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Abstract

Resilience is a process shaped by the interaction of risk and protective factors operating across the different layers of child's social ecology. This paper examines the overall adjustment of 159 Syrian refugees children, living in collective shelters in different area of Lebanon, through investigating the variety of multi-layered stressors and protective processes impacting their mental health, from individual characteristics to environmental mediators. The sample is divided into 4 groups according to the region where they are located: Akkar, the Bekka, Mount Lebanon and Beirut. The methodology employed combines qualitative and quantitative measures. Symptoms of child post-traumatic stress disorder and co-morbidity and psychosocial functioning, are collected through self report scales for children, parents and social workers, validated in Arabic language. Resilience measure includes items based on key actors perceptions of children needs and main resources. Specific drawing tools are employed in order to take into account children's own perception of risk and protective factors in their life. Results enable to define good practices of " assisted resilience " , in orienting and optimising NGO psycho-social interventions with refugees children, families and community. In particular the awareness of protective process, allow practitioners to identify the main resources which can be improved and reinforced through psycho-social interventions. Risk factors lead to define criteria for detecting and monitoring more vulnerable cases.
Risk and protection in mental health among Syrian children
displaced in Lebanon
Francesca Giordano
1
, Diego Boerchi
2
Veronica Hurtubia
3
Michel Maragel
4
Wissam Koteit
5
Lama Yazbek
6
Cristina Castelli
7
1
Ph.D., researcher in Development Psychology; member of Resilience Research
Unit,Department of Psychology, Catholic University of Milan (ITALY)
2
Ph.D., Adjunct Professor of Social and Developmental Psychology, member of Resilience
Research Unit, Department of Psychology, Catholic University of Milan (ITALY)
3
M.o.S. in educational science, member of Resilience Research Unit, Department of
Psychology, Catholic University of Milan (ITALY)
4
Psychologist, research coordinator , Himaya ONG (LEBANON)
5
Psychotherapist, project director, Himaya ONG (LEBANON)
6
Specialized educator, director of Himaya ONG (LEBANON)
7
Full professor of Development Psychology; director of Resilience Research Unit,
Department of Psychology, Catholic University of Milan (ITALY)
E-mails: francesca.giordano@unicatt.it, michel.maragel@arcenciel.org
Abstract
Resilience is a process shaped by the interaction of risk and protective factors operating across the
different layers of child’s social ecology. This paper examines the overall adjustment of 159 Syrian
refugees children, living in collective shelters in different area of Lebanon, through investigating the
variety of multi-layered stressors and protective processes impacting their mental health, from
individual characteristics to environmental mediators. The sample is divided into 4 groups according to
the region where they are located: Akkar, the Bekka, Mount Lebanon and Beirut. The methodology
employed combines qualitative and quantitative measures. Symptoms of child post-traumatic stress
disorder and co-morbidity and psychosocial functioning, are collected through self report scales for
children, parents and social workers, validated in Arabic language. Resilience measure includes items
based on key actors perceptions of children needs and main resources. Specific drawing tools are
employed in order to take into account children’s own perception of risk and protective factors in their
life. Results enable to define good practices of “assisted resilience”, in orienting and optimising NGO
psycho-social interventions with refugees children, families and community. In particular the
awareness of protective process, allow practitioners to identify the main resources which can be
improved and reinforced through psycho-social interventions. Risk factors lead to define criteria for
detecting and monitoring more vulnerable cases.
Keywords: Resilience; PTSD; Children; War; Refugees.
1 INTRODUCTION
Since the beginning of the civil war in Syria in March 2011, nearly 2.5 million people were forced to be
displaced [1]. Lebanon has welcomed more than 900.000 Syrian refugees
1
(36% of all Syrian
refugees) ([2],[3]). Shelter is a serious problem for this large population and more refugees are
gathering in informal settlements like camps which present extremely critical life conditions ([3],[4]).
These conditions accrue the deep sufferance caused by the traumatic experiences of war, violence
and forced displacement.
War experience can generate a variety of psychological and psychiatric consequences, which could
range from adaptive responses to diagnosable psychiatric disorders (5). Researches on mental health
1
Lebanese government hasn’t recognized yet the refugees status to Syrian population displaced in Lebanon.
of youth victim of war and displacement have revealed a high presence of post traumatic stress
disorder ([6], [7], [8], [9], [10], [11], [12]).
