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Mental health problems of Syrian refugee children: the role of parental factors

Abstract

War-torn children are particularly vulnerable through direct trauma exposure as well through their parents’ responses. This study thus investigated the association between trauma exposure and children’s mental health, and the contribution of parent-related factors in this association. A cross-sectional study with 263 Syrian refugee children-parent dyads was conducted in Turkey. The Stressful Life Events Questionnaire (SLE), General Health Questionnaire, Parenting Stress Inventory (PSI-SF), Impact of Events Scale for Children (CRIES-8), and Strengths and Difficulties Questionnaire were used to measure trauma exposure, parental psychopathology, parenting-related stress, children’s post-traumatic stress symptoms (PTSS), and mental health problems, respectively. Trauma exposure significantly accounted for unique variance in children’s PTSS scores. Parental psychopathology significantly contributed in predicting children’s general mental health, as well as emotional and conduct problems, after controlling for trauma variables. Interventions need to be tailored to refugee families’ mental health needs. Trauma-focused interventions should be applied with children with PTSD; whilst family-based approaches targeting parents’ mental health and parenting-related stress should be used in conjunction with individual interventions to improve children’s comorbid emotional and behavioural problems.

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References

  1. 1.

    Abidin RR (1990) Parenting Stress Index-Short Form. Pediatric Psychology Press, Charlottesville

    Google Scholar 

  2. 2.

    Ahmadzadeh G, Malekian A (2004) Aggression, anxiety, and social development in adolescent children of war veterans with PTSD versus those of non-veterans. J Res Med Sci 9:231–234

    Google Scholar 

  3. 3.

    Aiken LS, West SG, Reno RR (1991) Multiple regression: testing and interpreting interactions. Sage, London

    Google Scholar 

  4. 4.

    Almqvist K, Brandell-Forsberg M (1997) Refugee children in Sweden: post-traumatic stress disorder in Iranian preschool children exposed to organized violence. Child Abuse Negl 21:351–366

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Attanayake V, McKay R, Joffres M, Singh S, Burkle F Jr, Mills E (2009) Prevalence of mental disorders among children exposed to war: a systematic review of 7,920 children. Med Confl Surviv 25:4–19. https://doi.org/10.1080/13623690802568913

    Article  PubMed  Google Scholar 

  6. 6.

    Banyard V, Williams L, Siegel J (2001) The long-term mental health consequences of child sexual abuse: an exploratory study of the impact of multiple traumas in a sample of women. J Trauma Stress 14:697–715

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Bean T, Eurelings-Bontekoe E, Derluyn I, Spinhoven P (2004) Stressful life events (SLE): user’s manual. In: Centrum’45, Oegstgeest

  8. 8.

    Betancourt TS, Khan KT (2008) The mental health of children affected by armed conflict: protective processes and pathways to resilience. Int Rev Psychiatry 20:317–328. https://doi.org/10.1080/09540260802090363

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Bronfenbrenner U (1977) Toward an experimental ecology of human development. Am Psychol 32:513. https://doi.org/10.1037/0003-066X.32.7.513

    Article  Google Scholar 

  10. 10.

    Chaney A, Carballedo A, Amico F, Fagan A, Skokauskas N, Meaney J, Frodl T (2014) Effect of childhood maltreatment on brain structure in adult patients with major depressive disorder and healthy participants. J Psychiatry Neurosci 39:50–59

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Dalgaard N, Todd B, Daniel S, Montgomery E (2016) The transmission of trauma in refugee families: associations between intra-family trauma communication style, children’s attachment security and psychosocial adjustment. Attach Hum Dev 18:69–89

    Article  PubMed  Google Scholar 

  12. 12.

    Dardas L, Ahmad M (2013) Coping strategies and mediators and moderators between stress and quality of life among parents of children with autistic disorder. Stress Health 31:5–12

    Article  PubMed  Google Scholar 

  13. 13.

    Derluyn I, Broekaert E, Schuyten G (2008) Emotional and behavioural problems in migrant adolescents in Belgium. Eur Child Adolesc Psychiatry 17:54–62

    Article  PubMed  Google Scholar 

  14. 14.

