Mental health problems from direct vs indirect exposure to violent events among children born and growing up in a conflict zone of southern Thailand



This study aims to examine and compare the effects of direct and indirect exposure to armed conflicts on the mental health of primary school students in the three southernmost provinces of Thailand.


A school-based survey was conducted. Detailed exposure of traumatic events both directly and indirectly were measured by a self-completed questionnaire. Behavioral–emotional problems were measured by the Strength and Difficulty Questionnaire and screening for post-traumatic stress disorder (PTSD) was done using the Children’s Revised Impact of Events Scale (CRIES). Multivariate analysis adjusted for gender and other covariates was used to determine the effect of direct and indirect exposure of armed conflict on mental health problems.


Out of 941 students included in the study, almost half had direct exposure to an armed conflict event. Overall, 42.1% of students had at least one behavioral–emotional problem (47.6% and 38.5% in the direct- and indirect-exposed groups, respectively) and 30.5% was found to have PTSD (37.3% and 25.9% in the direct- and indirect-exposed groups, respectively). Students who had direct exposure to an armed conflict event had a two times higher odds of mental health problems than their peers. Other modifiable factors of mental health problems were receiving news from two sources including other adults and media, and exposure to other non-conflict-related traumatic life events.


Children living in armed conflict areas of southern Thailand, although without any direct exposure to traumatic events, also suffered from mental health problems. Research on appropriate interventions for these children should be further conducted.

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This study was financially supported by the Discipline of Excellence Program, Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand. We are grateful to all teachers and students who participated in the study.

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Correspondence to Rassamee Sangthong.

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Jayuphan, J., Sangthong, R., Hayeevani, N. et al. Mental health problems from direct vs indirect exposure to violent events among children born and growing up in a conflict zone of southern Thailand. Soc Psychiatry Psychiatr Epidemiol 55, 57–62 (2020) doi:10.1007/s00127-019-01732-8

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  • Armed conflict zone
  • Children
  • Mental health
  • PTSD
  • Behavioral–emotional problems
  • Deep southern Thailand