Bekir B. Artukoglu, M.D.,
Former APAF Fellow,
SUNY Downstate Health Sciences University
The number of forcibly displaced people around the world by persecution, conflict, and war has increased from 43.3 million in 2009 to 80.3 million by the end of 2021.1 Reports also suggest that 41 percent of all forcibly displaced people worldwide are children and adolescents. Children's development and physical and mental wellness are undoubtedly impaired due to violence and hardships that arise from flight and resettlement. To help the displaced children and adolescents in their adjustment, resilience, and mental wellness, we need to understand what molds their trajectories.
Individual Risk Factors for Mental Illness
Scharpf and colleagues conducted a systematic review of these risk and protective factors and synthesized the findings of 63 studies that included children from 12 African, 17 Asian, 10 Middle and South American, and five Eastern European countries.2 Authors highlighted that war-related traumatic events and longer stays in refugee camp settings placed children at greater risk for various mental health problems, including PTSD, depression, anxiety, and behavioral problems.
Preserving Families and Promoting Positive Parenting to Heal
The parent-child relationship is key in promoting wellness in displaced children. The authors of this review study stressed that separation from family members led to higher levels of PTSD, and emotional and behavioral problems in children. Their synthesis of the literature also posits that positive parenting (warmth, stability, perceived understanding, care and respect, freedom to express emotions), and higher parental mental health protect displaced children's mental wellness. Parenting styles with low emotional warmth and support, harshness, rejecting, and controlling, were associated with a variety of mental health problems.
The Importance of Community and Society
Authors underscore the protective function of feeling accepted and supported by teachers and fellow students for emotional and behavioral health. The authors found that a balance between maintaining the original culture and integrating into the new one may be protective against depression and anxiety. Authors highlight the importance of socioeconomic factors (hunger, caregiver employment, child labor) and the immigration process: mandatory detention and duration of asylum-seeking, may increase mental health problems, and lower children's resilience and life satisfaction. On the other hand, permanent visas or residency permits may improve children's mood and well-being through environmental improvements.
In Summary
Millions of children experience displacement worldwide and subsequently find themselves in environments that are detrimental to their development, and physical and mental health. This global crisis and its impact on children worldwide have only gotten worse with the war in Ukraine. In the review study by Scharpf and company, authors highlight key individual factors for displaced children's mental health such as exposure to war-related violence and longer stays in camps. Caregivers' mental health problems and parenting styles also appear to be of key importance.
Promoting healthy development and mental wellness in children in the face of war and displacement means keeping children with their caregivers, providing their human rights and basic needs, and providing them with higher-level mental health assessment and necessary evidence-based interventions.3 The authors of the review study also found protective factors on community and societal levels including school connectedness, peer support, and integration into the host society.
These findings highlight the importance of supporting the living conditions of families after migration and promoting economic and social opportunities for parents. Research indicates that providing children and adolescents with a sense of belonging is key to promoting mental health. School constitutes a platform where such acceptance, belonging and support can and should be achieved, highlighting the importance of the relationship between school staff and displaced youth.
References
- Refugees UNHC for. Global Trends. UNHCR. Accessed November 21, 2022. https://www.unhcr.org/flagship-reports/globaltrends
- Scharpf F, Kaltenbach E, Nickerson A, Hecker T. A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clin Psychol Rev. 2021;83:101930. doi:10.1016/j.cpr.2020.101930
- Bürgin D, Anagnostopoulos D; Board and Policy Division of ESCAP, et al. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry. 2022;31(6):845-853. doi:10.1007/s00787-022-01974-z