Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches

The lived experiences of childhood trauma in war: has post-traumatic growth occurred?

Background: This study seeks to explore the Post-Traumatic Growth (PTG) condition, a transformative psychological process that promotes improved cognitive functioning and resilience in individuals who suffered childhood trauma, including those affected by the Iran-Iraq war. PTG denotes positive psychological changes, such as enhanced reasoning abilities and emotional strength (Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1-18)).Method: This study views trauma responses as complex and multidimensional, including not only negative outcomes but also coping strategies and psychological growth. Data was collected through semi-structured interviews with 11 participants who witnessed the Iran-Iraq war during childhood. Participants were from a broad spectrum of ethnic backgrounds, reflecting the multiethnic diversity of the war-affected areas. This is significant as their cultural background could affect how they process and heal from trauma due to the multiplicity of values, beliefs, and behaviours. Also, participants' socio-economic backgrounds ranged from low to middle-income, allowing for an investigation of how trauma and growth are impacted by financial resources and constraints. Data were analyzed using Moustakas's phenomenological analysis approach.Results: The findings revealed eight primary and twelve secondary themes ranging from psychological effects and long-term coping mechanisms and wartime recollections. The analysis also revealed distinct patterns of trauma symptoms and growth in adults approaching middle age. The available evidence points to the fact that, although the war-afflicted participants had to contantly live with the lingering effects of trauma across different stages of their lives, they continued to flourish and remain resilient with efficient stress management.Conclusions: The study emphasizes that, in theoretical terms, unexpected developmental steps are crucial, suggesting that childhood trauma, while commonly associated with negative outcomes, can also lead to growth and resilience in certain circumstances.

The role of prenatal stress and maternal trauma responses in predicting children's mental health during war

Background: The negative effects of prenatal stress on children's development and the buffering effects of maternal behaviour are well documented. However, specific maternal responses to trauma, particularly among families experiencing cumulative stressors during pregnancy and early childhood, remain less understood.Objective: This study investigated the interplay between prenatal stress in the context of the coronavirus disease 2019 (COVID-19) pandemic and consequent maternal trauma responses and children's difficulties in the context of war-related trauma.Methods: We recruited 318 pregnant women in Israel during the first wave of the COVID-19 pandemic (Time 1). Prenatal depression, anxiety, and COVID-related stress symptoms were assessed. When children were approximately 3.5 years old (SD = 0.02), the mothers were asked to report on parental responses related to the ongoing war and their child's emotional and behavioural difficulties (Time 2). Structural equation modelling was used to examine how maternal trauma responses mediate the association between prenatal stress-related mental health symptoms and children's difficulties during war.Results: Maternal prenatal depressive, anxious, and COVID-19-related stress symptoms predicted maladaptive maternal trauma responses during the war, which in turn were associated with increased emotional and behavioural problems in their children. Among the specific maternal trauma-related responses examined, cognitive avoidance and overprotectiveness were the only behavioural responses during the war significantly associated with children's difficulties.Conclusions: Our study highlights the impact of pandemic-related prenatal stress on maternal responses and children's difficulties during war, emphasizing the importance of identifying at-risk families as well as developing targeted interventions that mitigate negative parenting responses, particularly avoidance and overprotection.

Addressing international research challenges in child and adolescent mental health during global crises: experience and recommendations of the Co-SPACE international consortium

During the most recent global crisis due to COVID-19 pandemic, mental health researchers globally were tasked with carrying out high-quality and responsive research to understand the changes and long-term trajectories in young people’s mental health symptoms. Comparative international longitudinal research has been recommended as a particularly promising avenue to understand pandemic impacts and facilitate global solutions. The Co-SPACE International Consortium comprises researchers from 14 sites who aimed to compare findings on the impact of the pandemic on young people and family mental health. This paper describes the process and challenges associated with the Consortium’s efforts to combine country-level data to produce global insights for research and clinical practice for the past three years. Several key challenges were identified, particularly about the conduct of international comparative research. These challenges concerned funding, ethics review, data sharing, variations in cultural and local contexts, lack of cross-culturally comparable or meaningful measures, research design, and dissemination. After considering these challenges, we provide a range of recommendations that provide a blueprint for the gathering of timely and robust evidence, the identification of global trends, the mobilisation of resources, and effective support to children and families in public health crises.

Conflict exposure and mental health: a survey of adolescent girls and young women in Myanmar post the 2021 coup d'état

BACKGROUND

Following the 2021 military coup in Myanmar, adolescent girls and young women have faced a multitude of threats to their health and wellbeing. Beyond direct exposure to armed combat, injuries and loss of life, they are also experiencing displacement, family separation, and restricted access to education and healthcare. These challenges are further compounded by military-imposed restrictions on humanitarian aid and access to the country. This study sought to address a critical gap in understanding how exposure to conflict in Myanmar is impacting adolescent girls' mental health.

METHODS

We conducted a survey, co-developed with peer-researchers, with 750 girls and young women aged 10 to 21 years from disproportionately disadvantaged communities across Myanmar. The survey included questions on participants' demographics, their exposure to conflict-related stressors and their self-reported depressive symptoms.

RESULTS

Participants reported widespread exposure to traumatic conflict-related stressors and high levels of depressive symptoms. There was a significant positive association between the number of different conflict-related stressors experienced by the study participants and the number of depressive symptoms reported. Additionally, participants who were living away from their parents reported significantly higher levels of depressive symptoms, emphasising the psychological implications of family separation during conflict.

CONCLUSIONS

Our results highlight the urgent need for tailored interventions for adolescents, particularly girls and young women, who are exposed to armed conflict. In contexts of protracted instability and uncertainty, such as in Myanmar, interventions should explore ways to foster a sense of social safety, especially among adolescent girls who are displaced or living away from their families. Strengthening social safety systems may help to reduce the adverse mental health impacts of conflict-related stressors.

Children's right to play in Chilean hospitals: A forgotten right?-A qualitative study protocol

BACKGROUND

Despite being a recognised human right (art. 31 of the United Nations Convention on the Rights of the Child), children's right to play is still insufficiently researched, understood and, above all, implemented. In Chile, the National Child Health Programme recognises the importance of this right for the hospitalised children but makes its provision dependent on the hospital's capacity. We therefore hypothesise that the provision of children's right to play in Chilean hospital settings will be irregular, varying from institution to institution, possibly reflecting the existing socio-economic inequalities in the country, thereby leaving much room for improvement.

AIMS

This study aims to collect qualitative data on the institutional arrangements and opportunities for children's play in public hospitals in Chile. Specifically, our goal is to (a) interpret the conditions and opportunities for play that Chilean public hospitals provide to children and adolescents; (b) interpret institutional arrangements and professional experiences of children's play in those institutions; (c) identify factors that favour and/or limit opportunities for children's play in the Chilean hospital setting.

