The mental health of children affected by armed conflict: protective processes and pathways to resilience

Maternal Perceptions and Responsiveness to Cry in Armed Conflict Zones: Links to Child Behavior Problems

Crying is a typical infant behavior that activates parental caregiving behaviors, acting as "human alarms" important for the infant's survival. When living under war-related threat, the auditory system may be sensitized given its importance for survival, potentially impacting maternal cry processing. Children living in armed-conflict zones are at increased risk for behavior problems, which may relate to both direct exposure and indirect effects through their parents' perceptions and behaviors. This hypothesis was examined in a sample of mothers and their first-born children (aged 10-45 months) living in the Gaza vicinity area in Israel, chronically exposed to missile alarms (high-exposure; n = 45), and a comparison group (low-exposure; n = 86). Group differences in child behavior problems and maternal perceptions of and responsiveness to cry were investigated. A moderated indirect-effect of maternal cry perceptions on child behavior problems via maternal responsiveness to cry was examined. In the high-exposure group, children had more externalizing problems and mothers rated cries as more aversive. Maternal cry perception was indirectly related to child behavior problems via responsiveness to cry only in the high-exposure group: higher perceptions of cry as aversive or the child as distressed were related to faster responding to crying, and faster cry responsiveness was linked with fewer behavior problems. Results suggest that in armed-conflict zones with auditory warning signals, the parental caring system may be easily activated by cries due to the strong association between alarms and threat. Furthermore, children may need their mothers to react faster when feeling distressed, possibly because of the surrounding threat.

The role of cumulative risk and armed conflict exposure in adolescent psychological symptoms in Turkey

Exposure to risk factors and adversity may cause immediate, and sometimes prolonged, psychological symptoms in adolescents. Identifying universal and specific risk factors in a particular context and examining their cumulative effects is crucial for understanding the mechanisms underlying psychological symptoms and informing about strategies for intervention. Using concurrent measures, the current study aimed to examine the role of armed conflict experiences and cumulation of other risk factors (e.g., maternal psychological symptoms, socioeconomic indicators) in predicting adolescent psychological symptoms in an underresearched community. The sample included 161 adolescents (54.7% female) aged 11-14 years (M = 12.36, SD = 1.27) and their mothers living in the east of Turkey. The cumulative risk index was calculated by summing the standardized scores of the corresponding factors. Hierarchical multiple regression analyses were conducted to predict internalizing and externalizing symptoms among adolescents by introducing demographic variables (age, gender) in the first step, armed conflict experiences and cumulative risk in the second step, and their interaction in the final step. Results showed that the levels of internalizing and externalizing symptoms were predicted by gender, armed conflict experience and cumulative risk. Being a girl was associated with higher levels of internalizing symptoms and lower levels of externalizing symptoms. Higher levels of internalizing and externalizing symptoms were predicted by exposure to armed and cumulative risk. After controlling for other factors, the interaction of armed conflict experience and cumulative risk significantly predicted externalizing, but not internalizing symptoms. These findings suggested that cumulative risk was a stronger predictor of psychological symptoms, and further amplified the strength of the association between armed conflict experiences and externalizing symptoms. These findings can be used in the formulation of intervention strategies and policies to promote psychological well-being in adolescents living in armed conflict zones under multiple risks.

Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises

BACKGROUND

Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.

OBJECTIVES

To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure).

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour.

MAIN RESULTS

We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.

AUTHORS' CONCLUSIONS

To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.

Positive and negative effects of child's agency on trauma symptoms and psychological difficulties in war-like conditions. The mediating role of hope and life satisfaction

BACKGROUND

Children affected by war and political violence deploy agentic competencies to cope with trauma symptoms and psychological difficulties. However, it does not always act as a protective factor to help them adjust to potentially traumatic events.

AIMS

We expected to explore the association between agency, trauma symptoms and psychological difficulties and the mediating role of hope and life satisfaction in a group of child victims of military violence in Palestine.

METHODS

965 children aged 8 to 14 were assessed with self-reported measures, War Child Agency Assessment Scale, Children Revised Impact of events scale, Strengths and difficulties scale, Child Hope Scale and Brief Multidimensional Students Life Satisfaction Scale. Structural Equation Modelling was performed having Agency as a predictor, trauma symptoms, psychological difficulties as an outcome variable and life satisfaction and hope as a mediator.

RESULTS

We found a direct and positive effect of agency on trauma symptoms, psychological difficulties, and life satisfaction and hope on the two dependent variables. Life satisfaction and hope mediated the association between agency and the outcome variables.

CONCLUSION

Agency can help defend children from trauma and psychological maladaptation when it acts on life satisfaction and hope. At the same time, it might worsen psychological dysfunctions when working directly on trauma symptoms and difficulties. Clinical interventions must help children to foster agentic resources in activating hope and life satisfaction.

Emergence and evolution of developmental resilience science over half a century

This reflection on the history and future of developmental resilience science (DRS) highlights its co-emergence with developmental psychopathology (DP), as well as the roles of this journal and its founding editor, Dante Cicchetti, in the evolution of these intertwined domains of scholarship. A remarkable constellation of scholars at the University of Minnesota shaped the course of both conceptual frameworks and their dissemination. I describe fundamental assumptions common to DP and DRS frameworks that reflect their common roots and the pervasive influence of systems theory on developmental science. I describe four waves of DRS and key principles of DRS at the present time. In conclusion, I consider the possibility that a fifth wave of DRS is emerging with a focus on understanding patterns of multisystem, multilevel processes of resilience and their implications for interventions in the context of interacting, interdependent, and complex adaptive systems. I close this commentary with questions for future research and a hopeful outlook on the future of human resilience.

A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries

The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0-18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied  risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.

Resilience processes among Ukrainian youth preparing to build resilience with peers during the Ukraine-Russia war

The war in Ukraine significantly impacts the mental health and well-being of its youth. Like other communities affected by war, Ukraine's youth are at risk of developing psychopathological symptoms, and there is a shortage of mental health and psychosocial support services to address this. Resilience-building initiatives present an alternative approach to supporting the well-being of young people by promoting protective processes to enhance the likelihood of positive development in the context of adversity. Emerging research findings suggest that young people themselves can serve as powerful facilitators of such initiatives with one another. Yet, evidence about culturally and contextually relevant protective processes is needed to guide such interventions, especially among young people experiencing the war and working to boost resilience within their communities. In this study, we identified key protective processes Ukrainian youth depend on as they adapt to the conflict while also preparing to implement a resilience-building intervention as a facilitator. Through thematic analysis of transcripts of three training sessions with Ukrainian youth (n = 15, 100% female; aged 18-22), we identified the following themes: positive thinking, sense of control, emotion awareness and regulation, close personal relationships, and community support. Findings also highlighted the cultural and contextual nuance of these protective processes, as well as individual differences in the ways they co-occurred and manifested within each youth. Results have implications for developing tailored yet flexible resilience-building interventions that can be delivered by lay people, including youth with their peers, in Ukraine and other cultures and contexts.

