multifaceted task, various dimensions must be considered when planning actions to support these states. It is essential to monitor the levels of resilience, during and following the resolution of the crisis, both in Ukraine and in the neighboring countries.

Neurotic Disorders in Children and Adults Under Social Stress Neurosis in Kids and Adults: Social Stress

ABSTRACT

The relevance of the research subject is to explore the neurotic disorders that arise in people affected by the Russian-Ukrainian war and who witness violence and war crimes. The purpose of the research is to reflect the specific features of the mental reaction of children and adults to military actions as an example of global social stress. Bibliographic, bibliosemantic, and statistical research methods were used in the research. Since the beginning of the full-scale invasion, the number of patients with prolonged depression and schizophrenia has increased, and neurotic disorders has become more severe and acute. Particular attention should be devoted to assistance to military personnel who have been in the combat zone for a long time and former military prisoners of war. Attention should be devoted to the psyche, emotionality, and behavior of people with labile and unformed nervous systems-children, adolescents, pregnant women, and people of retirement age.

Inter-relationships between suicidality and depressive symptoms among children and adolescents experiencing crisis: A network perspective

OBJECTIVES

Suicidality and depressive symptoms have emerged as major mental health issues reported among children and adolescents experiencing crises. In light of these concerns, this study was conducted to elucidate interrelationships between depressive symptoms and suicidality at an item level within this population during the COVID-19 pandemic, a worldwide public health crisis affecting children and adolescents.

METHOD

A cross-sectional study design was used. Primary and secondary school students completed the Children's Depression Inventory - Short Version (CDI-S) and two standard suicidality questions tapping suicidal ideation and suicide plans, respectively. A network analysis was performed to examine inter-connections between depressive symptoms and suicidality.

RESULTS

A total of 5380 students participated in the study. Prevalence of suicidal ideation and suicide plans were 12.8 % (95 % CI = 11.9 %-13.7 %) and 9.9 % (95 % CI = 9.2 %-10.8 %), respectively; the prevalence of depressive symptoms was 41.2 % (95%CI = 39.8 %-42.5 %). The network analysis identified CDI4 (self-hatred) as the most influential node with the highest centrality, followed by CDI8 (loneliness), CDI5 (crying), and CDI1 (sadness). Additionally, CDI5 (crying), CDI1 (sadness), CDI4 (self-hatred), and CDI10 (feeling unloved) were the most meaningful nodes linking depressive symptoms with suicidality.

CONCLUSIONS

Critical depressive symptoms linked with suicidality among children and adolescents living through the COVID-19 pandemic included self-hatred, loneliness, crying, and sadness. Interventions that target these depressive symptoms may have increased utility in reducing the risk of suicidality within this population.

Impact of COVID-19 on the Health of Migrant Children in the United States: From Policy to Practice

In this article, the authors provide an overview how the COVID-19 pandemic impacted the health and wellbeing of migrant children in conflict zones, in transit and post-settlement in the United States. In particular, the authors explore how policies implemented during the pandemic directly and indirectly affected migrant children and led to widening disparities in the aftermath of the pandemic. Given these circumstances, the authors provide recommendations for child health care providers caring for migrant children to mitigate and bolster resilience and health.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War

OBJECTIVE

More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions.

METHOD

Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network.

RESULTS

The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear.

CONCLUSION

There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

DIVERSITY & INCLUSION STATEMENT

We actively worked to promote sex and gender balance in our author group.

STUDY PREREGISTRATION INFORMATION

Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences

Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.

Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of the War in Ukraine

OBJECTIVE

War profoundly impacts people's lives, causing death, displacement, and psychological trauma, but research investigating suicidality of adolescents in this context has been limited. We compared suicidality or self-harm behavior among adolescents in regions that were, and were not, affected by Russia's initial invasion of Ukraine in 2014.

METHOD

This cross-sectional study comprised 2,752 school students aged 11 to 17 years from the war-affected Donetsk region and non-war Kirovograd region. Data collection occurred in 2016 and 2017 using self-report tools to assess suicidality or self-harm behavior; psychopathology including posttraumatic stress disorder (PTSD), depression, and anxiety; and war trauma exposure.