METHODS

This is exploratory qualitative research, combining multiple and instrumental case study with ethnographic research. Its data collection techniques are semi-structured interviews with professionals in hospital settings (supported by a self-assessment questionnaire), and non-participant observations of hospital playrooms (and/or other play spaces).

CONCLUSION

This will be the first study to investigate children's right to play in Chilean hospitals, with a particular focus on the extent of its implementation, its understanding among health professionals, as well as existing limitations and opportunities for its development.

Parent-child mental health in Ukraine in relation to war trauma and drone attacks

BACKGROUND

We aimed to address the knowledge gap regarding mental health in Ukrainian children and parents one year after Russia's 2022 full-scale invasion including associations with exposure to drone attacks.

METHODS

A cross-sectional, quota-sampled survey was conducted among parents of children aged 3-17 in Ukraine one year after the invasion (n = 858). Participants completed self-reported screening measures of the Pediatric Symptom Checklist-17, Child and Adolescent Trauma Screen-Caregiver, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, the International Trauma Questionnaire, and the University of California, Los Angeles (UCLA) 3-Item Loneliness Scale. We analyzed scores in relation to drone attack exposure using logistic regression.

FINDINGS

Many children aged 3-6 years had scores suggestive of ADHD (24.2 %), conduct disorder (20.5 %), and anxiety/mood disorder (12.1 %). Results were similar among children aged 7-17 (anxiety/mood disorder: 24.1 %, conduct disorder: 14.5 %, and ADHD: 14 %). Of the 45.0 % of children aged 3-6 and 57.0 % aged 7-17 exposed to post-invasion trauma, 21.8 % and 17.6 % had clinically relevant levels of PTSD symptoms, respectively. Parental symptoms met screening criteria for depressive disorder in 46.7 % and for anxiety disorder in 24.2 %. All parents reported post-invasion trauma, with 24.5 % screening positive for PTSD. Child mental health disorder odds increased with parental PTSD (OR 1.85, 95 %CI 1.29-2.72) and symptoms meeting screening criteria for depressive disorder (OR 1.99, 95 %CI 1.15-2.56). The odds of children aged 7-17 having clinically relevant levels of PTSD symptoms increased with parental symptoms screening positive for depressive disorder (OR 6.0, 95 %CI 2.0-18.3), anxiety disorder (OR 3.48, 95 %CI 1.76-6.8), and PTSD (OR 3.23, 95 % 1.67-6.2). Parents had a higher prevalence of screening positive for PTSD in high-intensity drone attack regions (28.9 %) than low- and moderate-intensity regions (25.0 % and 20.5 %, respectively, p = 0.04).

INTERPRETATION

The high prevalence of children and parents in Ukraine with symptoms screening positive for mental disorders indicates an urgent need for services for school-age children and parents in this war-affected region. High-intensity drone attacks increase the risk of parents screening positive for PTSD.

Does war moderate the association between mental wellbeing and its predictors among children? A multi-country cross-sectional study

BACKGROUND

This study explores how war or conflict influences the established predictors of mental well-being among children, addressing a significant gap in current research.

METHODS

Utilizing data from Multiple Indicator Cluster Surveys (MICS6) collected between 2016 and 2021, we examined children aged 5-17 years in four low or middle-low-income countries experiencing war or conflict and compared them to 20 control countries. We employed logistic models to analyze the data, focusing on mental well-being as the outcome. Primary independent variable was exposure to war, with an emphasis on the interaction between this exposure and potential predictors, including age, sex, having a physical disability, enrolled in education, having siblings, living with at least one parent, residence place, and family wealth status.

RESULTS

The analysis revealed significant modifications in the association between factors like age, disability, education, economic status, and place of residence and mental well-being due to war (p values < 0.05). Specifically, the impact of war was more pronounced in older children (OR = 1.48, 95%CI = 1.18-1.85) compared to younger ones. Education was found to mitigate anxiety in conflict-affected areas (OR = 0.75, 95%CI = 0.60-0.95), whereas children with disabilities were more vulnerable to mental health challenges (OR = 2.05, 95%CI = 1.65-2.55) in these settings.

LIMITATIONS

The mental well-being measure was based on caregiver reports, which may not fully capture the children's experiences.

CONCLUSION

Our findings provide crucial insights into the differential impact of war on children's mental well-being. They underscore the need for tailored, context-specific mental health interventions for children in conflict-affected areas and encourage further research into the nuanced effects of war on child and adolescent mental health.

"Fox-like. One eye open, one eye closed": child supervision among Syrian refugee mothers in Canada

When children live through violent conflict and forced displacement, the associated disruptions in their environment can profoundly affect their wellbeing and development, undermining stability and family cohesion essential for healthy growth. Adequate child supervision is an important component of supportive parenting but is understudied in the refugee migration context. Guided by the United Nations Convention on the Rights of the Child (CRC) (1989), which emphasizes the protection, provision, and participation of children as rights-holders, this study explored how Syrian refugee mothers resettled in Canada between late 2015 and 2017 perceived and practiced child supervision. Using a cross-sectional, qualitative design, we conducted semi-structured interviews with 20 mothers (half government-assisted refugees and half privately sponsored refugees) to examine their parenting across four migration stages: pre-conflict Syria, pre-flight conflict Syria, transit in various countries, and resettlement in Canada. Participants came from diverse religious and cultural backgrounds and spent varying times in transit (between 2 months to 5 years). Mothers' narratives revealed how their approaches to children's provision, protection, and participation evolved, shaped by material resources, social networks, and risks at each stage. Grounded in a critical children's rights framework, the analysis of mothers' daily negotiations highlights the dynamic and context-dependent nature of children's rights, and the interconnections and tensions between provision, protection, and participation in child supervision. This study contributes to a deeper understanding of how refugee mothers navigate and uphold children's rights throughout migration trajectories, advocating for policies and interventions that recognize these dynamic processes and the critical role of caregivers in ensuring children's dignity and wellbeing.

Reprint of Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict

BACKGROUND

In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues.

OBJECTIVE

This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations.

METHODS

The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health.

RESULTS

Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems.

CONCLUSIONS

Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.

The mental functioning of school-age children in Poland since the outbreak of war in Ukraine and during the subsequent refugee crisis

BACKGROUND

There is growing body of research focusing on the functioning of children who have fled from war-torn areas. However, there is currently lack of data regarding the functioning of children residing in host countries.

OBJECTIVE

The aim of this study is to examine the presence of emotional problems, negative attitudes, interpersonal problems, and functional difficulties among Polish children during the first month after the outbreak of war and initial phase of the current refugee crisis.

PARTICIPANTS AND METHOD

The study group comprised children aged 9-15 (N = 360), living in Poland. The Children's Depression Inventory 2 (CDI-2) and The Cognitive Triad Inventory for Children (CTIC) was used to measure emotional functioning. The study took place 7 to 39 days after the outbreak of the war in Ukraine.