    Duraković-Belko E, Kulenović A, Dapić R (2003) Determinants of posttraumatic adjustment in adolescents from Sarajevo who experienced war. J Clin Psychol 59:27–40. https://doi.org/10.1002/jclp.10115

    Article  PubMed  Google Scholar 

  15. 15.

    Durà-Vilà G, Klasen H, Makatini Z, Rahimi Z, Hodes M (2013) Mental health problems of young refugees: duration of settlement, risk factors and community-based interventions. Clin Child Psychol Psychiatry 18:604–623

    Article  PubMed  Google Scholar 

  16. 16.

    Ellis BH, MacDonald HZ, Lincoln AK, Cabral HJ (2008) Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychol 76:184. https://doi.org/10.1037/0022-006X.76.2.184

    Article  PubMed  Google Scholar 

  17. 17.

    Fazel M, Reed RV, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 379:266–282. https://doi.org/10.1016/S0140-6736(11)60051-2

    Article  PubMed  Google Scholar 

  18. 18.

    Field A (2013) Discovering statistics using IBM SPSS statistics. Sage, London

    Google Scholar 

  19. 19.

    Goldberg D, Williams R (1988) A user’s guide to the general health questionnaire. NFER-Nelson, Windsor

    Google Scholar 

  20. 20.

    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Hasanović M, Sinanović O, Pavlović S (2005) Acculturation and psychological problems of adolescents from Bosnia and Herzegovina during exile and repatriation. Croat Med J 46:105–115

    PubMed  Google Scholar 

  22. 22.

    Heptinstall E, Sethna V, Taylor E (2004) PTSD and depression in refugee children. Eur Child Adolesc Psychiatry 13:373–380

    Article  PubMed  Google Scholar 

  23. 23.

    Hjern A, Angel B (2000) Organized violence and mental health of refugee children in exile: a six-year follow-up. Acta Paediatr 89:722–727

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Higgins D, McCabe M (2000) Relationships between different types of maltreatment during childhood and adjustment in adulthood. Child Maltreat 5:261–272

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Hodes M, Jagdev D, Chandra N, Cunniff A (2008) Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry 49:723–732. https://doi.org/10.1111/j.1469-7610.2008.01912.x

    Article  PubMed  Google Scholar 

  26. 26.

    Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218. https://doi.org/10.1097/00006842-197905000-00004

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Karim K, Tischler V, Gregory P, Vostanis P (2006) Homeless children and parents: short-term mental health outcome. Int J Soc Psychiatry 52:447–458. https://doi.org/10.1177/0020764006066830

    Article  PubMed  Google Scholar 

  28. 28.

    Kendler K, Kuhn J, Prescott C (2004) Childhood sexual abuse, stressful life events and risk for major depression in women. Psychol Med 34:1475–1482

    Article  PubMed  Google Scholar 

  29. 29.

    Kinzie JD, Sack WH, Angell RH, Manson S, Rath B (1986) The psychiatric effects of massive trauma on Cambodian children: I. The children. J Am Acad Child Psychiatry 25:370–376. https://doi.org/10.1016/S0002-7138(09)60259-4

    Article  Google Scholar 

  30. 30.

    Kinzie J, Sack W, Angell R, Clarke G, Ben R (1989) A three-year follow-up of Cambodian young people traumatized as children. J Am Acad Child Adol Psychiatry 28:501–504

    CAS  Article  Google Scholar 

  31. 31.

    Krešić Ćorić M, Klarić M, Petrov B, Mihić N (2016) Psychological and behavioral problems in children of war veterans with post traumatic stress disorder. Eur J Psychiatry 30:219–230

    Google Scholar 

  32. 32.

    Loukas A, Zucker RA, Fitzgerald HE, Krull JL (2003) Developmental trajectories of disruptive behavior problems among sons of alcoholics. J Abnorm Psychol 112:119–131. https://doi.org/10.1037/0021-843X.112.1.119

    Article  PubMed  Google Scholar 

  33. 33.