Resilience is the capacity of a dynamic system to recover from traumatic experiences which threaten
its development [13]. It is shaped by the interaction of risk and protective factors operating across the
various ecological systems of child’s social ecology [14]. Risk factors, lead to increased likelihood of
the development of maladaptation; Protective factors are predictors of lower levels of psychological
symptoms [15].
In the last three decades resilience paradigm is guiding research and practice focused on mental
health of children victims of armed conflict and displacement aimed at understanding and improving
the adaptation of children victims of extreme adversities [15]
Intelligence, self regulations skills, meaning and hope in life, agency, religious beliefs that finds
meaning in suffering, adaptability, temperament and self-esteem appear to be the main individual
protective factors ([13], [15], [7], [16], [17]).
Family cohesion, support and communication, secure trust, strong bond between the primary
caregiver and the child, child’s trust in their parent’s abilities to protect them against danger, parental
psychological health and parent’s educational level result key family protective factors [13].
Community support, particularly available in peers networks and in school, are considered vital
environmental protective factor for individuals ([5],[15],[18],[19]).
The main risk factors detected in children victims of war and displacement are the number of traumatic
experiences before arrival in the new countries and stressful events after arrival ([6],[20]). Recent war
exposure, being a victim or witnessing violent acts, being exposed to violent shelling or combat,
personal life threat and life threat to loved ones, deaths of family member, being separated from
parents and forced displacement emerged as the most traumatic experiences ([21],[22],[23], [24],[25]).
Stakeholders are particularly concerned with the impact of extreme adversities in children [13]. Risk
and protective factors can become targets of intervention [19]. In this perspective, intervention
research is designed by both field and research experts, with the goal of exploring capacities, at
individual, family and community level, that allows to foster resilience in young victims.
Important recommendations emerged from the studies on this field. Researchers suggest a better
interaction between qualitative and quantitative methodology to reinforce the selection and adaption of
resilience predictors and outcomes [15].
Secondly they affirm that in child adaption process analyses it is important to refer to different
developmental domains, such as psychopathology and psycho-social wellbeing ([13],[26], [27]).
Furthermore it’s stated the importance of providing input from multiple informants [13], in order to
pursuit an “ecologically informed study of children’s adaptation following trauma” [28]
Last recommendation concerns the importance of assuming child perspective, which should be
distinguished and integrated with the adults ([29],[30] [31]).
“Above all, we need to listen to children. They can tell us better than any professional expert what war
does to the human spirit. They have witnessed it, close up and defenceless. They have learned, as I
did, that war is not good for children” [19].
Drawing represents an important media that allows children to express feelings and perception of their
own internal world. A study on narration and drawings of Lebanese refugee children, victims of war,
state that the origin of their own trauma wasn’t the war itself. The traumatic experience was the
disruption of what they call “collective envelope”, which is “temporality”, in terms of past memory and
future projection, and cultural and symbolic references. Significant life spaces, such as the child’s
home, and the human affective environment, which has been forming his social context, got lost due
to migration. At the same time, new places couldn’t be invested by the children, who felt therefore
stranger to the new context and depredated of a part of Self identity[32].
2 METHODOLOGY
2.1 Objective
This study is aimed at identifying significant risk and protective factors, that shape the overall
adjustment in Syrian children victims of war and displacement living in collective shelters in different
area of Lebanon.
2.2 Sample
The sample is composed by 4 groups of Syrian refugees children, hosted in: two tented settlements in
the Bekka region, in Zahle (Fayda Afandi camp) and in Taanail (Ssou camp); a group of collective
shelters in the town of Bebnine; homes located in Zaatrieh, a dangerous town run by drugs lords and
arms dealers. In the following tables the main characteristics of the sample are illustrated.
T
ABLE
1
DISTRIBUTION OF SAMPLE ON KEY DEMOGRAPHIC VARIABLES
Variables % Variables %
Gender
City provenances
Boy 44,9 Idlb 13,3
Girls 55,1 Halab 25,9
Age
Cham 19,0
( X = 10,7 years) Homs 30,4
7 years 0,6 Raqqa 6,3
8 years 17,1 Damascus 5,1
9 years 12,7
10 years 15,8 Zhale 13,3
11 years 13,3 Bebnine 59,5
12 years 19,6 Taanayel 15,8
13 years 8,9 Zaaiterieh 11,4
14 years 11,4 Type of dwelling
16 years 0,6 tented settlements 29,1
Shelter 59,5
House 11,4
2.3 Measures
The methodology employed combines qualitative and quantitative measures.