Macro level system mapping of the provision of mental health services to young people living in a conflict context in Colombia

Colombia has one of the longest running internal armed conflicts, which has significantly impacted the mental health of the population. This article is the first to present a national level mapping of the provision of mental health services to young people living in Colombia, through detailed review of documentation, interviews with key stakeholders and quantitative analysis of existing data on mental health and suicide. It explores the existing public mental health provision in the country, focussing on where mental health resources are concentrated and how these are implemented. We use this mapping to understand how the current mental health system in Colombia fits with international approaches to youth mental health. We show that whilst mental health policy is variously framed (biomedical, biosocial, psychologically or through human rights), Colombian policy clearly focusses on a differential approach. This differential approach shapes service provision to target support at those in need, consequently neglecting whole population level mental health support. This means that not all stakeholders were clearly articulated or included in policy and that key institutional stakeholders, such as the education sector, were not linked to implementation plans or activity. Policy approaches were also over-centralised with little cross-institutional collaboration. Youth were specifically missing from services, as was explicit understanding of the intergenerational effects and impact of conflict. This was exacerbated by unequal distribution of mental health care services concentrated in populous, urban areas away from conflict-affected regions. Suicide is the second most prevalent cause of death with 10% of population who were recorded as dying by violence, dying from completed suicide. Triangulation implies a strong relationship between suicide and poorer access to professional support in conflict-affected areas and suggests that international frameworks and policy approaches to supporting youth mental health have been insufficiently adapted for conflict and post conflict contexts.

Perspectives on early insights: pediatric cancer caregiving amidst natural calamities - A call for future preparedness

Natural disasters cause immense damage and disruption to the environment, human lives, and property, posing a threat to safety and well-being. These disasters annually affect individuals and communities, severely impacting mental health. Research indicates a significant link between catastrophic events and an increased risk of mental disorders, including anxiety, depression, substance use, and post-traumatic stress disorder (PTSD). Individuals with chronic conditions, like cancer patients, are particularly vulnerable post-disaster due to disrupted healthcare services. The recent earthquake in Morocco highlighted the urgent need for continued care, especially for vulnerable populations living in poverty. Soleterre Foundation's interventions focus on supporting young cancer patients and their families, emphasizing psychological support following the earthquake. Effective disaster response needs coordinated efforts, clear roles, communication, and standardized healthcare procedures, especially for vulnerable groups like cancer patients. Education programs for patients and clinicians are vital for disaster preparedness. Communication challenges and lack of medical history further emphasize the need for well-defined disaster preparedness plans and continued care guidelines for cancer patients.

Refugee caregivers: Associations between psychosocial wellbeing and parenting in Uganda

Caregivers in humanitarian settings experience compounding stressors that may challenge their ability to provide quality parenting to children in their care. In recognition of this precarity, our analysis examines the linkage between psychosocial wellbeing and parenting behaviours among caregivers in Kiryandongo Settlement, Uganda. Using baseline data from an evaluation of a psychosocial intervention designed to support caregiver wellbeing and engage caregivers to support children in their communities, multi-variable ordinary least square regressions were used to estimate how various measures of psychosocial wellbeing (i.e. psychological distress, social support, and functioning) and parenting attitudes (related to violence against children) are associated with parental warmth and rejection. Profound livelihood challenges were found, as nearly half of the sample (48.20%) indicated cash from INGOs as their income source and/or reported never attending school (46.71%). Increased social support (coef. 0.11; 95% CIs: 0.08-0.15) and positive attitudes (coef. 0.21; 95% CIs: 0.14-0.29) were significantly associated with more desirable parental warmth/affection. Similarly, positive attitudes (coef. 0.16; 95% CIs 0.11-0.20), reduced distress (coef. 0.11; 95% CIs: 0.08-0.14) and increased functioning (coef. 0.03; 95% CIs: 0.01-0.04) were significantly associated with more desirable scores of parental undifferentiated rejection. While further research is needed to examine underlining mechanisms and causal pathways, our findings both link individual wellbeing characteristics with parenting behaviours and suggest further exploration into whether and how broader elements of the ecosystem may influence parenting outcomes.

Psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived asylum-seeking children in Finland

This study examined psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived accompanied asylum-seeking children in the age groups of 2-6 years (n = 93) and 7-12 years (n = 91). Children and parents were assessed using mental health and trauma measures (SDQ, HSCL-25 and PROTECT). The prevalence of total difficulties was 34.9% among 2-6-year-olds and 29.6% among 7-12-year-olds. The most common symptoms in both age groups were peer problems, followed by conduct problems among 2-6-year-olds and emotional symptoms among 7-12-year-olds. In both age groups, the children's emotional symptoms were associated with the parents' anxiety and depression as well as the trauma symptoms, while the conduct problems were only associated with the parents' trauma symptoms. In conclusion, peer problems as well as conduct problems and emotional symptoms are common among recently arrived asylum-seeking children. To support the mental health of these children, both children and parents need adequate support.

Hope and life satisfaction in Palestinian children victim of military violence: The predictive role of agency, potentially traumatic experiences and symptoms of trauma

BACKGROUND

Children exposed political violence deploy resources to maintain functioning, hope and life satisfaction.

OBJECTIVE

We sought to explore whether or not children promote hope and life satisfaction trough agency, psychological difficulties, potentially traumatic experiences and symptoms in Palestine.

PARTICIPANTS AND SETTING

965 children (494 males and 471 females) in multiple geographical contexts, and areas were involved.

METHODS

We administered the War Child Agency Assessment Scale, Child Hope Scale, Multilevel Students'Life Satisfaction Scale-Bref, the Strength and difficulties scale, the Child Revised Impact of events Scale, and Trauma Checklist, and performed regression analysis; hope and life satisfaction were dependent and agency, strength and difficulties, trauma symptoms and traumatic events independent variables.

RESULTS

Specific forms of agency predicted life satisfaction (β = 0.219; ** p < .01, social agency; β = 0.11; ** p < .01, with agency in education) and hope (β = 0.07; ** p < .05, agency on free movement), while mental difficulties (conduct problems, β = -0.09; ** p < .01; hyperactivity, β = -0.07; ** p < .05; β = -0.15; ** p < .01 with life satisfaction) (conduct problems, β = -0.06; ** p < .05, and difficulties in pro-social behaviour, β = -0.21; ** p < .01 with hope), traumatic events (β = -0.16; ** p < .01, with life satisfaction; β = -0.15; ** p < .01, with hope) and trauma symptoms (β = -0.09; ** p < .05, with hope) were negatively associated with the dependents variables.