RESULTS

The children reported more emotional problems (t(359) = 9.340; p < .001; d = 0.49) with a negative mood (t(359) = 6.692; p < .001; d = 0.35) and negative self-esteem (t(359) = 9.632; p < .001; d = 0.51). The severity of depression symptoms was the highest in the first week after the outbreak of the war (F(5,354) = 2.472; p < .05; η2 = 0.03). The view of the self (F(1,358) = 3.858; p = .05; R2 = 0.01) and of the world (F(1,358) = 5.359; p < .05; R2 = 0.02) improved over time; however, their vision of the future remained unchanged.

CONCLUSION

The results shows that children who are not directly affected by the war can also display difficulties in mental functioning. In the initial months following the outbreak of the war and during the early stage of the current refugee crisis, Polish children demonstrated significantly higher levels of emotional problems and negative self-esteem. Moreover, the perception of oneself and the world appeared to be influenced by the duration since the onset of the war.

Mental health of university students twenty months after the beginning of the full-scale Russian-Ukrainian war

BACKGROUND

Russia's full-scale military invasion of Ukraine on February 24, 2022 led to an increase of anxiety and depressive states, psychosomatic manifestations, and a tendency to abuse alcohol and psychoactive substances in the population. The aim of this paper is to examine the mental health burden among university students twenty months after war and to identify risk and protective factors for mental health problems.

METHODS

A cross-sectional study was conducted among Ukrainian students in October 2023 (n = 1398). The online survey included sociodemographic data collection, evaluation of psychological well-being and measured depression, anxiety, PTSD symptoms and insomnia. Normality of included variables was verified by Kolmogorov-Smirnov test. An independent-samples t-test, Mann-Whitney U-test, χ2 test and analysis of variance were used to compare the data. Differences in PHQ-9 and GAD-7 levels based on sociodemographic characteristics were analyzed using ANOVA. Correlation between variables was calculated with Pearson correlation, adjusted with Benjamini-Hochberg procedure. To develop the predictive model the XGBoost algorithm was employed, additionally, the SHAP algorithm was utilized.

RESULTS

Symptoms of PTSD, as well as moderate and severe symptoms of anxiety, depression, and insomnia, were reported by 48.1%, 34.1%, 33.6%, and 19.3% of students, respectively. The severity of these symptoms varied based on factors such as sex, age, prior trauma experiences, and living conditions. Additionally, the type of relocation (within Ukraine or abroad) significantly influenced mental health outcomes. A majority of participants (68.5%) reported the experience of war-related traumatic events. Factors linked to higher depression symptom scores included lower initial well-being, greater social media use, female gender, exposure to multiple traumatic events, experiences of assault or sexual violence, the loss of a loved one, pre-existing and ongoing mental health treatment during the war, and the use of psychotropic medications.

CONCLUSIONS

Ukrainian university students face a significant mental health burden due to the ongoing war, with high rates of reported PTSD, anxiety, depression, and insomnia symptoms. These findings highlight the importance of tailored mental health interventions through different stakeholders that take into account individual needs, past experiences, burdens and social media usage.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War

OBJECTIVE

More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions.

METHOD

Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network.

RESULTS

The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear.

CONCLUSION

There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

PLAIN LANGUAGE SUMMARY

Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support for children and adolescents living in war affected regions. In this scoping review, the authors identified 1 study evaluating digital mental health interventions for children and adolescents affected by war and 5 for those affected by disasters. In addition, 35 interventions were identified through expert consultation as of possible relevance. The authors found very limited evidence for the use of digital mental health interventions for children and adolescents affected by war, and given this provide a framework to inform the development of new interventions.

DIVERSITY & INCLUSION STATEMENT

We actively worked to promote sex and gender balance in our author group.

STUDY PREREGISTRATION INFORMATION

Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

War Exposure and DNA Methylation in Syrian Refugee Children and Adolescents

Importance

Exposure to war is associated with poor mental health outcomes. Adverse and traumatic experiences can lead to long-lasting DNA methylation changes, potentially mediating the link between adversity and mental health. To date, limited studies have investigated the impact of war on DNA methylation in children or adolescents, hampering our understanding of the biological impact of war exposure.

Objective

To identify salivary DNA methylation differences associated with war exposure in refugee children and adolescents.

Design, Setting, and Participants

This cohort study included Syrian refugee children and adolescents, and their primary caregiver were recruited from tented settlements in Lebanon. Data collection was carried out in 2 waves, 1 year apart, from October 2017 to January 2018 and October 2018 to January 2019. Children and their caregiver were interviewed, and children provided saliva samples for DNA extraction. Data analysis was conducted in 2022, 2023, and 2024.

Exposure

War exposure assessed by interviewing children and their caregiver using the War Events Questionnaire.

Main Outcomes and Measures

Salivary DNA methylation levels were assayed with the Infinium MethylationEPIC BeadChip (Illumina). Epigenetic aging acceleration was estimated using a set of preexisting epigenetic aging clocks. A literature search was conducted to identify previously reported DNA methylation correlates of childhood trauma.

Results

The study population included 1507 children and adolescents (mean [SD] age, 11.3 [2.4] years; age range, 6-19 years; 793 female [52.6%]). A total of 1449 children provided saliva samples for DNA extraction in year 1, and 872 children provided samples in year 2. Children who reported war events had a number of differentially methylated sites and regions. Enrichment analyses indicated an enrichment of gene sets associated with transmembrane transport, neurotransmission, and intracellular movement in genes that exhibited differential methylation. Sex-stratified analyses found a number of sex-specific DNA methylation differences associated with war exposure. Only 2 of 258 (0.8%) previously reported trauma-associated DNA methylation sites were associated with war exposure (B = -0.004; 95% CI, -0.005 to -0.003; Bonferroni P = .04 and B = -0.005; 95% CI, -0.006 to -0.004; Bonferroni P = .03). Any war exposure or bombardment was nominally associated with decreased epigenetic age using the Horvath multitissue clock (B = -0.39; 95% CI, -0.63 to -0.14; P = .007 and B = -0.42; 95% CI, -0.73 to -0.11; P = .002).

Conclusions and Relevance

In this cohort of Syrian refugee children and adolescents, war exposure was associated with a small number of distinct differences in salivary DNA methylation.

Mental health and help-seeking behaviors among Mozambican youth: insights from a post-pandemic National Survey Amidst Internal Conflict

PURPOSE

This study aimed to investigate the prevalence and sociodemographic determinants of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among Mozambican youth aged 15-24 years, as well as their help-seeking behaviors.

METHODS

Data from 8,154 youth participants in the 2022-23 Mozambique Demographic Health Survey were analyzed. MDD and GAD were assessed using the PHQ-9 and GAD-7 scales, respectively. Univariate and multivariate logistic regression analyses were conducted to examine associations between sociodemographic factors and mental health outcomes and health-seeking behaviors.

