Impact of exposure to conflict, tsunami and mental disorders on school absenteeism: findings from a national sample of Sri Lankan children aged 12-17 years

Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

Evaluating the impact of Hazelwood mine fire event on students' educational development with Bayesian interrupted time-series hierarchical meta-regression

BACKGROUND

Environmental disasters such as wildfires, floods and droughts can introduce significant interruptions and trauma to impacted communities. Children and young people can be disproportionately affected with additional educational disruptions. However, evaluating the impact of disasters is challenging due to difficulties in establishing studies and recruitment post-disasters.

OBJECTIVES

We aimed to (1) develop a Bayesian model using aggregated school-level data to evaluate the impact of environmental disasters on academic achievement and (2) evaluate the impact of the 2014 Hazelwood mine fire (a six-week fire event in Australia).

METHODS

Bayesian hierarchical meta-regression was developed to evaluate the impact of the mine fire using easily accessible aggregated school-level data from the standardised National Assessment Program-Literacy and Numeracy (NAPLAN) test. NAPLAN results and school characteristics (2008-2018) from 69 primary/secondary schools with different levels of mine fire-related smoke exposure were used to estimate the impact of the event. Using an interrupted time series design, the model estimated immediate effects and post-interruption trend differences with full Bayesian statistical inference.

RESULTS

Major academic interruptions across NAPLAN domains were evident in high exposure schools in the year post-mine fire (greatest interruption in Writing: 11.09 [95%CI: 3.16-18.93], lowest interruption in Reading: 8.34 [95%CI: 1.07-15.51]). The interruption was comparable to a four to a five-month delay in educational attainment and had not fully recovered after several years.

CONCLUSION

Considerable academic delays were found as a result of a mine fire, highlighting the need to provide educational and community-based supports in response to future events. Importantly, this work provides a statistical method using readily available aggregated data to assess the educational impacts in response to other environmental disasters.

Pathways to inclusive and equitable quality early childhood education for achieving SDG4 goal—a scoping review

According to Sustainable Development Goal 4.2 (SDG 4.2), Equal Access to Quality Pre-primary Education, governments throughout the world are working to ensure that all children have access to high-quality early childhood development, care, and pre-primary education by 2030. In order to organize available evidence into a coherent framework, the current scoping review represents an exploratory synthesis addressing the broad question of what qualitative and inclusive Early Childhood Education and Care strategies are currently being established globally to achieve SDG4 targets. The goal of this scoping review in this respect, was to map the available research and offer an overview of micro-, meso-, and macro-level perspectives on evidence-based interventions and strategies, for the promotion of SDG4 globally. A layered model of early childhood education that is both inclusive and egalitarian education emerged, starting with the micro level: child, family and community, mezo level: nursery, and kindergarten and macro level: national policies and SDG 4.2 Agenda for 2030. The mezzo level connects the micro and macro levels, being the most solicited level of implementing inclusive and qualitative ECEC strategies. Thus, starting with putting a real emphasis on children rights, creating a qualitative and inclusive culture with a holistic understanding of child development, then investing in teacher preparation and instilling a strong belief and positive attitudes toward equity in early childhood services, developing inclusive educational policies with an authentic community support offered by all stakeholders, then adapting curriculum and assessment methods to all early childhood educational contexts and lastly piloting and up-scaling good practices, and investing in infrastructure, facilities and innovative educational services, SDG4.2 targets could transparently and efficiently be attained by 2030, with all the setbacks arisen from the pandemic context. The data provide light on a vast topic range, including human rights and values, policy actions, and ideologies. The micro-level themes emphasized the importance of fostering equitable and inclusive environments for children., as well as instructional approaches that encourage positive attitudes toward diversity and instructors' levels of experience in dealing with diversity. We also discovered the significance of creating chances that promote socialization, connection development, and a sense of belonging. Meso-level principles emphasized the relevance of schooling in a child's holistic development and skill acquisition. Mainstream availability for all children, national curriculum regulations, teacher preparation for inclusive early childhood education, excellent funding and governance, evaluation and monitoring, and research on inclusive early childhood education comprise the macro level. As a concept and an approach, inclusive and qualitative education necessitates the preparedness of all relevant educational components to participate. Providing inclusive education in the early years requires setting the foundation for subsequent levels of schooling. The active engagement of a young kid should be directed by developmentally and individually suitable curricula. Access to and participation in age-appropriate general curricula becomes critical in identifying and providing specialized support services. Inclusive programming does not imply that the educational programs will necessarily be of good quality. Efficiency and wellbeing are synonymous with equity. Equitable education investment benefits everyone in society, not just the most marginalized. Investing in education will help communities achieve all of the Sustainable Development Goals related to education.