    Mels C, Derluyn I, Broekaert E, Rosseel Y (2010) The psychological impact of forced displacement and related risk factors on Eastern Congolese adolescents affected by war. J Child Psychol Psychiatry 51:1096–1104

    Article  PubMed  Google Scholar 

  34. 34.

    Möhlen H, Parzer P, Resch F, Brunner R (2005) Psychosocial support for war-traumatized child and adolescent refugees: evaluation of a short-term treatment program. Aust N Zeal J Psychiatry 39:81–87. https://doi.org/10.1080/j.1440-1614.2005.01513.x

    Article  Google Scholar 

  35. 35.

    Montgomery E (2010) Trauma and resilience in young refugees: a 9-year follow-up study. Dev Psychopathol 22:477–489. https://doi.org/10.1017/S0954579410000180

    Article  PubMed  Google Scholar 

  36. 36.

    Ozer S, Sirin S, Oppedal B (2016) Bahcesehir study of Syrian refugee children in Turkey. Norwegian Institute of Public Health, Oslo. https://www.fhi.no/globalassets/dokumenterfiler/moba/pdf/bahcesehir-study-report3.pdf. Accessed Dec 2017

  37. 37.

    Papageorgiou V, Frangou-Garunovic A, Iordanidou R, Yule W, Smith P, Vostanis P (2000) War trauma and psychopathology in Bosnian refugee children. Eur Child Adolesc Psychiatry 9:84–90. https://doi.org/10.1007/s007870050002

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Punamäki RL, Palosaari E, Diab M, Peltonen K, Qouta SR (2015) Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: trauma, family-and child-related predictors. J Affect Disord 172:133–140

    Article  PubMed  Google Scholar 

  39. 39.

    Qouta S, Punamäki RL, El Sarraj E (2003) Prevalence and determinants of PTSD among Palestinian children exposed to military violence. Eur Child Adolesc Psychiatry 12:265–272. https://doi.org/10.1007/s00787-003-0328-0

    Article  PubMed  Google Scholar 

  40. 40.

    Qouta S, Punamäki RL, El Sarraj E (2005) Mother-child expression of psychological distress in war trauma. Clin Child Psychol Psychiatry 10:135–156. https://doi.org/10.1177/1359104505051208

    Article  Google Scholar 

  41. 41.

    Reed RV, Fazel M, Jones L, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet 379:250–265. https://doi.org/10.1016/S0140-6736(11)60050-0

    Article  PubMed  Google Scholar 

  42. 42.

    Rousseau C, Drapeau A, Corin E (1998) Risk and protective factors in Central American and Southeast Asian refugee children. J Refug Stud 11:20–37. https://doi.org/10.1093/jrs/11.1.20

    Article  Google Scholar 

  43. 43.

    Sack WH, Clarke GN, Seeley J (1996) Multiple forms of stress in Cambodian adolescent refugees. Child Dev 67:107–116. https://doi.org/10.2307/1131689

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Sirin S, Rogers-Sirin L (2015) The educational and mental health needs of Syrian refugee children. Migration Policy Institute, Washington DC. https://www.researchgate.net/profile/Selcuk_Sirin/publication/287998909_The_Educational_and_Mental_Health_Needs_of_Syrian_Refugee_Children/links/567ccd6c08ae19758384e4bf.pdf. Accessed Dec 2017

  45. 45.

    Smith M (2004) Parental mental health: disruptions to parenting and outcomes for children. Child Fam Soc Work 9:3–11. https://doi.org/10.1111/j.1365-2206.2004.00312.x

    Article  Google Scholar 

  46. 46.

    Smith P, Perrin S, Yule W, Hacam B, Stuvland R (2002) War exposure among children from Bosnia–Hercegovina: psychological adjustment in a community sample. J Trauma Stress 15:147–156. https://doi.org/10.1023/A:1014812209051

    Article  PubMed  Google Scholar 

  47. 47.