RESULTS

Adolescent girls in the war-affected region reported more suicide attempts (9.5% vs 5.1%; adjusted odds ratio [aOR] 1.8, 95% CI 1.2-2.8), suicidal ideation (39.3% vs 19.6%; aOR 2.6, 95% CI 2.01-3.3), or self-harm behavior (19.6% vs 13.1%; aOR 1.6, 95% CI 1.2-2.1), and boys reported more suicidal ideation (17.0% vs 9.8%; aOR 1.7, 95% CI 1.2-2.4). Boys and girls with PTSD, depression, or anxiety showed increased risks for any suicidality or self-harm. A dose-effect relation was observed between war trauma exposure and suicidality or self-harm. The association was strongest for adolescents who had experienced 5 or more different war trauma exposures (aOR 3.2, 95% CI 2.2-4.8).

CONCLUSION

War trauma exposure and psychopathology were strongly associated with suicidality or self-harm behavior, with a greater impact in girls than boys. The high prevalence of suicidality found in this study emphasizes the need for intervention on a large scale for adolescents living in war situations.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022

BACKGROUND

With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

MAIN BODY

In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

CONCLUSION

As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict

BACKGROUND

In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues.

OBJECTIVE

This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations.

METHODS

The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health.

RESULTS

Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems.

CONCLUSIONS

Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.

Young children's development after forced displacement: a systematic review

OBJECTIVES

To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes.

STUDY DESIGN

We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots.

RESULTS

Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies.

CONCLUSION

As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.

Effects of stress on pain in females using a mobile health app in the Russia-Ukraine conflict

The chronic and acute effects of stress can have divergent effects on health; long-term effects are associated with detrimental physical and mental health sequelae, while acute effects may be advantageous in the short-term. Stress-induced analgesia, the attenuation of pain perception due to stress, is a well-known phenomenon that has yet to be systematically investigated under ecological conditions. Using Flo, a women's health and wellbeing app and menstrual cycle tracker, with a world-wide monthly active usership of more than 57 million, women in Ukraine were monitored for their reporting of stress, pain and affective symptoms before, and immediately after, the onset of the Russian-Ukrainian conflict. To avoid potential selection (attrition) or collider bias, we rely on a sample of 87,315 users who were actively logging multiple symptoms before and after the start of the war. We found an inverse relationship between stress and pain, whereby higher reports of stress predicted lower rates of pain. Stress did not influence any other physiological symptoms with a similar magnitude, nor did any other symptom have a similar effect on pain. This relationship generally decreased in magnitude in countries neighbouring and surrounding Ukraine, with Ukraine serving as the epicentre. These findings help characterise the relationship between stress and health in a real-world setting.

Teachers' assessment of the mental health of children with special educational needs during the war

OBJECTIVE

Aim: To study the results of teachers' assessment of the mental health of high schoolers with special educational needs (SEN) after the 1.5 years of war in Ukraine.

PATIENTS AND METHODS

Materials and Methods: Teachers' assessment of the mental health of high schoolers with SEN was conducted through an anonymous survey of teachers using the questionnaire developed by the authors. The research, conducted in 2023, involved 739 teachers working with high schoolers (ages 6-10) with SEN.

RESULTS

Results: It was found that 32.3 % of high schoolers were in the combat zone or on the temporarily occupied territory; 31.7 % of high schoolers were forced to leave their homes and were temporarily displaced, 17.7 % went through a separation from their parents, 15.8 % witnessed hostilities, and 3.8 % suffered bullying from their peers. In the educational process, high schoolers with SEN most often experienced anxiety (55.2 %), "emotional swings" (48.4 %), restlessness (44.8 %), fear (37.2 %). During the 1.5 years of war, 15.4 % of high schoolers began to study worse, 12.9 % began to spend more time playing computer games and on social media. It was found that 59.9 % of teachers need more information on maintaining the mental health of high schoolers with SEN.

CONCLUSION

Conclusions: The results obtained proved the negative impact of hostilities on the territory of Ukraine on the mental health of high schoolers with SEN, which necessitates the provision of adequate psychological support by teachers of such high schoolers in the educational process.