RESULTS

The prevalence of MDD and GAD among Mozambican youth was 7.5% for each condition. However, only 9.3% of those with either MDD or GAD sought help for their symptoms, primarily from family and friends. Females had significantly higher odds of experiencing both MDD and GAD but lower help-seeking behavior as compared to males. Unemployment, lower household wealth, and being single were associated with higher odds of both disorders and lower odds of help-seeking behaviors. Higher education increased the odds of GAD and help-seeking behaviors. Significant regional variations were observed, with conflict-affected regions including Cabo Delgado, Nampula, and Zambezia showing the highest prevalence of MDD and GAD.

CONCLUSION

This study reveals substantial mental health challenges among Mozambican youth, with notable disparities across sociodemographic groups and regions. The low rates of help-seeking behavior underscore the need for targeted interventions to improve mental health awareness and access to services for socio-demographically vulnerable youth.

War exposure and changes in eating behaviours in Ukrainian school-aged children: A cross-sectional online survey

The war in Ukraine has exposed children to extremely high levels of acute and chronic stressors, which can impact their eating behaviour (EB). We aimed to determine the prevalence of war-induced, stress-related disruptions in EB of Ukrainian children. We conducted a cross-sectional online survey among parents of 5- to 17-year-old children, who had experienced the war in Ukraine in February-May 2023. Guardians reported their child's various war exposure changes in EBs using a modified version of the Child Eating Behaviour Questionnaire. We assessed associations between total and medium-term EB changes and age, sex, and war exposure using bivariate correlations and χ2 tests. Logistic regression models were fitted to explore the associations between socio-demographic factors, war exposure and frequency of EB changes. Of the 4854 children, 63% had changes in EBs during the war. The most common EB changes included food cravings (38%), food fussiness (37%), and aversion to certain foods (29%). Of the reported EB changes, 40% were medium-term, lasting over a month, and related to altered attitudes towards food. Food insecurity (adjusted OR 2.35, 95% CI: 1.76-3.14), and displacement (internally 2.01, 1.19-3.42) emerged as the most influential determinants of medium-term EB changes. The findings underscore a significant and robust association between war-related exposures and an increased risk of frequent EB changes. As healthy EBs are learned during childhood and have been shown to track into adulthood, the identified disruptions in EB may have medium-term consequences for the physical and mental health of Ukrainian children.

Health and socio-demographic background of Ukrainian minors and their families in Germany - challenges for refugee medicine : A cross-sectional study from the German Network University Medicine (NUM)

In 2022, over 1,000,000 people from Ukraine fled to Germany, mostly women and children. The aim of this study was to determine health status and socio-demographic background of Ukrainian refugee minors in Germany and to compare that to German minors. In this study, Ukrainian refugees of all ages, who voluntarily made contact with the study centres via flyers or refugee shelters, were interviewed with the help of trained interpreters from 09-12/2022. We assessed data from minors and their families on socio-economic status, general health perception, current and pre-existing infectious and non-contagious diseases, and vaccination status. The data for the minors were collected by interviewing the accompanying adults. In addition, a physical examination and serological screening for infectious and vaccine-preventable diseases were performed. Overall, 392 minors and accompanying adults (358) were included. Minors' general and mental health were reported as "at least good" in 83% (316) and 80% (304), respectively. In 16% (63), infectious or other underlying diseases were recorded. Tuberculosis infections (7, 1.8%) and hepatitis C (2, 0.5%) were found through the serological tests. HIV could only be detected in one previously known case. Self-reported vaccinations against measles and varicella, for example, did not match serological findings (protection against measles 304; 84%; varicella 230; 64%).

CONCLUSION

Accompanying adults often rate the general health and well-being of Ukrainian refugee minors as rather poor. Frequently, self-reported vaccinations and preexisting diseases did not match serology results; therefore, Ukrainian refugee minors without formal vaccination certificate should be offered all recommended vaccinations and be generously screened for hepatitis B, C and HIV in addition to tuberculosis.

WHAT IS KNOWN

• Infectious diseases (TB, hepatitis B/C, HIV) are more common among Ukrainian minors and vaccine hesitancy is more widespread than in many host countries and require appropriate medical care. • Displacement and war worsen medical care and have negative impact on mental health..

WHAT IS NEW

• Although intrafamilial spread of infectious diseases was rare (in this cohort), perceived general health of Ukrainian minors is rather poor. • Semi-structured interviews-even with interpreters-are often insufficient to collect valid medical information.

Suicidality and Self-Harm Behavior of Adolescents During the Early Phase of the War in Ukraine

OBJECTIVE

War profoundly impacts people's lives, causing death, displacement, and psychological trauma, but research investigating suicidality of adolescents in this context has been limited. We compared suicidality or self-harm behavior among adolescents in regions that were, and were not, affected by Russia's initial invasion of Ukraine in 2014.

METHOD

This cross-sectional study comprised 2,752 school students aged 11 to 17 years from the war-affected Donetsk region and non-war Kirovograd region. Data collection occurred in 2016 and 2017 using self-report tools to assess suicidality or self-harm behavior; psychopathology including posttraumatic stress disorder (PTSD), depression, and anxiety; and war trauma exposure.

RESULTS

Adolescent girls in the war-affected region reported more suicide attempts (9.5% vs 5.1%; adjusted odds ratio [aOR] 1.8, 95% CI 1.2-2.8), suicidal ideation (39.3% vs 19.6%; aOR 2.6, 95% CI 2.01-3.3), or self-harm behavior (19.6% vs 13.1%; aOR 1.6, 95% CI 1.2-2.1), and boys reported more suicidal ideation (17.0% vs 9.8%; aOR 1.7, 95% CI 1.2-2.4). Boys and girls with PTSD, depression, or anxiety showed increased risks for any suicidality or self-harm. A dose-effect relation was observed between war trauma exposure and suicidality or self-harm. The association was strongest for adolescents who had experienced 5 or more different war trauma exposures (aOR 3.2, 95% CI 2.2-4.8).

CONCLUSION

War trauma exposure and psychopathology were strongly associated with suicidality or self-harm behavior, with a greater impact in girls than boys. The high prevalence of suicidality found in this study emphasizes the need for intervention on a large scale for adolescents living in war situations.

PLAIN LANGUAGE SUMMARY

In a cross-sectional study of two thousand seven hundred fifty-two 11- to 17-year-olds, adolescents who were exposed to the early phase of war in Ukraine showed increased risk for suicide attempts, suicidal ideation, or self-harm behavior among girls living in war-affected region compared to those in non-war region while boys reported increased risk for suicidal ideation only.

Psychological impacts of the Gaza war on Palestinian young adults: a cross-sectional study of depression, anxiety, stress, and PTSD symptoms

BACKGROUND

The Gaza Strip has been embroiled in a violent military assault since October 2023, with an immense toll on the civilian population. Armed conflicts threaten the mental health of affected communities and survivors, and psychiatric morbidity increases with forced displacement and with severe and recurrent trauma. This study investigates the prevalence and predisposing factors of depression, anxiety, stress, and PTSD symptoms in a group of young adult students from the Gaza Strip during the war.