Symptoms of child post-traumatic stress disorder and co-morbidity are assessed through the Arabic
version of the Post Traumatic Stress Reaction Checklist - Child version [33]. It presents three
subscales, which correspond to the three main cluster of the PTSD in the DSM IV [34] Re-
experiencing, Iperarousal and Avoidance. The questionnaire is administrated together with the Child
War Trauma Questionnaire [35], which assess children’s exposure to war trauma. Both measures are
child self-report.
Psychosocial functioning is measured through the Strengths and Difficulties Questionnaires (SDQ)
[36], validated in Arabic language ([37],[38]). It presents 5 subscales: Conduct problems; Inattention-
hyperactivity; Emotional symptoms; Peer problems; Prosocial behaviours. It was completed by
parents.
Resilience was assessed through the Child and Youth Resilience Measure-28 items (CYRM-28) [39],
expressly translated in Arabic by the Lebanese team of research. The instrument’s subscales are
divided into individual resources, which includes individual personal skills, individual peer support,
individual social skills; Care giver resources, composed by Physical Care giving and Psychological
Care giving; Context resources divided into Spiritual, Educational and Cultural.
Socio-demographic characteristics concerning the child were collected.
Specific drawing ateliers, edited by the Team of the Resilience Research Unit of the Catholic
University of Milan, have been employed in order to explore children’s own perception of:
- the main risk and protective factors in their life (Under the Rain) [40]
- significant internal and external resources (The Self Bag) [41]
- the adaptation process to the new Lebanese reality in terms of significative places which child has
invested in Syria and in Lebanon (The Cardianl Points) [42] and in terms of what they felt they have
left in Siria and what they have taken to Lebanon (My marks on the Earth) [43]
- past and life history in terms of positive and negative memories (Time line) [44]
- capability of projecting himself in the future (The wishes Chest) [45]
The drawings activities have been coded through ex post content analysis, which leads to a
classification of units of analysis into a set of categories ([46],[47]). Specific domains of study of
resilience research oriented the definition of categories [48]. Criteria of exhaustivity, mutual exclusivity
and homogeneity have been followed in defining categories. In order to ensure objectivity, different
researchers have been included in the codify phase [49].
2.4 Procedure
The field workers team was composed by 2 psychologists from Himaya NGO. Sample’s families has
been recruited for the study through local NGO, tribal leaders and directly during researchers visit to
the settlements. Informant consensus has been signed by parents.
The children were divided into groups, of approximately 20 subjects, following similar age criteria,
guided by one researcher. The instruments have been administered through 6 2h30 hours sessions.
The setting varied depending on the locations: in Zahle and Taanail in opens spaces of the camps, in
Bebnine in the courtyard of the municipality, and in Zaaiterieh in the community centre “Voix de la
femme”.
3 RESULTS
Results are organized in two parts. In the first one, we will explore the relations between the single
scales of the four instruments described above: CWTQ; PTSRC; SDQ and CYRM-28. In the second
part, we will explore whether children who expressed specific contents in drawings ateliers, differed in
scales measure comparing to the ones who didn’t express them.
3.1 Relations inside the scales
CWTQ correlates positively with the three scales of the PTSRC: Re-experience .350 (p=.000);
Avoidance .295 (p=000); Hyperarousal .326 (p=.000). It indicates, as hypothesized, that the Post
Traumatic Stress Disorder is due, at least partly, to the frequency of negative war experiences. This
scale correlates weakly with the scale Behavioural problems of the SDQ (,170; p=.033).
PTSR is related also with the scales Emotional symptoms (Experience .354, p=.000; Avoidance .251,
p=002; Hyperarousal .276, p=.000) and Behavioural problems (Avoidance .158, p=048; Hyperarousal
.221, p=.008) of the SDQ and negatively with the scale Contest Educational, the importance to study
in our life (Avoidance -.267, p=001; Hyperarousal -.161, p=.045). No relations were found between
CYRM and both SDQ and CWTQ.
3.2 Relations between the scales and the categories of drawings, memories
or wishes differed
T-Student statistic has been used to estimate the significativity of the difference between subjects who
express or not specific contents on each scales of the four instruments. There will be reported
principals significant differences.
CWTQ Scale has a range between 0 and 1. In the following table we report the main results obtained
by relating drawing categories with CWTQ scale.
