Panter-Brick Catherine, Grimon Marie-Pascale, Eggerman Mark
Yale University, New Haven, Connecticut, USA.
J Child Psychol Psychiatry. 2014 Apr;55(4):313-27. doi: 10.1111/jcpp.12167. Epub 2013 Nov 29.
In humanitarian settings, family-level drivers of mental health are insufficiently documented; we examined the strength of caregiver-child associations with two-wave, family-level Afghan data.
We recruited a gender-balanced sample of 681 caregiver-child dyads (n = 1,362 respondents) using stratified random-sampling in government schools in Kabul (364 dyads) and refugee schools in Peshawar (317 dyads). One year after baseline, we re-interviewed 64% of Kabul and 31% of Peshawar cohorts (n = 331 dyads, 662 respondents), retaining fewer Peshawar families due to refugee repatriation. In multivariable analyses adjusted for baseline, we assessed the extent to which caregiver mental health (Self-Report Questionnaire, SRQ-20) was associated with child symptom scores of post-traumatic stress (Child Revised Impact of Events Scale, CRIES), depression (Depression Self-Rating Scale, DSRS), psychiatric difficulties, impact, and prosocial strength (Strength and Difficulties Questionnaire, SDQ).
Caregiver mental health was prospectively associated with all eight measures of child mental health at follow-up, adjusted for baseline. For post-traumatic stress, caregiver mental health had a predictive impact comparable to the child experiencing one or two lifetime trauma events. For depression, caregiver mental health approached the predictive impact of female gender. Thus a one SD change in caregiver SRQ-20 was associated with a 1.04 point change on CRIES and a 0.65 point change in DSRS. For multi-informant SDQ data, caregiver-child associations were strongest for caregiver ratings. For child-rated outcomes, associations were moderated by maternal literacy, a marker of family-level dynamics. Both adults and children identified domestic violence and quality of home life as independent risk and protective factors.
In the context of violence and displacement, efforts to improve child mental health require a thoughtful consideration of the mental health cascade across generations and the cluster of adversities that impact family wellbeing. We identify culturally meaningful leverage points for building family-level resilience, relevant to the prevention and intervention agenda in global mental health.
在人道主义环境中，家庭层面影响心理健康的因素记录不足；我们利用阿富汗家庭层面的两波数据，研究了照顾者与儿童之间关联的强度。
我们在喀布尔的政府学校（364对）和白沙瓦的难民学校（317对）采用分层随机抽样法，招募了一个性别均衡的681对照顾者-儿童样本（n = 1362名受访者）。在基线期一年后，我们对喀布尔队列的64%和白沙瓦队列的31%进行了重新访谈（n = 331对，662名受访者），由于难民遣返，白沙瓦的家庭样本减少。在针对基线进行调整的多变量分析中，我们评估了照顾者心理健康（自评问卷，SRQ-20）与儿童创伤后应激症状评分（儿童事件影响量表修订版，CRIES）、抑郁（抑郁自评量表，DSRS）、精神障碍、影响及亲社会能力（长处与困难问卷，SDQ）之间的关联程度。
在针对基线进行调整后，照顾者心理健康与随访时儿童心理健康的所有八项指标均存在前瞻性关联。对于创伤后应激，照顾者心理健康的预测影响与儿童经历一两次终身创伤事件相当。对于抑郁，照顾者心理健康的预测影响接近女性性别的预测影响。因此，照顾者SRQ-20得分每变化一个标准差，与CRIES得分变化1.04分及DSRS得分变化0.65分相关。对于多信息提供者的SDQ数据，照顾者-儿童之间的关联在照顾者评分方面最为强烈。对于儿童自评结果，关联受到母亲识字率的调节，母亲识字率是家庭层面动态变化的一个指标。成人和儿童均将家庭暴力和家庭生活质量确定为独立的风险因素和保护因素。
在暴力和流离失所的背景下，改善儿童心理健康需要深思熟虑地考虑代际间的心理健康级联效应以及影响家庭福祉的一系列逆境。我们确定了具有文化意义的增强家庭复原力的杠杆点，这与全球心理健康的预防和干预议程相关。
