Conflict of interest statement: No conflicts declared.
Caregiver—child mental health: a prospective study in conflict and refugee settings
Version of Record online: 29 NOV 2013
© 2013 The Authors. Journal of Child Psychology and Psychiatry. © 2013 Association for Child and Adolescent Mental Health.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Journal of Child Psychology and Psychiatry
Volume 55, Issue 4, pages 313–327, April 2014
How to Cite
Panter-Brick, C., Grimon, M.-P. and Eggerman, M. (2014), Caregiver—child mental health: a prospective study in conflict and refugee settings. Journal of Child Psychology and Psychiatry, 55: 313–327. doi: 10.1111/jcpp.12167
- Issue online: 24 MAR 2014
- Version of Record online: 29 NOV 2013
- Manuscript Accepted: 9 SEP 2013
- Welcome Trust
- prosocial behaviour;
- parent—child relationships
In humanitarian settings, family-level drivers of mental health are insufficiently documented; we examined the strength of caregiver—child associations with two-wave, family-level Afghan data.
We recruited a gender-balanced sample of 681 caregiver—child dyads (n = 1,362 respondents) using stratified random-sampling in government schools in Kabul (364 dyads) and refugee schools in Peshawar (317 dyads). One year after baseline, we re-interviewed 64% of Kabul and 31% of Peshawar cohorts (n = 331 dyads, 662 respondents), retaining fewer Peshawar families due to refugee repatriation. In multivariable analyses adjusted for baseline, we assessed the extent to which caregiver mental health (Self-Report Questionnaire, SRQ-20) was associated with child symptom scores of post-traumatic stress (Child Revised Impact of Events Scale, CRIES), depression (Depression Self-Rating Scale, DSRS), psychiatric difficulties, impact, and prosocial strength (Strength and Difficulties Questionnaire, SDQ).
Caregiver mental health was prospectively associated with all eight measures of child mental health at follow-up, adjusted for baseline. For post-traumatic stress, caregiver mental health had a predictive impact comparable to the child experiencing one or two lifetime trauma events. For depression, caregiver mental health approached the predictive impact of female gender. Thus a one SD change in caregiver SRQ-20 was associated with a 1.04 point change on CRIES and a 0.65 point change in DSRS. For multi-informant SDQ data, caregiver—child associations were strongest for caregiver ratings. For child-rated outcomes, associations were moderated by maternal literacy, a marker of family-level dynamics. Both adults and children identified domestic violence and quality of home life as independent risk and protective factors.
In the context of violence and displacement, efforts to improve child mental health require a thoughtful consideration of the mental health cascade across generations and the cluster of adversities that impact family wellbeing. We identify culturally meaningful leverage points for building family-level resilience, relevant to the prevention and intervention agenda in global mental health.