Children who indicated bad memories of grief and armed conflict and the ones who expressed the
future wish of their family recover and well-being reported higher exposure to war trauma. While
desires concerning future educational pathway were more frequent in children with less exposure to
traumatic experience
T
ABLE
2
MEANS CWTQ COMPARISON BETWEEN CHILDREN WHO EXPRESS OR NOT SPECIFIC CATEGORIES ON CWTQ
PTSRC Scale has a range between 0 and 1. In the following table we report the main results obtained
by relating drawing categories with PTSRC subscales.
Children who expressed bad memories of grief and armed conflict had higher rates of the PTSD
symptoms. While lower PTSD symptoms were typical of children who indicated self disappointment
experiences as bad memories and community events as positive memories.
Children who reported as risk factors war and violence experiences, but no negative perception of
current environment, presented higher symptomathology of PTSD in the three clusters.
The indication of school and places of worship in native country as significant places in child’s life was
typical of children with higher level of PTSD symptoms. While school, home and community centre in
the host country appeared as significant places in the drawings of children with less PTSD sufferance.
Children with wishes concerning their own educational pathway showed lower level of PTSD, while the
ones indicating wishes on their original family recovery and wellbeing reported higher PSTD complete
symtpomathology.
CWTQ Atelier Categories Sub. categories
Presence
mean
Absences
mean
Mean
difference
Sig. (2
-
tailed)
Exposure to
word traumas
Time line Neg. memories Grief ,36 ,25 ,11 0,40
Armed conflict 31 18 ,13 0,00
Cardinal points Host. Country Community centre 17 28 -,11 ,009
Wishes chest Self Education 20 28 -,79 ,045
Relation Original Family 35 25 ,10 ,029
TABLE N° 3
MEANS PTSRC COMPARISON BETWEEN CHILDREN WHO EXPRESS OR NOT SPECIFIC CATEGORIES ON PTSRC
PTSRC Atelier Categories Sub. categories Presence
mean
Absences
mean
Mean
difference
Sig. (2-
tailed)
Re-experiencing
Time line
Neg. memories
Grief 60 43 ,17 ,031
Armed conflict 52 31 ,21 ,001
Self disappointment 34 49 ,16 ,017
Posit.
memories
Community event 34 50 ,16 ,007
Under the rain Risk factors
War and violence 51 26 ,25 ,000
Current
Environment
37 52 -,15 ,007
Cardinal points Host country
School 15 49 -,34 ,000
Community centre 15 50 -,35 ,000
Home 14 49 -,35 ,000
Wishes chest Self Education 21 51 -,30 ,000
Relation Original Family 62 43 ,19 ,016
Avoidance
Time Line
Neg. memories
grief 68 40 ,28 ,004
Armed conflict 52 30 ,20 ,005
Self disappointment 28 51 -23 ,005
Posit.
memories
Community event 32 51 -,18 ,013
Under the rain Risk factors
War and violence 50 24 ,26 ,001
Current
Environment
35 51 -,16 ,024
Cardinal points
Native country School 50 34 ,16 ,035
Host. country
School 11 48 -,37 ,001
Community centre 13 49 -,36 ,001
Home 11 49 -,38 ,001
Wishes chest Self Education 22 49 -,27 ,003
Relation Original Family 79 38 ,41 ,000
Hyper arousal
Time line
Neg. memories
grief 67 36 ,31 ,00
Armed conflict 47 27 -,21 ,001
Self disappointment 34 49 -,16 ,017
Posit.
memories
Community event 24 46 -,22 ,003
Under the rain Risk factors
War and violence 47 20 ,27 ,001
Current
Environment
32 48 -,16 ,018
Protec. factors Family 47 22 ,25 ,001
Cardinal points
Native country
open spaces 51 34 ,16 ,015
School 42 38 ,04 ,050
places of worship 63 38 ,25 ,020
Host country
School 10 44 -,34 ,002
Community centre 13 45 -,33 ,001
Home 10 45 -,34 ,001
Wishes chest Self Education 15 46 -,31 ,000
Relation Original Family 64 37 ,28 ,003
CYRM Scale has a range between 1 and 5. In the following table we report the main results obtained
by relating drawing categories with CYRM subscales.
Children indicating grief negative experience presented less individual, family and context resources;
armed conflict experience was reported by children with less physical care giving support and less
educational resource.