CONCLUSIONS

We found a positive role of social, educational, and freedom of movement agentic behaviours in fostering hope and life satisfaction.

Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir

Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.

Trauma, risk, and resilience: A qualitative study of mental health in post-conflict Liberia

The Liberian civil wars led to widespread destruction and devastation for its individuals, communities, and economy. However, individuals' subjective trauma experiences and long-term psychological impact remain relatively understudied. This study aims to explore context-specific traumatic events and examine how risk and protective factors combine with traumas to influence trajectories of suffering and recovery over time. We conducted 43 semi-structured interviews with Liberian adults who were present during the Liberian civil wars, and we used line-by-line open coding, thematic analysis, and axial coding to analyze and contextualize the data. Eight key trauma themes emerged: Abuse (emotional, physical, and sexual), Captivity, Combat, Killings, Physical Illness, Resource Loss, Family Separation, and War Environment. The risk and protective factors that were reported as salient were: Age, Biological Sex, Socioeconomic Status, and Community Support. Further, key patterns emerged across interviews that indicated greater risk for long-term suffering: 1) exposure to multiple traumatic events, 2) certain types of traumatic events (like killing of a close family member), and 3) the combination of specific traumatic events and risk and protective factors (like older women witnessing the killing of their children). This study provides culturally relevant information on trauma, suffering, and resilience in post-conflict Liberia, with the aim of guiding the development of screening tools and targeted psychological interventions that improve well-being over time.

Exploring factors influencing domestic violence: a comprehensive study on intrafamily dynamics

Introduction

This econometric analysis investigates the nexus between household factors and domestic violence. By considering diverse variables encompassing mood, depression, health consciousness, social media engagement, household chores, density, and religious affiliation, the study aims to comprehend the underlying dynamics influencing domestic violence.

Methods

Employing econometric techniques, this study examined a range of household-related variables for their potential associations with levels of violence within households. Data on mood, depression, health consciousness, social media usage, household chores, density, and religious affiliation were collected and subjected to rigorous statistical analysis.

Results

The findings of this study unveil notable relationships between the aforementioned variables and levels of violence within households. Positive mood emerges as a mitigating factor, displaying a negative correlation with violence. Conversely, depression positively correlates with violence, indicating an elevated propensity for conflict. Increased health consciousness is linked with diminished violence, while engagement with social media demonstrates a moderating influence. Reduction in the time allocated to household chores corresponds with lower violence levels. Household density, however, exhibits a positive association with violence. The effects of religious affiliation on violence manifest diversely, contingent upon household position and gender.

Discussion

The outcomes of this research offer critical insights for policymakers and practitioners working on formulating strategies for preventing and intervening in instances of domestic violence. The findings emphasize the importance of considering various household factors when designing effective interventions. Strategies to bolster positive mood, alleviate depression, encourage health consciousness, and regulate social media use could potentially contribute to reducing domestic violence. Additionally, the nuanced role of religious affiliation underscores the need for tailored approaches based on household dynamics, positioning, and gender.

Parent-adolescent coping with prolonged geopolitical conflict: A qualitative analysis focusing on distress and resilience

Adolescents who were raised in conflict-ridden areas may face unique challenges that may also impact their transition to adulthood. We explored coping processes, distress symptoms, and resilience resources of late adolescents and their parents residing in Israeli communities bordering Gaza and exposed to ongoing conflict-related violence. We conducted in-depth interviews with late adolescents and one of their parents (n = 8 dyads, 16 individual interviews). Four main themes emerged: (a) dynamic adaptation - complex movement between coping styles; (b) distress symptoms; (c) siblingship - the central role of siblings in shaping adolescent resilience; and (d) community impacts - the ways in which social and physical environment can foster resilience. The findings broaden existing coping theories and offer practical implications for practitioners providing support to populations exposed to prolonged conflicts.

A systematic review of cross-cultural measures of resilience and its promotive and protective factors

As psychological resilience has been increasingly recognized as contextually constructed, mixed methods studies that map out local ecologies of resilience have become increasingly common. However, the direct adaptation of quantitative tools for cross-cultural use based on qualitative findings has been relatively lacking. The current review aims to provide an overview of existing measures of resilience used cross-culturally and to synthesize the protective and promotive factors and processes (PPFP) of resilience identified within these measures into a single resource. A January 2021 search of PubMed for studies of the development of psychological resilience measures that excluded studies of non-psychological resilience yielded 58 unique measures. These measures contain 54 unique PPFP of resilience, ranging from individual to communal-level characteristics. This review is intended to serve as a complementary tool for adapting standardized measures for stakeholders requiring an assessment tool that is attuned to their context for mental health risk assessment and intervention evaluation.

Effectiveness of the caregiver support intervention on child psychosocial wellbeing among Syrian refugees in Lebanon: Mediation and secondary analysis of a Randomized Controlled Trial

BACKGROUND

War and violence have a serious negative impact on the wellbeing and mental health of many children. Caregivers play an important role in mitigating or exacerbating this impact.

OBJECTIVE

This study evaluates the impact of the nine session Caregiver Support Intervention on improving children's wellbeing and examines putative mediators of changes in children's psychosocial wellbeing.

PARTICIPANTS AND SETTING

240 female caregivers were randomly allocated (1:1) to the CSI or a waitlist control comparison condition. The study was implemented in Lebanon, in an area characterized by high levels of poverty and a high number of the Syrian refugees.

METHODS

A parallel group Randomized Controlled Trial reporting on caregiver-reported child-level wellbeing. We used a combination of the Kid- and Kiddy-KINDL (parent version) for index children ages three to 12. Putative mediators of the CSI on children's psychosocial wellbeing included harsh parenting, caregiver psychological distress, caregiver wellbeing. Measurements were conducted at baseline, post-intervention and 3-months follow-up.

RESULTS

We demonstrated a statistically significant change in caregiver reported children's psychosocial wellbeing at post-intervention (Mdiff =4.39, 95 % CI = 1.12, 7.65, p < 0.01, d = 0.28) but not at follow-up (Mdiff = -0.97, 95 % CI = -4.27, 2.32, p > 0.05). The proportion of the total effect of the CSI intervention on child psychosocial wellbeing mediated by caregiver distress, caregiver wellbeing and harsh parenting was 77 %.

CONCLUSION

The CSI holds potential for down-stream short-term effect on improving children's psychosocial wellbeing, beyond the previously reported positive caregiver outcomes. This effect was not sustained three months post intervention. The study confirms caregiver wellbeing and parenting support as dual pathways mediating child psychosocial wellbeing. Prospective trial registration: ISRCTN22321773.