The Global Prevalence of Conduct Disorder: A Systematic Review and Meta-Analysis

Objective: There has been little effort to conduct systematic reviews or meta-analyses of the available literature to find global prevalence rates of conduct disorder and analyze the sources of heterogeneity. Method : We searched multiple databases, including Web of Science, PubMed, Scopus, and Google Scholar to identify cross-sectional studies with random or nonrandom sampling to assess the global prevalence of conduct disorder in children and adolescents aged under 18 in the general or school-based populations. Quality assessment and data extraction were independently carried out by two authors. Subgroup analysis was used to find the potential sources of heterogeneity. Results: We reached 50 studies, incorporating 186,056 children and adolescents from 35 countries. The total prevalence of conduct disorder was 8% (CI: 7-9%; I2: 99.77%), including 7% in females (CI: 4-9%; I2: 99.56%) and 11% in males (CI: 7-15%; I2: 99.74%). The results of subgroup analysis showed that total heterogeneity could be explained by measurement tools. When diagnostic interviews such as the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) and Development and Well-Being Assessment (DAWBA) were employed, the pooled prevalence rates for conduct disorder were 0.4% and 0.7%, respectively, and heterogeneity decreased. However, the use of the screening tools such as the Strengths and Difficulties Questionnaire (SDQ)-parent or teacher report and SDQ-self report increased the pooled prevalence of conduct disorder to 10% and 16% respectively. Conclusion: The prevalence of conduct disorder in the epidemiological studies should be estimated by employing the diagnostic interviews to reach accurately assessments.

Impact of child emotional and behavioural difficulties on educational outcomes of primary school children in Ethiopia: a population-based cohort study

BACKGROUND

The relationship between child emotional and behavioural difficulties (EBD) and educational outcomes has not been investigated in prospective, community studies from low-income countries.

METHODS

The association between child EBD symptoms and educational outcomes was examined in an ongoing cohort of 2090 mother-child dyads. Child EBD was measured when the mean age of children was 6.5 years, SD 0.04 (T0) and 8.4, SD 0.5 years (T1) using the Strength and Difficulties Questionnaire (SDQ). Educational outcomes were obtained from maternal report (drop-out) at T1 and from school records at when the mean age of the children was 9.3 (SD 0.5) years (T2).

RESULT

After adjusting for potential confounders, child EBD symptoms at T1 were associated significantly with school absenteeism at T2: SDQ total score: Risk Ratio (RR) 1.01; 95% confidence interval (CI) 1.01, 1.02; SDQ high score (≥ 14) RR 1.36; 95% CI 1.24, 1.48; emotional subscale RR 1.03; 95% CI 1.01, 1.04; hyperactivity subscale RR 1.03; 95% CI 1.02, 1.04 and peer problems subscale (RR 1.02; 95% CI 1.00, 1.04). High SDQ (β = - 2.89; 95% CI - 5.73, - 0.06) and the conduct problems sub-scale (β = - 0.57; 95% CI - 1.02, - 0.12) had a significant negative association with academic achievement. There was no significant association between child EBD and school drop-out.

CONCLUSION

Prospective associations were found between child EBD symptoms and increased school absenteeism and lower academic achievement, suggesting the need for child mental health to be considered in interventions targeting improvement of school attendance and academic achievement in low-income countries.

Mental health problems from direct vs indirect exposure to violent events among children born and growing up in a conflict zone of southern Thailand

PURPOSE

This study aims to examine and compare the effects of direct and indirect exposure to armed conflicts on the mental health of primary school students in the three southernmost provinces of Thailand.

METHODS

A school-based survey was conducted. Detailed exposure of traumatic events both directly and indirectly were measured by a self-completed questionnaire. Behavioral-emotional problems were measured by the Strength and Difficulty Questionnaire and screening for post-traumatic stress disorder (PTSD) was done using the Children's Revised Impact of Events Scale (CRIES). Multivariate analysis adjusted for gender and other covariates was used to determine the effect of direct and indirect exposure of armed conflict on mental health problems.

RESULTS

Out of 941 students included in the study, almost half had direct exposure to an armed conflict event. Overall, 42.1% of students had at least one behavioral-emotional problem (47.6% and 38.5% in the direct- and indirect-exposed groups, respectively) and 30.5% was found to have PTSD (37.3% and 25.9% in the direct- and indirect-exposed groups, respectively). Students who had direct exposure to an armed conflict event had a two times higher odds of mental health problems than their peers. Other modifiable factors of mental health problems were receiving news from two sources including other adults and media, and exposure to other non-conflict-related traumatic life events.

CONCLUSIONS

Children living in armed conflict areas of southern Thailand, although without any direct exposure to traumatic events, also suffered from mental health problems. Research on appropriate interventions for these children should be further conducted.

Assessment Tools for the Mental Health of School-Aged Children and Adolescents Exposed to Disaster: A Systematic Review (1988-2015)

Objectives

In this study, we aimed to conduct a systematic review of studies investigating psychosocial factors affecting children exposed to disasters.