METHODS

A cross-sectional, internet-based survey recruited medical students from the Gaza Strip and used the DASS21, SWLS, and PCL-5 instruments. PTSD diagnosis required having a PCL-5 score ≥ 23 and fulfilling the DSM-5 criteria. Rates of depression, anxiety, stress, and life satisfaction were compared with a previous dataset collected in 2022. Finally, logistic regression models were fitted using R software to identify factors significantly associated with depression, anxiety, stress, and PTSD.

RESULTS

Three hundred thirty-nine medical students participated. Most had been displaced several times, and the great majority had lost a relative, colleague, or friend. Also, a majority had lost their homes and income. 97.05% of participants suffered mild depressive symptoms or higher, while 84.37% and 90.56% reported mild anxiety and mild stress symptoms or higher, respectively. High levels of life dissatisfaction were also found, and 63.40% suffered from PTSD. Symptoms were significantly more prevalent than baseline rates. All participants with PTSD had at least one psychiatric comorbidity. Living in a shelter and having moderate stress symptoms or higher were significantly associated with depression. Being a female, losing a friend, having moderate stress symptoms or higher, and having PTSD predicted having moderate anxiety or higher. Having moderate or higher depression symptoms, moderate or higher anxiety symptoms, and PTSD predicted having moderate stress symptoms or higher. Finally, moderate or higher anxiety and stress symptoms predicted having PTSD.

CONCLUSION

The study detected very high rates of psychiatric disorders among its population of young adult medical students and outlined a myriad of risk factors associated with higher comorbidity. Interventions are needed to prevent a brewing mental health crisis in the Gaza Strip.

Social connections related to health and well-being needs identified by children and adolescents affected by displacement in Lebanon: a participatory research study

Introduction

The social connections surrounding children and adolescents support them in facing challenges and seeking help, ultimately acting as a protective factor in their mental, physical, and behavioral health outcomes across the life course. In complex contexts of political instability and dislocation, these social resources are often fractured, strained, or altogether unavailable, which restricts access to essential services and affects outcomes for these populations. This study aims to identify, characterize, and visually depict social connections related to the health and well-being needs of children and adolescents affected by displacement in Lebanon, by pilot testing the Participatory Assessment Tool for Mapping Social Connections (PATMSC). We hypothesize that this unique methodology will identify and describe different social connections by group quickly and efficiently.

Methods

An initial scoping review of scientific and grey literature followed by stakeholder interviews identified nutrition, mental health, and abuse scenarios that guided the PATMSC (a mixed- method data collection tool that identifies and visualizes types and qualities of social connections) topics. The PATMSC was piloted among children, caregivers, and providers affected by displacement in Lebanon.

Results

There were seven groups (Syrian children, Syrian adolescents, Syrian caregivers, Lebanese/Palestinian children, Lebanese/Palestinian adolescents, Lebanese/Palestinian caregivers, and providers) with a total of 42 participants across the PATMSC workshops. Syrian children identified the most connections across all scenarios (66 nodes) and Lebanese/Palestinian adolescents identified the fewest connections across all scenarios (26 nodes). Family and community nodes were highly connected across all scenarios. 56% of participants asked their family connections for help. Family connections were the most used by children (71%) and provider (33%) subgroups. Participants were asked for help by family connections the most (59%). Within subgroups, children (84%), Lebanese/Palestinian participants (73%), providers (50%), and caregivers (36%) were also asked for help by family connections the most.

Discussion

The study highlights that children, adolescents, and their caregivers in displaced settings in Lebanon have varied social connections when exploring resources related to key areas of concern. Overall, there is an importance placed on the role of family members in their social networks. However, the social connections and resources available differ depending on the circumstances, as evidenced by the variation in connections named across the three scenarios. Understanding the components of social networks, what drives them, and how they differ by sector, is essential in planning and maintaining programs and policies that meet evolving needs in resource-constrained settings.

Mental health needs in war-affected refugee children: barriers, gaps, and strategies for effective care

War-affected refugee children often experience significant disruptions to their mental health due to exposure to traumatic events, displacement, and the challenges of resettlement. This comprehensive overview examines the substantial mental health needs of these children and identifies the barriers and gaps that hinder effective mental health care delivery. The study highlights the critical aspects of mental health requirements, including the impact of trauma and displacement, and explores the systemic obstacles that prevent adequate access to care. By addressing these barriers and gaps, the paper aims to inform strategies for improving mental health services for war-affected refugee children, ultimately contributing to better mental health outcomes for this vulnerable population.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic

AIM

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic.

METHODS

In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase.

RESULTS

Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well.

CONCLUSIONS

After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

Gender identity and symptoms of anxiety and depression and their relationship with sleep disorders among Polish adolescents during the Covid-19 pandemic and the outbreak of war in the Ukraine

INTRODUCTION

For most people, gender identity is consistent with biological sex and such people are called cisgender. People in whom such a relationship does not occur or occurs to a lesser extent are referred to as gender non-conforming-and these include transgender, non-binary, agender and gender-fluid people. These individuals are usually affected by minority stress, which, combined with the circumstances of the pandemic and Russian aggression against Ukraine, may have led to mental disorders and sleep disorders in this population. The aim of the study was to analyze the symptoms of anxiety, depression and insomnia in a group of Polish youth during the Covid-19 pandemic and the outbreak of the war in Ukraine, taking into consideration gender differences, including non-binary gender.

METHODS

The study involved 1621 secondary school students aged 14 to 19, the average age was 16.73 ± 1.35, including 857 girls, 690 boys and 74 people who defined their gender as non-binary. A set of questionnaires for the Diagnosis of Depression in Children (CDI 2), the State-Trait Anxiety Inventory (STAI), the X-1 subscale, The Athens Insomnia Scale (AIS) and an original questionnaire of sociodemographic data were used in research.

RESULTS

Analyzing the results obtained in the study group, the respondents scored an average of 17.99 ± 9.55 points in the assessment of depressive symptoms. After division into groups taking into account gender, the corresponding score was 19.69 ± 9.40 points for girls, 15.03 ± 8.68 for boys and 25.86 ± 9.91 for non-binary people. The difference was statistically significant (p = 0.000) in all three study groups. In the anxiety symptoms assessment, the respondents scored an average of 46.92 ± 11.67 points. After division into gender groups, the corresponding score was 49.21 ± 11.12 points for girls, 43.39 ± 11.47 for boys and 53.39 ± 10.41 for non-binary people. The difference was statistically significant (p = 0.000) in all three study groups. Analyzing the results obtained in The Athens Insomnia Scale (AIS), the average score was 8.31 ± 4.58 points, which allows to evaluate sleep onset as a norm. After dividing into groups, the results were 8.95 ± 4.55 points, respectively for girls, 7.19 ± 4.21 points for boys and 11.35 ± 5.43 for non-binary people, the difference was significant in terms of comparisons between all statistically tested groups. The analysis of the relationships between the studied variables was presented for each gender separately. Statistically significant positive correlations were found between the results obtained on the scale assessing depressive symptoms (CDI-2) and anxiety symptoms (STAI-X1) and the results obtained on the AIS scale.