To Trust is to Survive: Toward a Developmental Model of Moral Injury

Research on trauma- and stressor-related disorders has recently expanded to consider moral injury, or the harmful psychological impact of profound moral transgressions, betrayals, and acts of perpetration. Largely studied among military populations, this construct has rarely been empirically extended to children and adolescents despite its relevance in the early years, as well as youths' potentially heightened susceptibility to moral injury due to ongoing moral development and limited social resources relative to adults. Application of the construct to young persons, however, requires theoretical reconceptualization from a developmental perspective. The present paper brings together theory and research on developmentally-oriented constructs involving morally injurious events, including attachment trauma, betrayal trauma, and perpetration-induced traumatic stress, and describes how they may be integrated and extended to inform a developmentally-informed model of moral injury. Features of such a model include identification of potentially morally injurious events, maladaptive developmental meaning-making processes that underlie moral injury, as well as behavioral and emotional indicators of moral injury among youth. Thus, this review summarizes the currently available developmental literatures, identifies the major implications of each to a developmentally-informed construct of moral injury, and presents a conceptual developmental model of moral injury for children and adolescents to guide future empirical research.

Post-Traumatic Stress Disorder in Unaccompanied Refugee Minors: Prevalence, Contributing and Protective Factors, and Effective Interventions: A Scoping Review

In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review the current literature regarding PTSD in unaccompanied refugee minors (URM). The authors searched Ovid Medline, Embase, and Cochrane Library from 1 January 2008 through 15 January 2019. Thirty full texts were chosen that specifically studied unaccompanied refugee minors (URM). The results showed that URM had a prevalence of post-traumatic stress disorder (PTSD of 17-85% across the studies reviewed. There were numerous factors that contributed to PTSD, including cumulative stress and trauma, guilt, shame, and uncertainty about legal status. Protective factors included resilience, a trusted mentor, belonging to a social network, religion, having an adult mentor, and having a family (even if far away). Immigrant youth can thrive most easily in multiculturally affirming countries. Five interventions demonstrated effectiveness, comprising trauma-focused cognitive behavioral therapy (TF-CBT); "Mein Weg", a TF-CBT combined with a group-processing mixed therapy approach; teaching recovery techniques (TRT), narrative exposure therapy for children (KIDNET), and expressive arts intervention (EXIT). The significant mental health conditions include depression, anxiety, internalizing and externalizing behaviors, and frequently PTSD. It is fair to conclude that the high levels of mental health problems experienced in URM are due to exposure to traumatic experiences, separation from parents, and lack of social support.

Drivers of 'voluntary' recruitment and challenges for families with adolescents engaged with armed groups: Qualitative insights from Central African Republic and Democratic Republic of the Congo

Globally, armed conflicts have increased threefold since 2010. The number of children voluntarily engaging with armed groups is also rising, despite increasing efforts to prevent this grave human rights violation. However, traditional approaches focusing on the prevention, release, and reintegration of children through forced recruitment do not adequately address the complex and interlinking push and pull factors of voluntary recruitment. This qualitative study sought to deepen understanding of the drivers and consequences of voluntary recruitment from the perspectives of adolescents and their caregivers, as well as to explore how to better support families living in conflict settings. In-depth interviews were conducted with 74 adolescents (44 boys and 30 girls) ages 14 to 20 years and 39 caregivers (18 men and 21 women) ages 32 to 66 years in two distinct conflict settings: North Kivu, Democratic Republic of Congo and Ouham-Pendé, Central African Republic. Interviews with adolescents utilized a visual narrative technique. The findings examine the unique perspectives of adolescents engaged with armed groups and their caregivers to understand how conflict experiences, economic insecurity, and social insecurity influence adolescent's engagement with armed groups and reintegration with their families. The study found that families living in conflict settings are subject to traumatic experiences and economic hardship that erode protective family relationships, leaving adolescent boys and girls particularly vulnerable to the systemic and overlapping factors that influence them to engage with and return to armed groups. The findings illustrate how these factors can disrupt protective social structures, and inversely how familial support can act as a potential protective factor against recruitment and break the cycle of reengagement. By better understanding the experiences of adolescents enduring recruitment and how to support caregivers of those adolescents, more comprehensive programming models can be developed to adequately prevent voluntary recruitment and promote successful reintegration, enabling children to reach their full potential.

A Developmental Psychopathology Perspective on Political Violence and Youth Adjustment

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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.

Psychological Resilience in Children and Adolescents: The Power of Self-Recovery

Many children in the world grow up without good enough opportunities under challenging conditions such as poverty, violence, neglect, abuse, family discord and diseases. These conditions hinder the mental, emotional and social development of children and young people, making it difficult for them to reach their potential to become healthy adults. In addition to all these, there are children who can survive even in the most severe conditions and continue their development with health and functionality. Psychological resilience is a resource that protects and develops the psychological well-being of children and adolescents, rather than an invariable, innate feature, it is a dynamic process that can be developed, continuous and shaped by the interaction of the individual with his own internal factors and environmental factors. The aim of this study is to present a review of the literature on resilience research from past to present. The article includes the definition of resilience, the history of resilience research, components of resilience, models, measurement, interventions, and future directions in resilience research. Investments in the development of resilience in children and adolescents will produce health-promoting outcomes that balance individual and community-based psychological well-being throughout life, including positive outcomes and potential improvements.

Mental Health and Psychosocial Support Interventions for Children Affected by Armed Conflict in low-and middle-income Countries: A Systematic Review

Background

. Armed conflicts continue to threaten a vast number of children across the world, especially in low-and middle-income countries (LMICs). Evidence-based interventions are vital to adequately address the mental health needs in these groups.

Objective

. This systematic review aims to provide a comprehensive update of the most current developments in mental health and psychosocial support (MHPSS) interventions for children affected by armed conflict in LMICs, since 2016. Such an update may be useful in determining where the current focus of interventions lies and whether there are changes in types of interventions that are commonly implemented.

Methods

. The main medical, psychological and social sciences databases (PubMed, PsycINFO, Medline) were searched to identify interventions aimed at improving or treating mental health problems in conflict-affected children in LMICs. For the period 2016-2022, a total of 1243 records were identified. Twenty-three articles met the inclusion criteria. A bio-ecological lens was used to organize the interventions and the presentation of findings.

Results

. Seventeen forms of MHPSS interventions with a wide range of treatment modalities were identified in this review. The reviewed articles focused mainly on family-based interventions. Very few studies empirically evaluated community-level interventions.

Conclusion

. Current focus of interventions is family-based; the addition of caregiver wellbeing and parenting skills components had the potential to enhance the effects of interventions designed to improve children's mental health. Future trials for MHPSS interventions need to give more attention to community-level interventions. Community-level supports such as person-to-person support, solidarity groups, and dialogue groups stand to reach large numbers of children and families.