Mental health of children with special educational needs in the context of long-term crisis challenges: as seen by parents

OBJECTIVE

Aim: To study the peculiarities of the mental health of children with special educational needs after 1.5 years of full-scale war in Ukraine.

PATIENTS AND METHODS

Materials and Methods: The mental health of children with special educational needs (SEN) as well as the peculiarities of the impact of hostilities on their emotional and volitional sphere was assessed through the anonymous survey of their parents using the questionnaire developed by the authors (25 questions). The research, which was conducted in 2023 using a Google form, involved 466 parents having children with SEN aged 6 to 10.

RESULTS

Results: It was found that among the surveyed families raising children with SEN, 30.7 % of children were in the combat zone or zone of temporary occupation for a week to a month, 19.1 % - for more than a month; 36.9 % of children experienced relocation, 23.4 % were separated from their parents, 19.7 % witnessed hostilities; 49.4 % of children experienced an unstable psycho-emotional state ("emotional swings") during 1.5 years of war in Ukraine, 40.1 % - restlessness, 38.6 % - anxiety; 23.2 % of parents noted that their children were "hooked" on computer games and social networks, 11.2 % - had problems with sleep, 10.5 % - demonstrated the emergence or increase in cognitive problems.

CONCLUSION

Conclusions: The negative impact of prolonged stress during the war on the mental health of children with SEN has been revealed, which requires psychological support for such children from parents and psychologists.

The mental condition of Polish adolescents during the COVID-19 pandemic and war in Ukraine

Recently, the experience of the COVID-19 global pandemic has significantly affected the mental condition of entire societies by increasing anxiety and stress resulting from its sudden and completely unexpected nature. In Poland, apart from the pandemic, there is an ongoing threat of an armed conflict just across the border, which can constitute direct and indirect threats to physical and mental health. Each of these situations is unusual and difficult. It is also in sharp contrast to the developmental needs of children and adolescents. It especially violates the principal need of this developmental period, which is to grow up in a predictable as well as physically and emotionally safe environment. The purpose of the conducted research was to assess the psychological condition of Polish adolescents, whose social situation is difficult, in order to take appropriate preventive measures based on this assessment. The study was conducted using the "Who are You?" Scale of Transparency Anxiety and the Revised Child Anxiety and Depression Scale (RCADS), as well as a researcher-made survey containing questions about well-being in relation to the pandemic, distance learning and the ongoing war in a neighbouring country. Approval was obtained from the Bioethics Committee to conduct the projected research. The study included 945 adolescents aged 11 to 15 (M = 13.10; SD = 1.11) making a representative sample of adolescents from 14 regions in Poland. The results of the research and analyses show that the adolescents under study have a medium level of intensity of neuroticism, with the highest levels occurring in adolescents aged 14. Moreover, the adolescents manifest relatively lower symptoms of anxiety and depression as well as concern about the pandemic and the war in Ukraine than expected.

The mental functioning of school-age children in Poland since the outbreak of war in Ukraine and during the subsequent refugee crisis

BACKGROUND

There is growing body of research focusing on the functioning of children who have fled from war-torn areas. However, there is currently lack of data regarding the functioning of children residing in host countries.

OBJECTIVE

The aim of this study is to examine the presence of emotional problems, negative attitudes, interpersonal problems, and functional difficulties among Polish children during the first month after the outbreak of war and initial phase of the current refugee crisis.

PARTICIPANTS AND METHOD

The study group comprised children aged 9-15 (N = 360), living in Poland. The Children's Depression Inventory 2 (CDI-2) and The Cognitive Triad Inventory for Children (CTIC) was used to measure emotional functioning. The study took place 7 to 39 days after the outbreak of the war in Ukraine.

RESULTS

The children reported more emotional problems (t(359) = 9.340; p < .001; d = 0.49) with a negative mood (t(359) = 6.692; p < .001; d = 0.35) and negative self-esteem (t(359) = 9.632; p < .001; d = 0.51). The severity of depression symptoms was the highest in the first week after the outbreak of the war (F(5,354) = 2.472; p < .05; η2 = 0.03). The view of the self (F(1,358) = 3.858; p = .05; R2 = 0.01) and of the world (F(1,358) = 5.359; p < .05; R2 = 0.02) improved over time; however, their vision of the future remained unchanged.