CONCLUSIONS

Among the studied group of teenagers, the highest intensity of depressive symptoms is demonstrated by non-binary people, followed by females, and finally by males. Similar results were obtained in the assessment of anxiety symptoms. The non-binary group achieved results indicating sleep disorders, while the cisgender group's results of sleep onset were borderline normal. Whatsmore, the greater the severity of depressive and anxiety disorders, the greater the sleep disorders in all study groups, regardless of gender.

Coming of age in war: Early life adversity, age at menarche, and mental health

Armed conflict and forced migration (ACFM) represent a set of extreme environments that are increasingly common for children and adolescents to experience. Adolescence may constitute a sensitive period (puberty and psychoneurological maturation) through which ACFM adversity leaves a lasting mark. Adolescence has become a focal point for analysis and intervention as it relates to the effects of early life adversity on puberty, linear growth, and mental health. Research in public health and psychological science suggests early life adversity (ELA) may accelerate puberty, heightening risks for mental health disorders. However, it is not well substantiated whether ACFM-derived adversities accelerate or delay relative pubertal timing. Secondly, ACFM provides salient context through which to probe the relationships between nutritional, psychosocial, and demographic changes and their respective impact on puberty and mental health. We conducted a narrative review which 1) examined constructions of early life adversity and their proposed influence on puberty 2) reviewed empirical findings (n = 29 studies, n = 36 samples) concerning effects of ACFM ELA on age at menarche and 3) discussed proposed relationships between early life adversity, puberty, and mental ill-health. Contrary to prior research, we found war-derived early life adversity was more consistently associated with pubertal delay than acceleration and may exert counterintuitive effects on mental health. We show that ELA cannot be operationalized in the same way across contexts and populations, especially in the presence of extreme forms of human stress and resilience. We further discuss the ethics of puberty research among conflict-affected youth.

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

Prevalence and correlates of emotion dysregulation among children and adolescents in Lebanon: results from a National Survey

BACKGROUND

Data on Emotion Dysregulation among youth in Lebanon is scarce. Given that Emotion Dysregulation is associated with psychopathology and has a negative impact on youth outcomes, there is a need to better understand the prevalence, clinical and demographic correlates of Emotion Dysregulation.

METHODS

This study is a secondary analysis of the Psychopathology in Children and Adolescents in Lebanon Study which recruited 1517 youth and one parent from a nationally representative sample. Participants completed The Screen for Child Anxiety Related Emotional Disorders, Mood and Feelings Questionnaire, Strengths and Difficulties Questionnaire, Peer Relations Questionnaire, Conflict Behavior Questionnaire (CBQ).Parents completed a sociodemographic questionnaire and the General Health Questionnaire (GHQ). The Strengths and Difficulties Questionnaire-Dysregulation Profile was used to measure Emotion Dysregulation.

RESULTS

The prevalence of Emotion Dysregulation was 11.26% among children aged 5 to < 8 years, 9.40% among children aged 8 to < 12 years and 6.60% among those older than 12 years. Emotion Dysregulation was associated with psychopathology across age groups and a number of correlates were identified. In the final regression models, among children aged 5 to < 8 years; Emotion Dysregulation was associated with lower odds of father employment (OR = 0.235;CI[0.078,0.704]). For those aged 8 to < 12 years old, Emotion Dysregulation was associated with acceptable school performance (OR = 2.246,CI[1.209,4.173]) as opposed to a good school performance, having a chronic physical illness (OR = 2.962; CI [1.495,5.867)], and higher parental GHQ scores (OR = 1.034;CI [1.010,10.58)] indicating worse parental mental health. Adolescents aged 12 years and older who screened positive for Emotion Dysregulation were more likely to be younger (OR = 0.688, CI[0.527,0.899]), be a bully (OR = 2.467;CI[1.036,5.875] and to have higher parental CBQ scores (OR = 1.092;CI [1.011,1.180]), indicating worse parent-child conflict. Youth who screened positive for emotion dysregulation were more likely to seek psychiatric care than their counterparts who screen negative for emotion dysregulation.

CONCLUSION

Age, school performance, parental mental health, parental conflict, chronic physical illness and bullying emerge as important correlates of Emotion Dysregulation. Findings add to the limited data on Emotion Dysregulation in Lebanon and the region and are a first step towards developing intervention and prevention strategies.

War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms

This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANOVA indicating a significant impact of female gender in civilians only. A hierarchical regression indicated that moral injury is a predictor of PTSD symptoms in both active-duty and civilian student groups. However, previous family trauma of genocide is associated with PTSD symptoms in active soldiers only. The findings of the current study could contribute insights for clinical practice for combatants and civilians during the current war.

Coping Mechanisms and Posttraumatic Stress Exhibited by Children in Areas of Yemen's Armed Conflict in Southern Saudi Arabia

This study is an attempt to explore war-related trauma, its stressful effects, and the coping strategies of Saudi schoolchildren. The authors hypothesized that children exposed to war-related trauma will show higher levels of PTSD, and that those with higher levels of PTSD symptoms use more maladaptive coping strategies. The study describes the correlation between traumatic events and posttraumatic stress disorder (PTSD) as well as coping strategies. Five hundred twenty-seven intermediate and high school students, 12 to 18 years old, living in the conflict zone in southern Saudi Arabia completed three standardized self-reported scales: the War Zone Traumatic Events Checklist, the Child PTSD Symptom Scale, and the Children's Coping Strategies Checklist. Each participating student was randomly chosen. Analysis was based on two groups: the high-PTSD symptoms group (182 children) and the low-PTSD symptoms group (345 children). The study was conducted between September 2020 and April 2022 while the war was ongoing as part of an ongoing larger study. Children exposed to war-related traumatic events exhibited greater prevalence rates for PTSD. The children reported high levels of PTSD symptoms and applied a variety of coping strategies to manage related stress. Participants rarely reported that psychological or educational interventions had been used to manage the war-related traumatic experiences and PTSD or to improve related coping styles. The results are discussed in the context of mental health services needed for children in the conflict zone. To bridge the gap between health care services and the needs of children with PTSD, and for better understanding and interventions, health professionals are invited to develop a biopsychosocial model that identifies the risks of PTSD related to exposure to war-related traumatic events in school-aged children and, hence, provide a multidisciplinary intervention program that educates, encourages, and supports teachers and parents in following medical recommendations and goals.