Parental Engagement in Grief Programming Is Related to Children's Outcomes

A multivariate model was used to study outcomes of childhood bereavement. The model included exogenous factors such as engagement and within-person resilience factors. Sixty-two parent-child dyads were recruited from a local children's grief center and completed measures of engagement in the programming, resilience and grief. A complex model was revealed in which parental engagement in the grief program was related to child engagement and the child's control beliefs which in turn were significantly related to the child's grief symptoms. These variables existed within a system, rather than within an individual.

Impact of the Russian Invasion on Mental Health of Adolescents in Ukraine

OBJECTIVE

Very limited evidence is available on the psychological impact of war on adolescents in Ukraine. This study compared war experiences and posttraumatic stress disorder (PTSD), anxiety and depression in adolescents living in war-torn and peaceful regions of Ukraine, more than 2 years after Russia first invaded in 2014.

METHOD

The cross-sectional study included 2,766 students aged 11 to 17 years living in the war-torn Donetsk region and in Kirovograd in central Ukraine. Self-reported PTSD, depression, and anxiety were assessed by Harvard Trauma Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. Data were collected from September 2016 to January 2017. Binary and multinomial logistic regression models were used to examine the association between PTSD, anxiety, and depression and regions.

RESULTS

War trauma and daily stress were higher in adolescents in the Donetsk region; 881 (60.2%) adolescents had witnessed armed attacks, 204 (13.9%) were victims of violence, and 409 (27.9%) were forced to leave their homes. They also had significantly increased risks for PTSD (odds ratio [OR] 4.11, 95% CI 2.37-7.13), severe anxiety (OR 3.10, 95% CI 1.83-5.27), and moderately severe/severe depression (OR 2.65, 95% CI 1.79-3.92).

CONCLUSION

Traumatic events and daily stress were strongly associated with psychological distress in adolescents living in a war-torn region in Ukraine. These findings can help in understanding, measuring, and addressing the long-term impact that the current escalating war in Ukraine will have on adolescents' mental health and social functioning.

Interventions to enhance psychological resilience in forcibly displaced children: a systematic review

BACKGROUND

Children represent nearly 40% of forcibly displaced populations and are subject to stressors that affect well-being. Little is known about the effects of interventions to enhance psychological resilience in these children, outside clinical settings.

METHODS

We conducted a systematic review, following Cochrane methods. Eligible studies tested resilience-enhancing interventions outside clinical settings in forcibly displaced children/adolescents. We included longitudinal quantitative studies with comparator conditions irrespective of geographical scope or language. We searched articles published between January 2010 and April 2020 in PubMed, Embase, Cochrane Library, Web of Science, PsycINFO and the WHO's Global Index Medicus. To standardise effect sizes across the different reported outcomes, we transformed reported mean differences to standardised mean differences using Hedge's g statistic with associated 95% CI. We pooled data for meta-analysis where appropriate. We used Cochrane tools to assess study risk of bias and used Grading of Recommendations Assessment, Development and Evaluation to determine evidence quality for meta-analysed outcomes.

RESULTS

Searches yielded 4829 results. Twenty-three studies met inclusion criteria. Studies reported 18 outcomes measured by 48 different scales; only 1 study explicitly measured resilience. Eight studies were randomised controlled trials; the rest were non-randomised pre-post studies. Interventions were diverse and typically implemented in group settings. Studies reported significant improvement in outcomes pertinent to behavioural problems, coping mechanisms and general well-being but not to caregiver support or psychiatric symptoms. In meta-analysis, resilience was improved (g_av=0.194, 95% CI 0.018 to 0.369), but anxiety symptoms and quality of life were not (g_av=-0.326, 95% CI -0.782 to 0.131 and g_av=0.325, 95% CI -0.027 to 0.678, respectively). Risk of bias varied. Quality of evidence for most graded outcomes was very low.

CONCLUSIONS

The multiplicity of study designs, intervention types, outcomes and measures incumbered quantifying intervention effectiveness. Future resilience research in this population should use rigorous methods and follow reporting guidelines.

PROSPERO REGISTRATION NUMBER

CRD42020177069.

Mental health interventions for immigrant-refugee children and youth living in Canada: a scoping review and way forward

BACKGROUND

Traumatic life events experienced by immigrant-refugee children and youth may deteriorate their mental health and well-being. It is a public health priority to develop appropriate mental health interventions for this population.

AIMS

To understand the psychosocial needs of immigrant-refugee children and youth resettled in Canada in the context of their school and community and to identify the characteristics of school-/community-based mental health programs for this group.

METHOD

Arksey and O'Malley's methodology for scoping reviews was used to select the studies based on criteria, extract data in a table, and synthesize main findings.

RESULTS

Fifteen peer-reviewed articles and five grey literature were identified. Key findings show that collaboration between schools, communities, and families play a crucial role in developing and implementing comprehensive mental health interventions for immigrant-refugee children/youth. Involving cultural brokers/interpreters and racially diverse school teachers/staff, is important to establish a trustful relationship between school authorities and marginalized population.

CONCLUSIONS

Further research is needed to examine the impact of collaborative mental healthcare among multiracial and newcomer families in Canada. Furthermore, there is a need to study the impact of adopting creative expression programs at schools/communities to improve emotional/behavioural problems and enhance school performance of these groups.

Running Away from the War in Ukraine: The Impact on Mental Health of Internally Displaced Persons (IDPs) and Refugees in Transit in Poland

A growing body of research highlights how communities traumatized by conflict and displacement suffer from long-term mental and psychosocial illnesses. The Russian army's attack on Ukraine has resulted in an estimated 10 million people being internally or externally displaced from Ukraine, of whom more than 3.8 million have left Ukraine to seek refuge elsewhere in Europe. Soleterre has decided to launch an intervention to provide psychological support to Ukrainian refugees and IDPs, aimed at containing war trauma, assessing the severity of symptoms, and enabling those affected to receive psychological support. The intervention model envisioned the administration of an intake form to provide a rapid collection of qualitative and quantitative information for those arriving in Poland or Lviv from Ukraine. Our results showed how most of the samples reported high or very high levels of anxiety, depression, and sleep disturbances. Moreover, results highlighted how being close to families or being able to keep in touch with them work as a protective factor in enhancing resilience, as well as a support network. These findings underscored the importance of re-thinking our perception of "family" in a broader sense, considering the new facets it can take on in post-conflict situations.