    Smith P, Perrin S, Yule W, Rabe-Hesketh S (2001) War exposure and maternal reactions in the psychological adjustment of children from Bosnia–Hercegovina. J Child Psychol Psychiatry 42:395–404. https://doi.org/10.1111/1469-7610.00732

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Sourander A, Helstelä L, Helenius H (1999) Parent-adolescent agreement on emotional and behavioral problems. Soc Psychiatry Psychiatr Epidemiol 34:657–663

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Spinhoven P, Elzinga B, Hovens J, Roelofs K, Zitman F, van Oppen P, Penninx B (2010) The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders. J Affect Disord 126:103–112

    Article  PubMed  Google Scholar 

  50. 50.

    Sveaass N, Reichelt S (2001) Refugee families in therapy: from referrals to therapeutic conversations. J Fam Ther 23:119–135. https://doi.org/10.1111/1467-6427.00173

    Article  Google Scholar 

  51. 51.

    Syria Regional Refugee Response (2016) Inter-agency Information Sharing Portal. http://data.unhcr.org/syrianrefugees/regional.php. Accessed Dec 2017

  52. 52.

    Thabet AA, Ibraheem A, Shivram R, Winter E, Vostanis P (2009) Parenting support and PTSD in children of a war zone. Int J Soc Psychiatry 55:226–237. https://doi.org/10.1177/0020764008096100

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Thabet AA, Tawahina AA, El Sarraj E, Vostanis P (2008) Exposure to war trauma and PTSD among parents and children in the Gaza strip. Eur Child Adolesc Psychiatry 17:191. https://doi.org/10.1007/s00787-007-0653-9

    CAS  Article  PubMed  Google Scholar 

  54. 54.

    Thabet AA, Vostanis P (1999) Post-traumatic stress reactions in children of war. J Child Psychol Psychiatry 40:385–391. https://doi.org/10.1111/1469-7610.00456

    CAS  Article  PubMed  Google Scholar 

  55. 55.

    United Nations High Commissioner for Refugees (UNHCR) (2017) UNHCR Syria regional refugee response. http://data.unhcr.org/syrianrefugees/country.php?id=224. Accessed 14 Nov 2017

  56. 56.

    United Nations High Commissioner for Refugees (UNHCR) (2016) Global trends: forced displacement in 2015. http://www.unhcr.org/576408cd7.pdf. Accessed Dec 2017

  57. 57.

    Vostanis P (2014) Helping children and young people who experience trauma: children of despair, Children of Hope. Radcliffe Publishing, London

    Google Scholar 

  58. 58.

    Vostanis P (2014) Meeting the mental health needs of refugee and asylum seekers. Br J Psychiatry 204:176–177

    Article  PubMed  Google Scholar 

  59. 59.

    Vostanis P (2016) New approaches to interventions for refugee children. World Psychiatry 15:75–77

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J, Spahovic D, Sclove S, Pavkovi I, Feetham S, Rolland J (2008) Evaluating a multiple-family group access intervention for refugees with PTSD. J Mar Fam Ther 34:149–164

    Article  Google Scholar 

  61. 61.

    Weine SM, Raina D, Zhubi M, Delesi M, Huseni D, Feetham S, Kulauzovic Y, Melmestein R, Campbell R, Rolland J, Pakvoic I (2003) The TAFES multi-family group intervention for Kosovan refugees: a feasibility study. J Nerv Ment Disord 191:100–107

    Google Scholar 

  62. 62.

    Werner EE (2012) Children and war: risk, resilience and recovery. Dev Psychopathol 24:553–558

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful to all the families who took part in the study. Our sincere thanks to the two school principals and teachers for their kind support.

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Correspondence to Panos Vostanis.

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This article is part of the focused issue ‘Mental health issues in refugees’.

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Eruyar, S., Maltby, J. & Vostanis, P. Mental health problems of Syrian refugee children: the role of parental factors. Eur Child Adolesc Psychiatry 27, 401–409 (2018). https://doi.org/10.1007/s00787-017-1101-0

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Keywords

  • Refugee
  • Trauma
  • Child
  • Parent
  • Mental health