Methods

In total, 140 studies were retrieved. The studies were published from 1988 to 2015. A systematic review was performed using the PRISMA guidelines. MEDLINE, EMBASE, Cochrane Central, Web of Science, PsycINFO, PubMed, and Google Scholar were searched. Each database was searched using the following terms: 'Child,' 'Adolescent,' 'Youth,' 'Disaster,' 'Posttraumatic,' 'Psychosocial,' 'Assessment,' 'Evaluation,' and 'Screening.' The identified studies were subjected to data extraction and appraisal.

Results

The database search identified 713 articles. Based on the titles and abstracts, the full texts of 118 articles were obtained. The findings of this review can be used as a basis for the design of a psychosocial evaluation tool for disaster preparedness.

Conclusion

Given the paramount importance of post-disaster evaluation and the weaknesses of current disaster evaluation tools, the need to develop valid and reliable tools and psychometric evaluations cannot be overstated. Our findings provide current evidence supporting various assessments in children, who are very vulnerable psychologically following disasters.

Psychosocial wellbeing and physical health among Tamil schoolchildren in northern Sri Lanka

BACKGROUND

Mental disorders contribute to the global disease burden and have an increased prevalence among children in emergency settings. Good physical health is crucial for mental well-being, although physical health is multifactorial and the nature of this relationship is not fully understood. Using Sri Lanka as a case study, we assessed the baseline levels of, and the association between, mental health and physical health in Tamil school children.

METHODS

We conducted a cross sectional study of mental and physical health in 10 schools in Kilinochchi town in northern Sri Lanka. All Grade 8 children attending selected schools were eligible to participate in the study. Mental health was assessed using the Sri Lankan Index for Psychosocial Stress - Child Version. Physical health was assessed using Body Mass Index for age, height for age Z scores and the Multi-stage Fitness Test. Association between physical and mental health variables was assessed using scatterplots and correlation was assessed using Pearson's R.

RESULTS

There were 461 participants included in the study. Girls significantly outperformed boys in the MH testing t (459) = 2.201, p < 0.05. Boys had significantly lower average Body Mass Index for age and height for age Z scores than girls (BMI: t (459) = -4.74, p <0.001; Height: t (459) = -3.54, p < 0.001). When compared to global averages, both sexes underperformed in the Multi-Stage Fitness Test, and had a higher prevalence of thinness and stunting. We identified no meaningful association between the selected variables.

CONCLUSIONS

Our results do not support the supposition that the selected elements of physical health are related to mental health in post-conflict Sri Lanka. However, we identified a considerable physical health deficit in Tamil school children.

School performance after experiencing trauma: a longitudinal study of school functioning in survivors of the Utøya shootings in 2011

BACKGROUND

The psychological impact on survivors of terrorism has been well documented. However, studies on adolescent survivors and the academic performance of high school students following a terrorist attack are lacking.

OBJECTIVE

This study investigated academic performance, absenteeism, and school support amongst survivors of a terrorist attack in Norway.

METHOD

Data from a longitudinal interview study were linked to officially registered grades of students (N=64) who successfully completed their 3-year senior high school program. Statistical tests of mean differences and linear regression were used to compare the survivors' registered grades with the national grade point average, before and after the event, as well as to assess absenteeism, self-reported grades and to test the association with school support.

RESULTS

The students' grades were lower the year after the event than they had been the year before, and they were also lower than the national grade point average (p<0.001). However, their grades improved in the last year of high school, indicating possible recovery. Absence from school increased after the event, compared to the previous year. However, students reported high satisfaction with school support.

CONCLUSION

The results indicate that academic functioning was reduced in the year after the traumatic event, but for students who successfully completed high school, the school situation improved 2 years after the event. The findings underscore the importance of keeping trauma-exposed students in school and providing support over time. A more defined educational approach to maintaining school attendance and educational measures which compensate for learning loss are needed in trauma-sensitive teaching.

Exposure to conflict and disaster: A national survey on the prevalence of psychotic experiences in Sri Lanka