Un día en la vida de niños y niñas del Suroccidente Colombiano con experiencias de violencia sociopolítica

La investigación desarrollista sobre la violencia socio-política se ha centrado principalmente en explicar sus efectos psicológicos a mediano y largo plazo en la niñez y ha generalizado a partir de grandes muestras. Pocos estudios se han centrado en explorar momento a momento las experiencias de la vida cotidiana de niños y niñas que sufrieron episodios de ese tipo de violencia. En esta investigación se usó un diseño basado en la observación de un día en la vida de dos niñas y dos niños del Suroccidente Colombiano para describir el contexto en que se desarrollan, cómo se ven a sí mismos y cómo resignifican experiencias de violencia política que vivieron en su primera infancia. Se usaron relatos autobiográficos, entrevistas y un análisis de temas emergentes. Se identificaron identidades y experiencias estrechamente ligadas a la construcción de relaciones basadas en el respeto a los demás, la valoración positiva de sí mismos, el reconocimiento de la familia como organizadora de sus experiencias, la construcción de saberes para desarrollar habilidades y la resignificación de las experiencias dolorosas. La discusión se centró en las implicaciones de adoptar una concepción del proceso de desarrollo en términos de trayectorias de desarrollo no siempre previsibles, ni orientadas a un estado final; así como el papel que tiene el método seleccionado en esa indagación. Se concluye que las experiencias actuales no necesariamente se derivan de trayectorias lineales, pues son afectadas por factores situacionales inherentes a la ecología social en las que viven las personas.  

Conflict and Climate Factors and the Risk of Child Acute Malnutrition Among Children Aged 24-59 Months: A Comparative Analysis of Kenya, Nigeria, and Uganda

Acute malnutrition affects a sizeable number of young children around the world, with serious repercussions for mortality and morbidity. Among the top priorities in addressing this problem are to anticipate which children tend to be susceptible and where and when crises of high prevalence rates would be likely to arise. In this article, we highlight the potential role of conflict and climate conditions as risk factors for acute malnutrition, while also assessing other vulnerabilities at the individual- and household-levels. Existing research reflects these features selectively, whereas we incorporate all the features into the same study. The empirical analysis relies on integration of health, conflict, and environmental data at multiple scales of observation to focuses on how local conflict and climate factors relate to an individual child's health. The centerpiece of the analysis is data from the Demographic and Health Surveys conducted in several different cross-sectional waves covering 2003-2016 in Kenya, Nigeria, and Uganda. The results obtained from multi-level statistical models indicate that in Kenya and Nigeria, conflict is associated with lower weight-for-height scores among children, even after accounting for individual-level and climate factors. In Nigeria and Kenya, conflict lagged 1-3 months and occurring within the growing season tends to reduce WHZ scores. In Uganda, however, weight-for-height scores are primarily associated with individual-level and household-level conditions and demonstrate little association with conflict or climate factors. The findings are valuable to guide humanitarian policymakers and practitioners in effective and efficient targeting of attention, interventions, and resources that lessen burdens of acute malnutrition in countries prone to conflict and climate shocks.

Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress

Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health.

Evaluating the Role of Maternal and Paternal Trauma Exposure, Emotional Security, and Mental Health in Predicting Psychological Adjustment among Palestinian Adolescents

Previous research has established a strong relationship between family system functioning and child adjustment outcomes. However, within the context of Gaza, an evaluation of both maternal and paternal factors associated with adolescent psychological adjustment has not yet been thoroughly evaluated. The current study examines how maternal and paternal trauma exposure, emotional security, and mental health are related to parent-reported scores of adolescent psychological adjustment, while controlling for adolescent trauma exposure and security in the family. The sample included N = 68 family units living in the Gaza Strip, with two parents and one adolescent surveyed within each unit (adolescent Mage = 14.03 years). The regression model examining maternal factors was significant overall (F = 7.44, R2 = 42.70%, p < 0.001), with increased maternal depression associated with greater adolescent adjustment difficulties (β = 0.31, p = 0.011) and greater maternal emotional security in the family associated with fewer adolescent adjustment difficulties (β = −0.36, p = 0.004). The regression model examining paternal factors was also significant (F = 4.57, R2 = 31.00%, p < 0.001), with increased paternal trauma exposure associated with greater adolescent adjustment difficulties (β = 0.32, p = 0.012). Understanding family-level factors associated with adolescent adjustment is an important step in conceptualizing the mental health needs of conflict-affected youth within the context of Gaza and more broadly.

Pediatric mental health emergency visits during the COVID-19 pandemic

Introduction

Paediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 outbreak. Long-term consequences of the COVID-19 pandemic will include increases in mental healthcare needs, especially among vulnerable groups such as children and adolescents.

Aim

This study examined changes in the number of overall and diagnosis-specific mental health ED visits among patients aged <18 years following the onset of the COVID-19 pandemic in Madrid, Spain.

Methods

Using clinical records from all psychiatric ED visits at a major teaching hospital between October 2018 and April 2021, we conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1st March 2020).

Results

A total of 663 patients were included. In March 2020, there was a marked initial decrease of -12.8 (95% CI -21.9, - 7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95% CI 2.6, 4.2) additional monthly mental health ED visits.

Conclusion

After the onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.

School-based MHPSS interventions in humanitarian contexts: a realist review

OBJECTIVE

The aim of this review is to elucidate the characteristics of school-based mental health and psychosocial support (MHPSS) interventions in humanitarian contexts and the hypothesised mechanisms by which they influence well-being or learning outcomes.

METHODS

We conducted a realist review and searched PubMed, Embase, Global Health, CINAHL, PsychInfo, PILOTS and grey literature through January 2022. Eligible studies included children age 6-12 years, were conducted in humanitarian contexts in low-income or middle-income countries, and focused on universal MPHSS prevention in an educational setting, using any study design. Data were extracted and analysed using narrative synthesis and realist analysis techniques to create 'context-mechanism-outcome' configurations that were iteratively developed to modify, refine and substantiate programme theories.

RESULTS

Twenty-seven articles, representing 19 studies, were included in the review. We analysed data from 26 articles. Eleven evidenced-informed programme theories were developed at the levels of the child (n=4), teacher (n=3), caregiver (n=2), school environment (n=1) and school managers/administrators (n=1). At the child level, mechanisms related to strengthening coping skills, emotion regulation, interpersonal relationships led to improved psychosocial well-being or learning outcomes. At the teacher level, coping skills and the provision of support to students were linked to psychosocial well-being and learning outcomes. At the caregiver level, strengthening interpersonal bonds trigger improved psychosocial well-being, and at the school environment level, fostering feelings of security was linked to psychosocial well-being and learning outcomes. We did not find any evidence supporting the programme theory at the school managers/administrators level. We found limited evidence of positive impacts of the included interventions to support these programme theories.

CONCLUSIONS

These programme theories are a promising start towards ensuring school-based MHPSS interventions in humanitarian contexts better address the well-being and learning needs of children. Future research is needed to support these programme theories and enhance the evidence base.