Children recognizing their past and present environment as risk factors presented more individual,
family and context resources. Children reporting their own house, school and community centre in
Lebanon as significant places showed higher resources in the three levels. While those who indicate
Syrian urban points as significant places reported lower level of individual resources.
Wishes concerning future education pathway were associated with higher family resources.
TABLE N° 4
MEANS CRYM COMPARISON BETWEEN CHILDREN WHO EXPRESS OR NOT SPECIFIC CATEGORIES ON CRYM
CRYM Atelier Categories Sub. categories
Presence
mean
Absences
mean
Mean
difference
Sig. (2
-
tailed)
Individual
personal
skills
Time line Neg. memories
Grief 4,10 4,46 -,36 ,009
Cardinal points Nat. country Urban point 4,00 4,41 -,41 ,028
Individual
peer support
Time line Neg. memories Grief 4,02 4.42 -,40 ,020
Under rain Risk factors Past environment 4,47 4,20 ,27 ,037
Cardinal points
Nat. country Urban point 4,00 4,41 -,41 ,028
Host. Country School 4,78 4,30 ,48 ,022
Home 4,74 4,31 ,43 ,035
Individual
social skills
Time line Neg. memories Grief 4,06 4,36 -,29 ,036
Under rain Risk factors Current
environment
4,44 4,21 ,23 ,027
Cardinal points
Nat. country Urban point 3,94 4,36 -,42 ,005
Host. Country home 4,60 4,27 ,33 ,045
Physical Care
giving
Time line Neg. memories Grief 4,26 4,65 -,38 ,004
Armed conflict 4,51 4,72 -,21 ,049
Under rain
Risk factors School 4,87 4,52 ,34 ,010
Current
environment
4,71 4,50 ,21 ,037
Cardinal points Host. Country Community center 4,93 4,54 ,39 ,006
Whish chest Self Education 4,89 4,52 ,36 ,004
Psychological
Care giving
Time line Neg. memories Grief 4,10 4,50 -,40 ,001
Under rain Risk factors Current
environment
4,54 4,36 ,18 ,054
Cardinal points Host. Country Community center 4,72 4,39 ,33 ,016
Whish chest Self Education 4,68 4,39 ,29 ,016
Spiritual Time line Neg. memories Grief 4,11 4,41 -,30 ,054
My marks Leave School 4,45 4,13 ,32 ,013
Educational
Time line Neg. memories Armed conflict 4,41 4,72 -,31 ,012
Under rain
Risk factors Past environment 4,62 4,36 ,26 ,026
Current
environment
4,67 4,39 ,28 ,015
Cardinal points
Host. Country School 4,88 4,47 ,41 ,032
Community center 4,88 4,45 ,43 ,011
home 4,85 4,47 ,39 ,037
Cultural
Time line Neg. memories Grief 4,22 4,53 -,31 ,016
SDQ Scale has a range between 0 and 2. In the following table we report the main results obtained by
relating drawing categories with SDQ subscales.
Armed conflict experience was reported by children with lower level of pro-social behavior, and grief
experience by the ones with higher peer relations problems.
Community as protective factors was frequent in children with higher level of pro-social behavior and
with less behavioral problems and less difficulties in peer relations. Even school and beliefs or faith
reported as protective factors was associated with less problematic peers relations and less
hyperactivity.
Children who recognized their home, school and community centre as significant places show less
behavioral problems and less emotional symptoms.
Future wishes linked to educational pathway were associated with lower emotional problems, while
the ones concerning original families recover and well-being were typical of children with emotional
problems.
4 DISCUSSION
The strong relation between war-related experiences and Post Traumatic Stress Disorder symptoms
show the relevance of the traumatic experience reported in the CWTQ. The correlation between Post
Traumatic Stress Disorder and child psycho-social functioning, is consistent with the clinical
description of traumatic symptomathology in children. The weak relations between resilience
measures, war-related experiences and social functioning appears in contrast with the definition of
resilience as positive outcome despite adversities.
Grief and armed conflict appear to be the main traumatic experiences as it correlates positively with
symptomathology and negatively with resilience subscales. This results is coherent with the main risk
factors illustrated by the literature ([21],[22],[23],[24],[25]). The lower symptoms reported by children
who indicated self disappointment experiences as bad memory can be due to one of the main
peculiarity of traumatic experiences: they overwhelm the person, and transmit him the feeling of
helplessness and hopelessness. Self disappointment experiences are due to self failures; therefore
controlled by the individual.