CONCLUSION

The results shows that children who are not directly affected by the war can also display difficulties in mental functioning. In the initial months following the outbreak of the war and during the early stage of the current refugee crisis, Polish children demonstrated significantly higher levels of emotional problems and negative self-esteem. Moreover, the perception of oneself and the world appeared to be influenced by the duration since the onset of the war.

Pediatric traumatic brain injuries in war zones: a systematic literature review

Background

Pediatric casualties in war zones are a devastating consequence of armed conflicts, causing significant challenges for affected children, especially in the context of poor access to care. This study aimed to understand traumatic brain injuries (TBIs) in this high-risk population and to identify and provide information for the stakeholders, as well as to recognize severe long-term consequences and develop strategies to prevent them, thus minimizing their burden while aiding in the management of these cases.

Methods

We carried out a systematic literature review following PRISMA guidelines to identify publications discussing traumatic brain injuries in children in the context of war zones, and we analyzed all the collected data.

Results

Our study showed that head injuries were the most common casualty in war zones; male and female children were affected, and the mean age was 8-10 years. Most children were reported to be from Afghanistan, and blasts were the most common mechanism of injury. The mortality fluctuated from 3 to 47%.

Conclusion

There is a lack of evidence-based information regarding the characterization, approach, and management of children with TBI in conflict zones. While the world finds ways to live in peace, there is an urgency to research, train, and deploy enough specialists to these areas, if governments are serious about improving outcomes for this population.

The outbreak of the 2022 Russo-Ukrainian war: mental health of poles and their attitude to refugees

Introduction

The outbreak of the Russo-Ukrainian war on 24 February 2022 has sparked a migration crisis in Europe. As a result, Poland has emerged as the country with the highest number of refugees. Due to differing social and political sentiments, this has been a significant challenge for the hitherto mono-ethnic Polish society.

Methods

Computer-assisted web interviews (CAWIs) were conducted with 505 Poles, mainly women with higher education from large urban centers, involved in helping refugees. Their attitudes toward refugees were assessed using an original questionnaire, while their mental health was also evaluated using the General Health Questionnaire-28 (GHQ-28).

Results

The vast majority of respondents reported favorable attitudes toward refugees from Ukraine. In addition, 79.2% believed refugees should be given free access to medical care, and 85% supported free access to education for migrants. Nearly 60% of respondents were not worried about their financial status due to the crisis; moreover, 40% believed that immigrants could boost the Polish economy. And 64% believed it would enrich Poland culturally. However, the majority of respondents feared infectious diseases and believed migrants should be vaccinated according to the vaccination schedule applicable in the country. Fear of war correlated positively with fear of refugees. On the GHQ-28, almost half of the respondents scored above clinical significance. Higher scores were typical for women and those fearing war and refugees.

Conclusion

Polish society has shown a tolerant attitude in the face of the migration crisis. The vast majority of respondents showed positive attitudes toward refugees from Ukraine. The ongoing war in Ukraine has a negative impact on the mental health of Poles, which correlates with their attitude toward refugees.

Parenting app to support socio-emotional and cognitive development in early childhood: iterative codesign learnings from nine low-income and middle-income countries

OBJECTIVE

Many children in low-income and middle-income countries are disadvantaged in achieving early developmental potential in childhood as they lack the necessary support from their surroundings, including from parents and caregivers. Digital technologies, such as smartphone apps, coupled with iterative codesign to engage end-users in the technology-delivered content development stages, can help overcome gaps in early child development (ECD). We describe the iterative codesign and quality improvement process that informs the development of content for the Thrive by Five International Program, localised for nine countries in Asia and Africa.

DESIGN

Between 2021 and 2022, an average of six codesign workshops in each country were conducted in Afghanistan, Indonesia, Kyrgyzstan, Uzbekistan, Cameroon, the Democratic Republic of the Congo, Ethiopia, Kenya and Namibia.ParticipantsA total of 174 parents and caregivers and 58 in-country subject matter experts participated and provided feedback to refine and inform the cultural appropriateness of the Thrive by Five app and its content. Detailed notes from the workshops and written feedback were coded and analysed using established thematic techniques.