The Multidimensional Taxonomy of Individual Resilience

Theoretical work in resilience has continuously evolved to inform and respond to advances in empirical work. In order to further scientific inquiry, it must continue to do so. This narrative overview of the field of resilience science focuses on contemporary challenges confronted by theoretical models of individual resilience and proposes a taxonomic structure for resilience-the multidimensional taxonomy of individual resilience (MTIR). The goal of the MTIR is to articulate a systematic framework within which extant theoretical and empirical work can be nested. Consistent with existing work, the MTIR organizes resilience into two primary branches-manifested resilience and generative resilience. These two components are then organized into subdomains that demonstrate evidence of conceptual distinctiveness. The specification of the subdomains in the MTIR draws support from a diverse body of work on resilience across disciplines and in multiple global contexts. The MTIR makes several critical advances, including expanding and refining the definitions and components of resilience in psychology, providing a clearer framework for conceptualizing mixed profiles of resilience, and tempering assumptions regarding the relational dependencies across domains of resilience. Finally, the utility of the MTIR in organizing research in resilience and advancing theory-testing and development is discussed.

Alternative Ways of Capturing the Legacies of Traumatic Events: A Literature Review of Agency of Children Living in Countries Affected by Political Violence and Armed Conflicts

BACKGROUND

It has been revealed that the construct of agency plays a crucial role in contributing to children's positive functioning and well-being despite their traumatic contexts. Yet there is little agreement within the literature about the definition of agency, how agency is displayed by children, or how it should be investigated.

AIMS

This study provides a synthetic overview of studies that have analyzed the agency of children living in contexts affected by political violence and armed conflict. In the process, it highlights major theoretical breakthroughs and findings in this area of research. The aim was to review research investigating the different ways in which children's agency manifests itself within their everyday lives, as well as possible policy implications.

METHOD

We identified published peer-reviewed studies relating to children's agency in conflict-affected environments through a narrative literature review. An ecological framework was used to organize studies according to the different settings (personal, familial, cultural, or contextual) within which the children's agency was displayed.

RESULTS

Of 682 studies identified from online searches of the literature and the three additional sources gathered through bibliography mining, 63 qualified for full review, with 15 studies included in the final synthesis. Overall, the literature focused mostly on the ways in which children's ability to mobilize resources emerged in order to cope with their challenging contexts.

CONCLUSION

Scholars advocated for community-oriented and child-centered programs that are aimed not only at promoting recovery from symptoms but also at fostering advocacy and a sense of agency in children.

Making meaning of community violence among adolescents: Associations between exposure, pro-violence attitudes and psychological symptoms

This study examined one type of adolescent meaning making (i.e., the development of beliefs about violence) and its association with reported mental health symptoms in a sample of youth exposed to community violence. Eighty-seven adolescents (age 11-18; 64.4% female) from a metropolitan city in the Northeast were recruited through Craigslist and recreation center postings and data collection occurred from 2009 to 2013. Participants completed self-reported measures of community violence exposure, attitudes toward violence, and psychological symptoms of depression and posttraumatic stress disorder [PTSD]. Bivariate correlations, hierarchical linear regressions, and mediation analyses examined the associations between exposure, beliefs about violence, and mental health symptoms. Self-reported pro-violence attitudes were positively correlated with depression symptoms (r = 0.32, p < 0.01) and PTSD (r = 0.45, p < 0.01). Pro-violence attitudes significantly mediated the relationship between community violence exposure and depression symptoms (95% confidence interval [CI] = 0.003-0.061) and PTSD symptoms (95% CI = 0.046-0.260). Preliminary findings suggest that meaning making through the development of pro-violence attitudes may not protect against symptoms of PTSD and depression among youth. Findings can inform the integration of meaning making processes into community mental health interventions for youth.

Neighbourhood effects on psychotic and depressive symptoms in the context of religious sectarianism in Northern Ireland: A data linkage study

BACKGROUND

The incidence of psychotic disorders is higher in ethnic minorities groups. The 'ethnic density effect', in which living in a neighbourhood with a low own-group proportion increases the risk of psychosis, is one explanatory factor. The density effect in the ethno-religious and sectarian context of Northern Ireland has been found to be reversed, particularly for Catholics, in which there is harmful effect of high own-group density areas. This is partly explained by high urbanicity, deprivation and unemployment, but is otherwise not well understood.

AIMS

This study aimed to examine the density effect at the level of symptomology (positive and negative psychosis symptoms and depressive symptoms) in a representative sample of people with a first episode of psychosis in Northern Ireland.

METHOD

Data linkage methodology was used drawing on data from the Northern Ireland First Episode Psychosis Study (NIFEPS) and the 2001 Census of Northern Ireland.

RESULTS

In total, 223 people between the ages of 18 to 64 were included in the study. A significant density effect was found for Catholics for total psychosis scores, but not for positive, negative and depressive symptoms, nor for general psychopathology, after adjusting for individual and area characteristics. The model accounted for just over 12% of the variance. No effect was found for Protestants.

CONCLUSION

The findings suggest that the density effect for Catholics is unrelated to the core features of psychosis (hallucinations, delusions and anhedonia) but rather to broader cognitive and emotional disturbances and area deprivation. Explanations of exposure to social adversity and inequality are proposed, with implications for public mental health and social policy.

Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion

Background

Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions.

Methods

Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012–2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics.

Results

The risk of marginalisation was 2.1–2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77–85% of associations eliminated).

Conclusions

The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.

Well-being and Life Satisfaction in Children Living in Contexts of Political Violence: A Narrative Literature Review

Background

Children and youth growing up in contexts characterized by political violence are at high risk of developing mental health impairments. In recent years, a growing interest has been directed to the study of children’s well-being after being exposed to political violence in order to develop interventions aimed at preserving and enhancing it.

Objective

This study provides a synthetic overview of studies that have explored or implemented interventions aimed at improving well-being and life satisfaction in conflict-affected children.

Methods

We identified peer-reviewed studies relating to children’s well-being in conflict-affected environments through a narrative literature review. An ecological framework was used to organize the studies in relation to the individual, family, social and community factors playing a role in promoting and preserving participants’ well-being. Implications for practices, policies and research were summarized to highlight areas in which they need strengthening.

Results

Of 1221 unique studies returned from online searches of the literature, 70 qualified for full review, with a total of 22 peer-reviewed studies included in the final synthesis. Results indicate a range of domains and dimensions that mutually interact to either enhance or diminish children’s well-being and life satisfaction. Four studies explicitly focused on assessing the effectiveness of interventions aimed at promoting and assessing children’s well-being and health.

Conclusions

Researchers were able to identify several dimensions that were contributing to the children’s well-being in situations of significant adversity. The concept of well-being emerged as a combination of personal resources and supportive contexts—such as family, peers, and community—that vary over time or across contexts. Well-being and life satisfaction in children living in contexts of political violence: a narrative literature review.