The second peculiarity of child war trauma that emerges through drawings ateliers is the disruption of
his “collective envelope”,[32] and the consequent chaos of space-time dimensions. Significant life
spaces of past reality represent still an important reference for the child, but they got lost due to
migration and new places of present reality cannot be invested. The traumatic overinvestment in past
reality emerged in the perception of different sites in native country as significant places, which
appearesd frequent in children with higher PTSD symptomathology and lower level of individual
resources. While the recognition of school, home and community centre in the host country as
TABLE N° 5
MEANS SDQ COMPARISON BETWEEN CHILDREN WHO EXPRESS OR NOT SPECIFIC CATEGORIES ON SDQ
SDQ Atelier Categories Sub. categories Presence
mean
Absences
mean
Mean
difference
Sig.
(2-
tailed)
Prosocial
behaviour
Time line Neg.
memories
Armed conflict 1,63 1,78 -,15 ,041
Under the
rain
Protec.
factors
Community 1,79 1,65 ,15 ,059
Hyperactivity Under the
rain
Protec.
factors
Family ,84 ,64 ,20 ,007
Beliefs faith ,66 ,82 -,15 ,080
Emotional
symptoms
Cardinal
points
Native
country
Place of worship 1,16 ,87 ,28 ,030
Host country
School ,50 ,95 -,45 ,001
Community
centre
,65 ,94 -,28 ,017
Home ,51 ,95 -,43 ,001
Wishes
chest
Self Education ,62 ,96 -,34 ,001
Relation Original Family 1,13 ,87 ,26 ,025
Behavioural
problems
Time line Posit.
memories
Community ,55 ,73 ,17 ,028
Under the
rain
Protec.
factors
Community 0,54 0,72 -,18 ,041
Cardinal
points Host country
School ,38 ,70 -,31 ,012
Community
centre
,42 ,70 -,27 ,012
Home ,40 ,70 -,30 ,013
Peers relations
Time line Neg.
memories
grief 83 65 ,18 ,019
Under the
rain
Protec.
factors
Community 0,51 0,74 -,23 ,001
School ,54 ,71 -,16 ,034
Beliefs faith ,51 ,71 -,20 ,009
significant places is typical of children with lower PTSD sufferance, less behavioral problems and less
emotional symptoms.
Children who reported as risk factors war and violence experiences, but no negative perception of
current environment, beside the several criticises they are facing in the settlements, presented higher
symptomathology of PTSD in the three clusters. The reason can be that traumatic events fixation
doesn’t allow the child to detach from the memory of the event and to move on with the present reality.
Findings on the positive adaptation of children who reported community, school and beliefs as
protective factors are coherent with the letterature ([5],[7],[15],[16],[18],[26],[32]).
Presenting future wishes concerning personal educational pathway may show the child capability of
projecting himself in the future, where he will grow up and develop and therefore it’s frequent in
children with less war exposure, lower level of PTSD symptomatology, resilient skills and less
emotional problems. The high prevalence of psychological sufferance in children who reported future
wishes of the original family recovery and wellbeing may indicate that they are still focused on
reparation process from the impact of traumatic experiences which they still feel very present.
5 CONCLUSION
This study presents typical limits of researches on extreme adversities, such as difficult availability of
assessment tools suitable to the culture and situation, chaotic and hazardous settings due to the
physical and political conditions, absence of pre-disaster baseline data, difficulties of engaging
comparison groups and the lack of funds on this field [13].
But at the same time results appear to have implications for interventions aimed at protecting children,
mitigating risks and promoting resilience. It’s important to be aware of the type of experiences lived by
the child and to monitor the ones who has been exposed to high level of violence and grief.
Restoring a sense of agency in child and supporting his investment in the present reality, starting from
the everyday concrete places, such as personal settlement, school and community centre are
fundamental protective factor. Finally future project and wishes concerning the child are important
protective factors, which should be supported. Community, school and personal beliefs play a central
role in the resilient process.
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... Studies and field reports indicate that chronic adversity is generating high levels of stress among Syrian caregivers (in this paper, we use the term caregivers to refer to any primary caregivers of children, most but not all of whom are their biological parents). This includes those still in Syria as well as Syrian refugees in Lebanon and other adjacent countries [1][2][3][4][5]. In addition to coping with the impact of war-related experiences of violence and loss, Syrian refugee caregivers are contending with a host of ongoing stressors. ...
