Department of Research and Development, War Child Holland, Amsterdam, The Netherlands.
Center for Global Mental Health, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
Curr Psychiatry Rep. 2016 Jun;18(6):58. doi: 10.1007/s11920-016-0692-3.
Research on the mental health and psychosocial wellbeing of children in conflict-affected settings has undergone a significant paradigm shift in recent years. Earlier studies based on a war exposure model primarily emphasized the effects of direct exposure to armed conflict; this has gradually given way to a broader understanding of the diverse pathways by which organized violence affects children. A robustly supported comprehensive model includes risk factors at multiple points in time (prior war exposure, ongoing daily stressors) and at all levels of the social ecology. In particular, findings suggest that material deprivation and a set of family variables, including harsh parenting, parental distress, and witnessing intimate partner violence, are important mediators of the relationship between armed conflict and children's wellbeing. To date, however, interventions aimed at supporting war-affected children's wellbeing, both preventive and treatment-focused, have focused primarily on direct work with children, while paying only modest attention to ongoing risk factors in their families and broader environments. Possible reasons for the ongoing prioritization of child-focused interventions are considered, and examples are provided of recent evidence-based interventions that have reduced toxic stressors (harsh parenting and the use of violent discipline by teachers) in conflict-affected communities.
近年来，受冲突影响环境中儿童的心理健康和社会心理福祉研究发生了重大范式转变。早期基于战争暴露模型的研究主要强调了直接接触武装冲突的影响；这逐渐让位于更广泛的认识，即有组织暴力通过多种途径影响儿童。一个得到充分支持的综合模型包括在多个时间点（战前暴露、持续的日常压力源）和社会生态系统各个层面的风险因素。具体而言，研究结果表明，物质匮乏和一系列家庭变量，包括严厉的育儿方式、父母的困境以及目睹亲密伴侣暴力，是武装冲突与儿童福祉之间关系的重要中介因素。然而，迄今为止，旨在支持受战争影响儿童福祉的干预措施，无论是预防还是治疗重点，主要都集中在直接与儿童合作，而对其家庭和更广泛环境中的持续风险因素关注甚少。考虑了持续优先考虑以儿童为中心的干预措施的可能原因，并提供了一些最近的基于证据的干预措施的例子，这些干预措施减少了冲突环境中有毒的应激源（严厉的育儿方式和教师使用暴力纪律）。