RESULTS

Four themes emerged from the codesign workshops: local realities, barriers to positive parenting, child development and lessons learnt about the cultural context. These themes, as well as various subthemes, informed content development and refinement. For example, childrearing activities were requested and developed to promote inclusion of families from diverse backgrounds, encourage best parenting practices, increase engagement of fathers in ECD, address parents' mental well-being, educate children about cultural values and help bereaved children with grief and loss. Also, content that did not align with the laws or culture of any country were removed.

CONCLUSIONS

The iterative codesign process informed the development of a culturally relevant app for parents and caregivers of children in the early years. Further evaluation is required to assess user experience and impact in real world settings.

Fortifying the Foundations: A Comprehensive Approach to Enhancing Mental Health Support in Educational Policies Amidst Crises

In recent times, global crises such as the COVID-19 pandemic, climate change, and geopolitical conflicts have significantly impacted pupils' mental health. This opinion article presents evidence-based recommendations to bolster mental health support within educational systems, aiming to alleviate the psychological burden faced by students during these challenging times. This article argues that a proactive, holistic approach to mental health is essential for building a resilient educational infrastructure. More than ever, we support the call for the integration of mental health education into the core curriculum, equipping students with vital coping skills and fostering emotional intelligence. Additionally, we emphasize the importance of training educators and staff to identify and address mental health issues. Furthermore, this article highlights the need for interdisciplinary collaboration involving general practitioners, mental health professionals, community organizations, and policymakers in crafting and implementing support strategies. Educational institutions can effectively leverage the expertise of diverse stakeholders to create targeted interventions by cultivating partnerships. Finally, the significance of continuously evaluating and refining mental health support policies to ensure their efficacy and adaptability in the face of evolving crises is emphasized. Through these comprehensive recommendations, this opinion article seeks to catalyze a transformation in educational policies, prioritize mental health support, and empower pupils to thrive during tumultuous times.

Development and psychometric evaluation of the Man-Made Disaster-Related Distress Scale (MMDS)

Man-made disasters (MMD²) are a widespread cause for psychological burden, both in directly and indirectly affected regions, as currently highlighted by the Russian invasion of Ukraine. Yet, measurement instruments that assess psychological distress associated with MMD are lacking. The study aimed to develop and validate such an instrument in an indirectly affected region. The resulting "man-made disaster-related distress scale" (MMDS) was tested within a German-speaking sample (N = 327). Exploratory and confirmatory factor analysis revealed a two-factorial structure ("Psychological distress" and "Change of existing belief systems") of the MMDS. The confirmatory model had an acceptable to good fit with CFI/TLI higher than 0.90. Internal consistency of the MMDS and its subscales was high with α and ω higher than 0.80. Correlational analyses suggested convergent, discriminant, and criterion validity. Measurement invariance was confirmed for gender and age with a change in CFI smaller than 0.01 but was rejected for educational level. The MMDS resulted in a 14-item assessment instrument based on a 7-point Likert-scale with good psychometric properties. Its administration is readily and economical, yielding the option to be used as a standardized measurement tool.

Editorial: Measuring and Buffering the Mental Health Impact of the War in Ukraine in Young People

The Russian invasion of Ukraine on February 24, 2022, has caused social, political, and financial instability worldwide. In Ukraine, the war has brought the greatest levels of violence, devastation, and disruption seen in Europe since World War II. Of course, the impact of war on the mental health of Ukrainian young people is likely substantial. Yet, more specific information about the prevalence and distribution of mental health disorders in young people is essential to document their needs, to select the best interventions, and to deliver these through international humanitarian efforts. The study by Osokina and Silwal et al.¹ presents some of the best evidence to date about the mental health impact of the war in Ukraine on young people.

