Research conducted in war-affected situations has found an association between exposure to traumatic events and mental health outcomes. However, there have been few studies focusing on the mental health outcomes of children and adolescents affected by war. Panter-Brick, et al. (2009) conducted a study aimed at determining a causal relationship between war and mental health problems, specifically looking at associations related to gender, traumatic events, caregiver mental health, and socio-demographic characteristics. The sample targeted children ages 11 to 16, who were randomly drawn from randomly selected schools in three purposively chosen regions of Afghanistan. Data were gathered from three informants (children, caregivers, and teachers), who were interviewed with a variety of brief measures. Measures were chosen because they had high reliability in other contexts of instability. To increase instrument diagnostic validity, measures were translated, back-translated, and reviewed by a multi-disciplinary team. The research found that the variables of exposure to multiple trauma and caregiver mental health were predictive of psychopathology for in-school Afghan adolescents. Previous research corroborates this finding and adds to the study’s external validity. Furthermore, the study found that girls were more likely than boys to develop poor mental health outcomes, such as depression.
The authors explore the quality of traumatic events to include not just war-related events, but accidents, corporal punishment, illness, death of a relative. The quality of the particular incident is not indicative of predicting poor mental health, but rather the accumulation of traumatic events contribute to risk factors for mental health problems. The study includes a few threats to validity. By only sampling school children, the study neglects out-of-school youth, who may be at high risk of developing psychopathology. Furthermore, even though the sample of in-school youth was stratified to include accurate proportions of boys and girls, the focus on in-school youth disproportionately excludes girls, because boys are more likely to attend school than girls. The school samples were restricted to three urban areas, affecting external validity and indicating that future research might consider including a sample from a rural setting. Despite its limitations, this study indicates the value of working within the school system to assess children’s mental health needs and proves the value of school-based mental health services. Furthermore, the findings contribute to the small but much needed knowledge base about the mental health of war-affected children.
Panter-Brick, C., Eggerman, M., Gonzalez, V., and Safdar, S. (2009). Violence, suffering, and mental health in Afghanistan: a school-based survey. The Lancet, 374, 807-816.