Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK.
Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon.
Epidemiol Psychiatr Sci. 2022 Jun 15;31:e41. doi: 10.1017/S2045796022000191.
Children's responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on cross-sectional data in high-income countries. We aimed to (1) investigate change in resilience across two timepoints in a highly vulnerable sample of Syrian refugee children in Lebanon, and (2) explore predictors of their mental health problems across time.
In total, 982 Syrian child-caregiver dyads living in refugee settlements in Lebanon completed questionnaires via interview at baseline and follow-up one year later. We categorised children into groups based on their risk for mental health problems across both timepoints (stable high risk/SHR, deteriorating, improving, stable low risk) according to locally validated cut-offs on measures of post-traumatic stress disorder (PTSD), depression and behavioural problems. Analyses of covariance identified how the groups differed on a range of individual and socio-environmental predictors, followed up by cross-lagged panel models (CLPMs) to investigate the directionality of the relationships between significantly related predictors and symptoms.
The sample showed a meaningful amount of change in mental health symptoms from baseline to follow-up. Over half (56.3%) of children met SHR criteria and 10.3% deteriorated over time, but almost one-quarter (24.2%) showed meaningful improvement, and 9.2% were consistently at low risk for mental health problems at both timepoints. Several predictors differentiated the groups, particularly social measures. According to CLPMs, maternal acceptance ( = -0.07) predicted child mental health symptoms over time. Self-esteem ( = -0.08), maternal psychological control ( = 0.10), child maltreatment ( = 0.09) and caregiver depression ( = 0.08) predicted child symptoms and vice versa ( = -0.11, = 0.07, = 0.08, = 0.1, = 0.11). Finally, child symptoms predicted loneliness ( = 0.12), bullying ( = 0.07), perceived social support ( = -0.12), parent-child conflict ( = 0.13), caregiver PTSD ( = 0.07), caregiver anxiety ( = 0.08) and the perceived refugee environment ( = -0.09).
Our results show risk and resilience are dynamic, and the family environment plays a key role in children's response to war and displacement. Conversely, children also have a significant impact on the family environment and caregiver's own mental health. Interventions to promote resilience in refugee children should therefore consider family-wide mechanisms.
儿童对战争和流离失所的反应各不相同；许多人在挣扎，而另一些人则表现出坚韧。然而，对这些结果的研究过分集中在高收入国家的横断面数据上。我们的目的是：（1）在黎巴嫩一个高度脆弱的叙利亚难民儿童样本中，在两个时间点上调查韧性的变化；（2）探索其精神健康问题随时间的变化预测因素。
共有 982 对叙利亚儿童-照顾者在黎巴嫩难民营中通过访谈完成了基线和一年后随访的问卷。我们根据创伤后应激障碍（PTSD）、抑郁和行为问题的当地验证切点，根据两个时间点的精神健康问题风险（稳定的高风险/高风险、恶化、改善、稳定的低风险）将儿童分为不同的组别。协方差分析确定了各组在一系列个体和社会环境预测因素上的差异，随后进行交叉滞后面板模型（CLPM）以调查显著相关预测因素和症状之间的关系的方向性。
该样本的精神健康症状从基线到随访有显著变化。超过一半（56.3%）的儿童符合高风险标准，10.3%的儿童随时间恶化，但近四分之一（24.2%）的儿童有显著改善，9.2%的儿童在两个时间点都持续处于低风险。有几个预测因素区分了各组，特别是社会措施。根据 CLPM，母亲的接受程度（= -0.07）随时间预测儿童的精神健康症状。自尊（= -0.08）、母亲心理控制（= 0.10）、儿童虐待（= 0.09）和照顾者抑郁（= 0.08）预测儿童症状，反之亦然（= -0.11、= 0.07、= 0.08、= 0.1、= 0.11）。最后，儿童症状预测孤独感（= 0.12）、欺凌（= 0.07）、感知社会支持（= -0.12）、父母-子女冲突（= 0.13）、照顾者创伤后应激障碍（= 0.07）、照顾者焦虑（= 0.08）和感知难民环境（= -0.09）。
我们的结果表明，风险和适应力是动态的，家庭环境在儿童对战争和流离失所的反应中起着关键作用。相反，儿童对家庭环境和照顾者自身的心理健康也有重大影响。因此，促进难民儿童适应力的干预措施应考虑到家庭范围的机制。