Beyond arrival: safeguarding unaccompanied asylum-seeking children in the UK

Unaccompanied children (also called unaccompanied minors) are children who have been separated from both parents and other relatives and are not being cared for by an adult who, by law or custom, is responsible for doing so. From 2010 to 2020, unaccompanied minors accounted on average for 15.4% of the total number of first-time asylum applicants aged less than 18 years in the UK. These young people risk their lives and undergo traumatic journeys in search of a better life. However, when they arrive in the UK, they are vulnerable to significant ongoing traumatic experiences.In this review, we look at the reasons young people are forced to flee their countries, how they make their journey, and the risks and dangers they face along the way. We examine safety and victimisation risks faced by children and young people after arrival in the UK, which mechanisms and processes exist to safeguard these individuals, and examine the data available on outcomes of unaccompanied asylum-seeking child (UASC. Finally, we share two case examples that represent both the strengths and weaknesses of existing processes for UASC.

The role of faith in parenting; considerations when implementing family skills interventions with families affected by armed conflict or displacement

Religious beliefs and practices are fundamental to shaping family functioning in many countries and cultures around the world. They are often associated with a strong influence on parenting, and a potential resource for parents. While nurturing caregiving can act as a protective shield, buffering against the negative effects on children's well-being, armed conflict and displacement often compromises parental well-being and positive parenting practices. Making interventions available to families affected by conflict and displacement that help to develop the quality of parenting is now seen as an important component in the care of war-affected children, causing a rise in family skills interventions for humanitarian contexts. Accordingly, there are certain considerations that need to be taken to achieve cultural sensitivity and acceptability, that account for the influence of religion. Here we share our United Nations Office on Drugs and Crime (UNODC) experience in the case of implementing "Strong Families," a UNODC family skills programme implemented in over 30 countries, providing key recommendations. (1) Appreciate and account for common religious beliefs and practices in your target populations; (2) ensure programme material acceptability and sensitivity; (3) avoid initiation of direct discussions, on religious beliefs or practices; and (4) facilitator need to be trained and prepared to respond to questions about faith. Though these considerations are presented considering the implementation of family skills programmes, they are also relevant to a range of other programming in which direct social (or other) contact is made with families in challenged contexts, aiming to reduce any perceived gaps between trainers and the families they are working with, and give families a sense that their religious beliefs, values, and priorities are understood.

Refugee Health: A Global and Multidisciplinary Challenge

The ongoing war and evolving humanitarian crisis in Ukraine have forced millions of women, children, and elderly people to flee the war zones and relocate across Poland, other European countries, and elsewhere in the world. As a result, numerous health issues have emerged in the host countries, ranging from the refugees' low immunization coverage to psychological distress and multimorbidities. Humanitarian support and multidisciplinary approach to the issues may help to improve the refugees' health and well-being. Involving relocated medics in rehabilitation and medical care of their compatriots may offer psychosocial and health benefits.

Thinking about young refugees' mental health following the Russian invasion of Ukraine in 2022

The Russian invasion of Ukraine on 24th February 2022 has prompted this article to summarise some of the salient mental health issues experienced by young asylum seekers and refugees focussing on resettlement countries, drawing on the substantial literature, for Child and Adolescent Mental Health Practitioners. Firstly, the various UNHCR categories of persons affected by war and persecution and statistics are described. By July 2022, over 100 million people globally were of concern to UNHCR, a number increased by the many millions of refugees fleeing Ukraine to neighbouring countries. Selected findings on the psychiatric epidemiology of young refugees are summarised, and some principles of Child and Adolescent Mental Health Service delivery and treatments are outlined. The research on Ukrainian refugees' mental health is limited and this is an area that requires further investigation alongside active attempts to meet their mental health needs.

Life and mental health in limbo of the Ukraine war: How can helpers assist civilians, asylum seekers and refugees affected by the war?