Fetal exposure to the Ukraine famine of 1932-1933 and adult type 2 diabetes mellitus

The short-term impact of famines on death and disease is well documented, but estimating their potential long-term impact is difficult. We used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the relation between prenatal famine and adult type 2 diabetes mellitus (T2DM). This ecological study included 128,225 T2DM cases diagnosed from 2000 to 2008 among 10,186,016 male and female Ukrainians born from 1930 to 1938. Individuals who were born in the first half-year of 1934, and hence exposed in early gestation to the mid-1933 peak famine period, had a greater than twofold likelihood of T2DM compared with that of unexposed controls. There was a dose-response relationship between severity of famine exposure and increase in adult T2DM risk.

A full-scale Russian invasion of Ukraine in 2022: Resilience and coping within and beyond Ukraine

The study examined the resilience and coping of samples from Ukraine and five nearby countries during the war in Ukraine. The research focused on (1) the levels of community and societal resilience of the Ukrainian respondents compared with the populations of five nearby European countries and (2) commonalities and diversities concerning coping indicators (hope, well-being, perceived threats, distress symptoms, and sense of danger) across the examined countries. A cross-sectional study was conducted, based on data collection through Internet panel samples, representing the six countries' adult populations. Ukrainian respondents reported the highest levels of community and societal resilience, hope, and distress symptoms and the lowest level of well-being, compared to the population of the five nearby European countries. Hope was the best predictor of community and societal resilience in all countries. Positive coping variables, most notably hope, but also perceived well-being are instrumental in building resilience. While building resilience on a societal level is a complex, multifaceted task, various dimensions must be considered when planning actions to support these states. It is essential to monitor the levels of resilience, during and following the resolution of the crisis, both in Ukraine and in the neighboring countries.

Neurotic Disorders in Children and Adults Under Social Stress Neurosis in Kids and Adults: Social Stress

ABSTRACT

The relevance of the research subject is to explore the neurotic disorders that arise in people affected by the Russian-Ukrainian war and who witness violence and war crimes. The purpose of the research is to reflect the specific features of the mental reaction of children and adults to military actions as an example of global social stress. Bibliographic, bibliosemantic, and statistical research methods were used in the research. Since the beginning of the full-scale invasion, the number of patients with prolonged depression and schizophrenia has increased, and neurotic disorders has become more severe and acute. Particular attention should be devoted to assistance to military personnel who have been in the combat zone for a long time and former military prisoners of war. Attention should be devoted to the psyche, emotionality, and behavior of people with labile and unformed nervous systems-children, adolescents, pregnant women, and people of retirement age.

Inter-relationships between suicidality and depressive symptoms among children and adolescents experiencing crisis: A network perspective

OBJECTIVES

Suicidality and depressive symptoms have emerged as major mental health issues reported among children and adolescents experiencing crises. In light of these concerns, this study was conducted to elucidate interrelationships between depressive symptoms and suicidality at an item level within this population during the COVID-19 pandemic, a worldwide public health crisis affecting children and adolescents.

METHOD

A cross-sectional study design was used. Primary and secondary school students completed the Children's Depression Inventory - Short Version (CDI-S) and two standard suicidality questions tapping suicidal ideation and suicide plans, respectively. A network analysis was performed to examine inter-connections between depressive symptoms and suicidality.

RESULTS

A total of 5380 students participated in the study. Prevalence of suicidal ideation and suicide plans were 12.8 % (95 % CI = 11.9 %-13.7 %) and 9.9 % (95 % CI = 9.2 %-10.8 %), respectively; the prevalence of depressive symptoms was 41.2 % (95%CI = 39.8 %-42.5 %). The network analysis identified CDI4 (self-hatred) as the most influential node with the highest centrality, followed by CDI8 (loneliness), CDI5 (crying), and CDI1 (sadness). Additionally, CDI5 (crying), CDI1 (sadness), CDI4 (self-hatred), and CDI10 (feeling unloved) were the most meaningful nodes linking depressive symptoms with suicidality.

CONCLUSIONS

Critical depressive symptoms linked with suicidality among children and adolescents living through the COVID-19 pandemic included self-hatred, loneliness, crying, and sadness. Interventions that target these depressive symptoms may have increased utility in reducing the risk of suicidality within this population.

Impact of COVID-19 on the Health of Migrant Children in the United States: From Policy to Practice

In this article, the authors provide an overview how the COVID-19 pandemic impacted the health and wellbeing of migrant children in conflict zones, in transit and post-settlement in the United States. In particular, the authors explore how policies implemented during the pandemic directly and indirectly affected migrant children and led to widening disparities in the aftermath of the pandemic. Given these circumstances, the authors provide recommendations for child health care providers caring for migrant children to mitigate and bolster resilience and health.

Comparing the effectiveness of narrative therapy and EMDR-GTEP protocols in the treatment of post-traumatic stress in children exposed to humanitarian crises

Background

The mental health of children living in humanitarian crisis situations is a major issue. Post-traumatic stress disorder (PTSD) causes great psychological suffering and has negative consequences on children's development. The aim of the study was to analyze retrospective data collected in a mental health and psychosocial support program for children in the Central African Republic, and to compare results of two trauma-focused treatment interventions: the narrative protocol Action contre la Faim (ACF)/KONO; and the EMDR-based Group Trauma Episode Protocol (G-TEP). Both protocols are proposed in a group setting and led by paraprofessionals.

Methods

In the program, 884 children attended a psychoeducation session and after that, 661 children (290 for ACF/KONO and 371 for G-TEP) benefited from all treatment sessions. PTSD was measured by the Children's Revised Impact of Event Scale (CRIES-8). General distress was measured by the Child Psychosocial Distress Screener (CPDS). Data were collected before and after treatment, and measured 5 months after the end of treatment for 185 children.

Results

Participants in the ACF/KONO group show a significant reduction on CRIES-8 (t = 44.8; p < 0.001, effect size = 2.63) and CPDS (t = 38.2; p < 0.001, effect size = 2.24). Participants to the G-TEP protocol show a significant effect with reduced scores on the CRIES-8 (t = 49.2; p < 0.001, effect size = 2.55) and CPDS (t = 57.2; p < 0.001, effect size = 2.97). A Student's t-test comparing the ACF/KONO and G-TEP groups shows no significant difference between the two types of treatment between pre- and post-treatment CRIES-8 scores (t = 1.744; p = 0.514, effect size = 0.040) and CPDS scores (t = 1.688; p = 0.092, effect size = 0.323). An analysis of the follow-up data for the 185 children shows that the effects of both protocols are maintained over time with mean scores after treatment and follow-up below the clinical cut-off for both CPDS (<8) and CRIES-8 (<17).

Conclusions

Both protocols have been shown to be effective in reducing traumatic symptoms in children exposed to conflict; they can be conducted by paraprofessionals and used in humanitarian crisis situations.

Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences

Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022

BACKGROUND

With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

MAIN BODY

In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

CONCLUSION

As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict

BACKGROUND

In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues.

