@article {215, title = {Caregiver-child mental health: a prospective study in conflict and refugee settings.}, journal = {J Child Psychol Psychiatry}, volume = {55}, year = {2014}, month = {2014 Apr}, pages = {313-27}, abstract = {

BACKGROUND: 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.

METHODS: 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).

RESULTS: 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.

CONCLUSIONS: 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.

}, keywords = {Adolescent, Adult, Afghan Campaign 2001-, Afghanistan, Child, Child of Impaired Parents, Depression, Female, Humans, Male, Mental Disorders, Mental Health, Parent-Child Relations, Parents, Prospective Studies, Psychiatric Status Rating Scales, Questionnaires, Refugees, Sex Factors, Stress Disorders, Post-Traumatic}, issn = {1469-7610}, doi = {10.1111/jcpp.12167}, author = {Panter-Brick, Catherine and Grimon, Marie-Pascale and Eggerman, Mark} }