The terror spread by the war disrupts lives and severs families, leaving individuals and communities devastated. People are left to fend for themselves on multiple levels, especially psychologically. It is well documented that war adversely affects non-combatant civilians, both physically and psychologically. However, how the war puts civilians' lives in a limbo is an under-researched area. This paper focuses on three aspects: (1) how the mental health and well-being of Ukrainian civilians, asylum seekers, and refugees are affected by the war caused limbo; (2) what factors affect this process of being stuck in the limbo of war; and (3) how psychologists and helpers in the war-ridden and host countries can provide meaningful support. Based on the authors' own practical work with Ukrainian civilians, refugees, and professional helpers during the war, this paper provides an overview of multi-level factors that impact human psyches in a war, and possible ways to help those who are living in the war limbo. In this research and experiential learning-based review, we offer some helpful strategies, action plans, and resources for the helpers including psychologists, counselors, volunteers, and relief workers. We emphasize that the effects of war are neither linear nor equal for all civilians and refugees. Some will recover and return to a routine life while others will experience panic attacks, trauma, depression, and even PTSD, which can also surface much later and can prolong over the years. Hence, we provide experience-based ways of dealing with short-term and prolonged trauma of living with war and post-traumatic stress disorder (PTSD). Mental health professionals and other helpers in Ukraine and in host countries can use these helping strategies and resources to provide effective support for Ukrainians and for war refugees in general.

The mental health consequences on children of the war in Ukraine: A commentary

The news from Ukraine is currently full of heart-wrenching stories accompanied by graphic images of civilian casualties and massacres that are telecast world-wide on a daily basis. It is hard to fathom the magnitude of the devastation and disruption to regular lives and everyday routines that war brings with it, the witnessing of countless deaths, the associated trauma of living in perpetual fear, and the daily experience of many families and orphans who are crowded into basement bomb shelters now for months on end. These issues make us contemplate the mental health consequences, among other lasting effects, of this costly war in Ukraine, and wars in other countries not so widely featured in Western news. Despite people of all ages being affected by war, children are especially vulnerable. This commentary outlines some of the epidemiology of the consequences of war, the mental health sequelae specifically, and the complexity of providing culturally and contextually relevant interventions that meet the needs of children.

Experiences of the Ukrainian adolescents during the Russia-Ukraine 2022 War

Purpose

The study aims to explore the current experiences of Ukrainian adolescents affected by the Russia-Ukraine war. The study focused on the changes in adolescents’ lives caused by the war, adolescents’ emotional reactions to the disruptions caused by the war, coping strategies employed by adolescents in dealing with disruptions and the role of information technology in supporting new realities and coping strategies of adolescents.

Design/methodology/approach

This study relied on semi-structured interviews conducted on Zoom with 27 Ukrainian adolescents ages 10-18. Participants were recruited using the snowball sample and came from various regions of Ukraine. The interview notes and partial transcripts were analyzed using thematic analysis to identify the common and unique patterns in participant responses.

Findings

The interview data revealed the signs of traumatic experiences and various stages and methods of coping with them. Participants’ resilience was supported by external factors, including families, communities, continuous schooling, ability to talk to friends, information technology, as well as internal skills, including social competence, problem-solving, critical consciousness, autonomy and a sense of purpose. Participants shared specific recommendations for improving information platforms and online content, e.g. making them more accessible and affordable for Ukrainian users, improving content curation and personalization, creating and promoting Ukrainian content and others.

Research limitations/implications

Research relied on convenience sample of participants who had access to information communication technology (ICT), were aware and had an ability to participate. Field work is needed to reach out to participants without access to ICT.

Practical implications

This study contains broad recommendations for improving information technologies for the use of Ukrainian adolescents.

Social implications

This research offers three timely account of the first-hand experiences of Ukrainian adolescents affected by the Russia-Ukraine war and can inform future work aimed at improving life conditions for teen population.

Originality/value

This study relied on first-hand reports of Ukrainian adolescents’ experiences, feelings and coping strategies during the first three months of Russia-Ukraine war. The study applied war trauma and resilience frameworks to interpret the findings and translate some of the findings into practical recommendations for the information science community.

Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border

Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being.

HIGHLIGHTS

The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.

The Ukrainian children emergency: How the Pediatric Oncology Unit of Turin supports cancer patients and their families who have escaped war

Due to the war in Ukraine, many children have been killed and those who suffer from severe diseases, such as oncological pathologies, are facing serious challenges as their treatment is interrupted. The objective of this report is to describe one of the first Italian humanitarian expeditions launched to rescue children and their families to provide them with the best possible cancer care. The Pediatric Oncology Unit of Turin has welcomed 60 Ukrainians who are patients, caregivers and siblings. This report underlines the activities that have been implemented to offer this new type of patient the best possible care.