OBJECTIVE

This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations.

METHODS

The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health.

RESULTS

Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems.

CONCLUSIONS

Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.

Young children's development after forced displacement: a systematic review

OBJECTIVES

To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes.

STUDY DESIGN

We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots.

RESULTS

Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies.

CONCLUSION

As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.

Effects of stress on pain in females using a mobile health app in the Russia-Ukraine conflict

The chronic and acute effects of stress can have divergent effects on health; long-term effects are associated with detrimental physical and mental health sequelae, while acute effects may be advantageous in the short-term. Stress-induced analgesia, the attenuation of pain perception due to stress, is a well-known phenomenon that has yet to be systematically investigated under ecological conditions. Using Flo, a women's health and wellbeing app and menstrual cycle tracker, with a world-wide monthly active usership of more than 57 million, women in Ukraine were monitored for their reporting of stress, pain and affective symptoms before, and immediately after, the onset of the Russian-Ukrainian conflict. To avoid potential selection (attrition) or collider bias, we rely on a sample of 87,315 users who were actively logging multiple symptoms before and after the start of the war. We found an inverse relationship between stress and pain, whereby higher reports of stress predicted lower rates of pain. Stress did not influence any other physiological symptoms with a similar magnitude, nor did any other symptom have a similar effect on pain. This relationship generally decreased in magnitude in countries neighbouring and surrounding Ukraine, with Ukraine serving as the epicentre. These findings help characterise the relationship between stress and health in a real-world setting.

Teachers' assessment of the mental health of children with special educational needs during the war

OBJECTIVE

Aim: To study the results of teachers' assessment of the mental health of high schoolers with special educational needs (SEN) after the 1.5 years of war in Ukraine.

PATIENTS AND METHODS

Materials and Methods: Teachers' assessment of the mental health of high schoolers with SEN was conducted through an anonymous survey of teachers using the questionnaire developed by the authors. The research, conducted in 2023, involved 739 teachers working with high schoolers (ages 6-10) with SEN.

RESULTS

Results: It was found that 32.3 % of high schoolers were in the combat zone or on the temporarily occupied territory; 31.7 % of high schoolers were forced to leave their homes and were temporarily displaced, 17.7 % went through a separation from their parents, 15.8 % witnessed hostilities, and 3.8 % suffered bullying from their peers. In the educational process, high schoolers with SEN most often experienced anxiety (55.2 %), "emotional swings" (48.4 %), restlessness (44.8 %), fear (37.2 %). During the 1.5 years of war, 15.4 % of high schoolers began to study worse, 12.9 % began to spend more time playing computer games and on social media. It was found that 59.9 % of teachers need more information on maintaining the mental health of high schoolers with SEN.

CONCLUSION

Conclusions: The results obtained proved the negative impact of hostilities on the territory of Ukraine on the mental health of high schoolers with SEN, which necessitates the provision of adequate psychological support by teachers of such high schoolers in the educational process.

Mental health of children with special educational needs in the context of long-term crisis challenges: as seen by parents

OBJECTIVE

Aim: To study the peculiarities of the mental health of children with special educational needs after 1.5 years of full-scale war in Ukraine.

PATIENTS AND METHODS

Materials and Methods: The mental health of children with special educational needs (SEN) as well as the peculiarities of the impact of hostilities on their emotional and volitional sphere was assessed through the anonymous survey of their parents using the questionnaire developed by the authors (25 questions). The research, which was conducted in 2023 using a Google form, involved 466 parents having children with SEN aged 6 to 10.

RESULTS

Results: It was found that among the surveyed families raising children with SEN, 30.7 % of children were in the combat zone or zone of temporary occupation for a week to a month, 19.1 % - for more than a month; 36.9 % of children experienced relocation, 23.4 % were separated from their parents, 19.7 % witnessed hostilities; 49.4 % of children experienced an unstable psycho-emotional state ("emotional swings") during 1.5 years of war in Ukraine, 40.1 % - restlessness, 38.6 % - anxiety; 23.2 % of parents noted that their children were "hooked" on computer games and social networks, 11.2 % - had problems with sleep, 10.5 % - demonstrated the emergence or increase in cognitive problems.

CONCLUSION

Conclusions: The negative impact of prolonged stress during the war on the mental health of children with SEN has been revealed, which requires psychological support for such children from parents and psychologists.

The mental condition of Polish adolescents during the COVID-19 pandemic and war in Ukraine

Recently, the experience of the COVID-19 global pandemic has significantly affected the mental condition of entire societies by increasing anxiety and stress resulting from its sudden and completely unexpected nature. In Poland, apart from the pandemic, there is an ongoing threat of an armed conflict just across the border, which can constitute direct and indirect threats to physical and mental health. Each of these situations is unusual and difficult. It is also in sharp contrast to the developmental needs of children and adolescents. It especially violates the principal need of this developmental period, which is to grow up in a predictable as well as physically and emotionally safe environment. The purpose of the conducted research was to assess the psychological condition of Polish adolescents, whose social situation is difficult, in order to take appropriate preventive measures based on this assessment. The study was conducted using the "Who are You?" Scale of Transparency Anxiety and the Revised Child Anxiety and Depression Scale (RCADS), as well as a researcher-made survey containing questions about well-being in relation to the pandemic, distance learning and the ongoing war in a neighbouring country. Approval was obtained from the Bioethics Committee to conduct the projected research. The study included 945 adolescents aged 11 to 15 (M = 13.10; SD = 1.11) making a representative sample of adolescents from 14 regions in Poland. The results of the research and analyses show that the adolescents under study have a medium level of intensity of neuroticism, with the highest levels occurring in adolescents aged 14. Moreover, the adolescents manifest relatively lower symptoms of anxiety and depression as well as concern about the pandemic and the war in Ukraine than expected.

Pediatric traumatic brain injuries in war zones: a systematic literature review

Background

Pediatric casualties in war zones are a devastating consequence of armed conflicts, causing significant challenges for affected children, especially in the context of poor access to care. This study aimed to understand traumatic brain injuries (TBIs) in this high-risk population and to identify and provide information for the stakeholders, as well as to recognize severe long-term consequences and develop strategies to prevent them, thus minimizing their burden while aiding in the management of these cases.

Methods

We carried out a systematic literature review following PRISMA guidelines to identify publications discussing traumatic brain injuries in children in the context of war zones, and we analyzed all the collected data.

Results

Our study showed that head injuries were the most common casualty in war zones; male and female children were affected, and the mean age was 8-10 years. Most children were reported to be from Afghanistan, and blasts were the most common mechanism of injury. The mortality fluctuated from 3 to 47%.

Conclusion

There is a lack of evidence-based information regarding the characterization, approach, and management of children with TBI in conflict zones. While the world finds ways to live in peace, there is an urgency to research, train, and deploy enough specialists to these areas, if governments are serious about improving outcomes for this population.