Trajectories of psychological symptoms and resilience in conflict-affected children in low- and middle-income countries

Marianna Purgato; Federico Tedeschi; Chiara Bonetto; Joop de Jong; Mark J D Jordans; Wietse A Tol; Corrado Barbui

doi:10.1016/j.cpr.2020.101935

Trajectories of psychological symptoms and resilience in conflict-affected children in low- and middle-income countries

Clin Psychol Rev. 2020 Dec:82:101935. doi: 10.1016/j.cpr.2020.101935. Epub 2020 Oct 20.

Authors

Marianna Purgato¹, Federico Tedeschi², Chiara Bonetto², Joop de Jong³, Mark J D Jordans⁴, Wietse A Tol⁵, Corrado Barbui⁶

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy. Electronic address: marianna.purgato@univr.it.
² WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.
³ Amsterdam University Medical Center, The Netherlands; Boston University School of Medicine, Boston, MA, USA.
⁴ Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands; Research and Development Department, War Child Holland, Amsterdam, The Netherlands.
⁵ Department of Public Health, University of Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy; Cochrane Global Mental Health, University of Verona, Verona, Italy.

PMID: 33126036
DOI: 10.1016/j.cpr.2020.101935

Abstract

Longitudinal studies on children's and adolescents' psychological reactions to conflict-related traumatic events in low- and middle-income countries are scarce. The present study aimed to analyze children's and adolescents' responses to conflict-related potentially traumatic events (PTEs) and the impact of the number of different types of PTEs on psychological symptoms and resilience over time. We investigated the presence of psychological symptoms and resilience, defined as low levels of symptoms and high levels of hope, in a sample of 597 conflict-affected children and adolescents allocated to a waiting list condition in four randomized trials conducted in Burundi, Indonesia, Nepal and Sri Lanka. A decrease in functional impairment (p < 0.001), symptoms of PTSD (p < 0.001), anxiety (p < 0.001), depression (p = 0.052), and an increase in social support (p < 0.001), was observed over a six-month follow-up. More than one third of children and adolescents (34.6%) exposed to conflict-related traumatic events improved at follow-up. Levels of hope did not significantly change. Improvement in psychological symptoms and resilience were significantly associated with the number of different types of PTEs experienced before study entry. This study showed that children and adolescents have the capacity to react to multiple traumatic events, and that the number of different types of traumatic events has an impact on resilience mechanisms. This will help differentiate the choice and focus of psychosocial interventions according to the amount of traumatic events experienced by children and adolescents, and will inform the development and testing of new psychosocial interventions.

Keywords: Clinically significant change; Humanitarian settings; Longitudinal analysis.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Adolescent
Child
Developing Countries
Humans
Longitudinal Studies
Resilience, Psychological*
Social Support
Stress Disorders, Post-Traumatic*