Recent research conducted in high-income countries suggests psychotic experiences are common in the general population, but evidence from low- and middle-income countries (LMIC) remains limited. Sri Lanka is a LMIC affected by three decades of civil conflict and, in 2004, a devastating tsunami. This study aimed to investigate the prevalence of psychotic experiences in a general population sample in Sri Lanka and associations with conflict- and tsunami-related trauma. This is a first National Mental Health Survey conducted in Sri Lanka. A cross-sectional, multi-stage, cluster sampling design was used to estimate the prevalence of psychotic symptoms. Data on socio-demographic characteristics, conflict- and tsunami-related trauma, and psychotic experiences were collected using culturally validated measures in a sample of 5927 participants. The weighted prevalence of psychotic symptoms was 9.7%. Exposure to one or more conflict-related events (adj. OR 1.79, 95% CI 1.40-2.31, p<0.001) and loss or injury of a family member or friend through conflict (adj. OR, 1.83, 95% CI 1.42-2.37, p<0.001) were associated with increased odds of reporting psychotic experiences. Psychotic experiences were more common in individuals directly exposed to tsunami disaster (adj. OR, 1.68, 95% CI 1.04-2.73, P=0.035) and in those who had a family member who died or was injured as result of tsunami (adj. OR, 1.42, 95% CI 1.04-1.94, p=0.029). Our findings suggest that psychotic experiences are common in the Sri Lankan population. Exposure to traumatic events in armed conflicts and natural disasters may be important socio-environmental factors in the development of psychotic experiences.

Risk of mental health and nutritional problems for left-behind children of international labor migrants

BACKGROUND

One-in-ten Sri Lankans are employed abroad as International Labor Migrants (ILM), mainly as domestic maids or low-skilled laborers. Little is known about the impact their migration has on the health status of the children they 'leave behind'. This national study explored associations between the health status of 'left-behind' children of ILM's with those from comparative non-migrant families.

METHODS

A cross-sectional study design with multi-stage random sampling was used to survey a total of 820 children matched for both age and sex. Socio-demographic and health status data were derived using standardized pre-validated instruments. Univariate and multivariate analyses were used to estimate the differences in mental health outcomes between children of migrant vs. non-migrant families.

RESULTS

Two in every five left-behind children were shown to have mental disorders [95%CI: 37.4-49.2, p < 0.05], suggesting that socio-emotional maladjustment and behavioural problems may occur in absence of a parent in left-behind children. Male left-behind children were more vulnerable to psychopathology. In the adjusted analyses, significant associations between child psychopathological outcomes, child gender and parent's mental health status were observed. Over a quarter (30%) of the left-behind children aged 6-59 months were 'underweight or severely underweight' compared to 17.7% of non-migrant children.

CONCLUSIONS

Findings provide evidence on health consequences for children of migrant worker families in a country experiencing heavy out-migration of labour, where remittances from ILM's remain as the single highest contributor to the economy. These findings may be relevant for other labour 'sending countries' in Asia relying on contractual labor migration for economic gain. Further studies are needed to assess longitudinal health impacts on the children left-behind.

Conflict, forced displacement and health in Sri Lanka: a review of the research landscape

Sri Lanka has recently emerged from nearly three decades of protracted conflict, which came to an end five years ago in 2009. A number of researchers have explored the devastating effect the conflict has had on public health, and its impact on Sri Lanka's health system - hailed as a success story in the South Asian region. Remarkably, no attempt has been made to synthesize the findings of such studies in order to build an evidence-informed research platform. This review aims to map the 'research landscape' on the impact of conflict on health in Sri Lanka. Findings highlight health status in select groups within affected communities and unmet needs of health systems in post-conflict regions. We contend that Sri Lanka's post-conflict research landscape requires exploration of individual, community and health system resilience, to provide better evidence for health programs and interventions after 26 years of conflict.

Food insecurity in children but not in their mothers is associated with altered activities, school absenteeism, and stunting

Household food insecurity has substantial detrimental effects on children, but little is known about the mechanisms through which these effects occur. This study investigated some possible mechanisms by examining associations of food insecurity reported by children and mothers with daily activities, school absenteeism, and stunting. We conducted a cross-sectional study in a nonprobabilistic sample of 131 mother-child pairs from a poor peri-urban area in Miranda State, Venezuela. We assessed food insecurity in children by using an instrument developed through a naturalistic approach that had 10 items for food insecurity and 9 items for management strategies. To obtain mothers' reports of food insecurity, a previously validated 12-item instrument was used. Children's daily activities, school absenteeism, and stunting were measured. Chi-square tests for contingency tables and logistic and multiple regression analyses were used to test associations of food insecurity with outcomes. There was no association between mothers' reports of food-insecurity and any child outcome. Children's reports of food insecurity were associated with higher odds of doing passive home chores (OR: 1.17; 95% CI: 1.02, 1.32), cooking at home (OR: 1.21; 95% CI: 1.05, 1,38), taking care of siblings (OR: 1.15; 95% CI: 1.01, 1.31), and doing labor (OR: 1.22; 95% CI: 1.04, 1.42) and lower odds of playing video games (OR: 0.86; 95% CI: 0.76, 0.98) (all P < 0.03). Children's reports of management strategies were associated with 5 of 7 work activities measured. Labor in food-insecure children was the main activity that explained school absenteeism. Food insecurity reported by children can be assessed by pediatricians, school personnel, and other practitioners by using a simple instrument to identify food-insecure children and to respond to mitigate their food insecurity and its consequences.