Prevalence and predictors of relapse among adolescent patients with mental illness in Butembo city (Eastern Part of the Democratic Republic of Congo)

This study aimed to determine the prevalence and predictors of relapse in adolescents with mental illness. To carry this cross-sectional study, we recruited participants from the patients who attended healthcare services at five mental healthcare units located in the eastern Democratic Republic of Congo. We enrolled patients aged between 10 and 17 years old, with a history of being readmitted at least once to a mental facility. Nearly one in 10 patients with mental illness is an adolescent, and seven in 10 adolescents with mental illness are readmissions. The majority of participants were males, aged 17 years old; lived in rural settings, were illiterate, and were single mothers/fathers. The predictors of relapse are low educational level, being a female or a single mother/father, having the age of 17 years, low self-esteem, perceived poor social support, living in rural areas, and the highly expression emotions. Being treated for bipolar and substance use disorder increases the risk of relapse in adolescents. Our results highlight the burden of mental illness in adolescents.

Effectiveness of psychosocial school interventions in Finnish schools for refugee and immigrant children, "Refugees Well School" in Finland (RWS-FI): a protocol for a cluster randomized controlled trial

BACKGROUND

Schools are natural environments in which to enhance young people's social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to.

METHODS

A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ).

DISCUSSION

The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group.

TRIAL REGISTRATION

ISRCTN ISRCTN64245549 . Retrospectively registered on 10 June 2020.

When COVID-19 Met Families Living in Armed-Conflict Zones: The Importance of Maternal Trauma and Child Self-Regulation

The COVID-19 outbreak began in Israel at the end of February 2020, and on March 17, 2020, a general lockdown was announced. Families were instructed to stay at home and schools and non-essential businesses were closed. Aiming to understand how families who were already living in areas of high exposure to armed conflict would be affected by another external stressful condition, data were collected before and after the outbreak. Mothers and children (aged 10-45 months) were recruited from areas with high (n = 40) and low (n = 78) exposure to armed conflict. Mothers reported on their posttraumatic stress symptoms (PTSS) and on their child's effortful control tendencies prior to the outbreak. Toward the end of the first lockdown, mothers were interviewed regarding adverse effects of the outbreak on their family. No group differences were found for maternal perceptions of adverse effects of COVID-19. However, a moderation model was revealed, indicating that maternal PTSS as well as child effortful control predicted adverse effects of COVID-19 only in the high-exposure group. Results are discussed considering cumulative stress and risk factors.

War and reintegration for girls and young women in northern Uganda: A scoping review

BACKGROUND

During the civil war in northern Uganda (1986-2006), thousands of girls were abducted into rebel and government forces. Most of the females who were not abducted lived in abhorrent conditions in camps for internally displaced people (IDP). As the war was drawing to a close, reintegration programs emerged and some continue today.

OBJECTIVE

Using a feminist lens, we conducted a scoping review to examine the literature written about these girls and young women. The impetus for this research was to determine the breadth of literature available; compare how this population is represented in the academic, practitioner and popular literature and to analyse how this representation may be impacting reintegration programming.

METHODS

Key words were entered into 14 academic databases, search engines and practitioner websites. Articles were included if they covered the recruitment, retention, return, and/or reintegration of formerly abducted and/or war-affected girls and women and if they were published between 2005 and 2019. A total of 112 articles were categorized and coded according to topics, themes and theoretical approaches.

RESULTS

Based on the findings of this scoping review, it appears that many articles describe formerly abducted and war-affected young women from a deficit-based perspective, while relatively fewer articles are written with a strength-based, resiliency-focused lens.

CONCLUSION

Based on our analysis, we argue for a more nuanced representation of women formerly engaged with armed groups, and argue for a gendered, inclusive approach to reintegration programming.

Mental Health of Refugee and Non-refugee Migrant Young People in European Secondary Education: The Role of Family Separation, Daily Material Stress and Perceived Discrimination in Resettlement

While scholarly literature indicates that both refugee and non-refugee migrant young people display increased levels of psychosocial vulnerability, studies comparing the mental health of the two groups remain scarce. This study aims to further the existing evidence by examining refugee and non-refugee migrants' mental health, in relation to their migration history and resettlement conditions. The mental health of 883 refugee and 483 non-refugee migrants (mean age 15.41, range 11-24, 45.9% girls, average length of stay in the host country 3.75 years) in five European countries was studied in their relation to family separation, daily material stress and perceived discrimination in resettlement. All participants reported high levels of post-traumatic stress symptoms. Family separation predicted post-trauma and internalizing behavioral difficulties only in refugees. Daily material stress related to lower levels of overall well-being in all participants, and higher levels of internalizing and externalizing behavioral difficulties in refugees. Perceived discrimination was associated with increased levels of mental health problems for refugees and non-refugee migrants. The relationship between perceived discrimination and post-traumatic stress symptoms in non-refugee migrants, together with the high levels of post-traumatic stress symptoms in this subsample, raises important questions on the nature of trauma exposure in non-refugee migrants, as well as the ways in which experiences of discrimination may interact with other traumatic stressors in predicting mental health.

Mental health in Lebanon: Tomorrow's silent epidemic

Lebanon is a middle-income country that has been recently crippled by several tragedies including the economic collapse, COVID-19, and the fourth of August Beirut port explosion, the world’s most powerful non-nuclear explosion of the twenty-first century. Recent data on mental health from Lebanon is summarised, and other topics such as the psychological impact of cumulative adversities and the role of international support in Lebanon are examined. Data from Lebanon shows severe levels of distress among the people, in a country with minimal resources. Given current adversities in Lebanon, recent data in the country, and the literature on adversity and mental health outcomes of man-made disasters, Lebanon is most likely going to face an epidemic in poor mental health. A call is made for the wider scientific community and international organizations to support the mental health field in the country and help prevent further negative mental health outcomes. Understanding how to better navigate mental health in places with extreme adversity and emergencies can be beneficial to other communities which might face similar challenges.

Syrian Refugee Youth Resettled in Norway: Mechanisms of Resilience Influencing Health-Related Quality of Life and Mental Distress

Background: The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms to inform future interventions and policy. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect.

Methods: This was a cross-sectional study of Syrian youth recently resettled in Norway, aged 13–24 years. Regression and moderation analyses were used to explore different interactions, including moderated mediation using the PROCESS macro for SPSS.

Result: A direct main effect of promotive resilience was found for health-related quality of life (HRQoL) and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of protective resilience were found. Post-migration stressors mediated the effects of potentially traumatic events (PTE) from war and flight, and this indirect effect was present at all levels of resilience.

Conclusion: Despite high risk exposure and mental distress, resilience was also high. Broad resilience interventions targeting multiple factors would likely benefit the group, but these should include both individual assets and building supportive environments. Additionally, reducing current stress and providing treatment for those in need could enable recovery and increase the efficacy of resilience factors already present.