... The development and piloting of these measures is described in a forthcoming paper. Briefly, we decided to develop new measures for these key outcomes after we searched the literature extensively and were unable to identify measures that [1] were suitable for caregivers with children of such a broad age range (3-12 years); had been validated for use with Syrians, Lebanese, or Palestinians; and [3] were worded in ways that would be deemed acceptable in the target communities. All items on the new questionnaires were drafted in English (with Arabic terminology and idioms in mind), reviewed by a panel of experts, translated into Arabic and back-translated into English, with all discrepancies resolved through a consensus process among bilingual project staff. ...
... The CSI was developed with the aim of strengthening parenting in refugee communities by [1] lowering the stress and increasing the psychosocial wellbeing of refugee parents, and [2] strengthening their parenting knowledge and skills. The ultimate aim is to create an evidence-based, scalable intervention that can be adapted and implemented in diverse refugee communities and contexts. ...
Article
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Background: There is evidence that chronic stress negatively impacts parenting among refugees and other war-affected communities. Persistent parental stress and distress may lead to unresponsive, anxious, or overly harsh parenting and a corresponding increase in emotional and behavior problems among children. Most parenting interventions emphasize the acquisition of knowledge and skills; however, this overlooks the deleterious effects of chronic stress on parenting. The Caregiver Support Intervention (CSI) aims to strengthen quality of parenting skills by lowering stress and improving psychosocial wellbeing among refugee caregivers of children aged 3-12 years, while also increasing knowledge and skills related to positive parenting. The CSI is a nine-session psychosocial group intervention delivered by non-specialist providers. It is intended for all adult primary caregivers of children in high-adversity communities, rather than specifically targeting caregivers already showing signs of elevated distress. Methods/design: The primary objective of this study is to assess the effectiveness of the CSI through a parallel group randomized controlled study with Syrian refugee families in North Lebanon. Participants will be primary caregivers of children aged 3-12 years, with one index child per family. Families will be randomized to the CSI or a waitlist control group. A total of 240 families (480 caregivers) will be recruited into the study. Randomization will be at the family level, and CSI groups will be held separately for women and men. The study will be implemented in two waves. Outcomes for both arms will be assessed at baseline, post-intervention, and at a 3-month follow-up. The primary outcome is quality of parenting skills. Secondary outcomes include parental warmth and sensitivity, harsh parenting, parenting knowledge, and child psychosocial wellbeing. Putative mediators of the CSI on parenting are caregiver stress, distress, psychosocial wellbeing, and stress management. Discussion: This trial may establish the CSI as an effective intervention for strengthening parenting in families living in settings of high adversity, particularly refugee communities. Trial registration: International Society for the Registration of Clinical Trials, ISRCTN22321773. Registered on 5 August 2019.
... The Child and Youth Resilience Measure-28 items (CYRM-28) Arabic version (Giardano et al., 2014) was used to assess resilience. The original CYRM-28 was developed and validated by Ungar and Liebenberg (2011). ...
... Therefore, it is highly sensitive and convenient to use with different groups. The instrument was used with refugee populations (e.g., Abualkibash & Lera, 2015;Giardano et al., 2014) many times. ...
Article
Forced migration is a phenomenon that profoundly affects the levels of resilience and life satisfaction of refugees. Hence, the purpose of current study is to address how Syrian refugee university students who study in Turkey recovered after deformation caused by significant changes in their life. This study employed a convergent mixed method design. The quantitative results indicated that there were positive relationships among life satisfaction and factors of resilience. The qualitative results revealed that three themes (psychological resilience, self-recovery, efforts to reach goals) formed resilience and two themes (future plans and happiness) formed life satisfaction.
... La resilienza è un processo che scaturisce dall'interazione tra fattori di rischio e fattori protettivi. I fattori di rischio portano a una maggior probabilità di maladattamento, mentre quelli protettivi predicono livelli inferiori di sintomatologia (Di Blasio, 2015;Giordano et al., 2014). Nello specifico, i fattori protettivi associati alla resilienza in minori vittime di violenza includono risorse interne e, al contempo, del contesto sociale, in cui il minore è 3 inserito, a livello familiare e comunitario (Klika & Herrenkohl, 2013). ...
... Quest'aspetto è in linea con la letteratura che afferma l'importante influenza che esercita il contesto di appartenenza nel determinare le peculiarità del processo di resilienza (Masten, 2004;Masten, Burt, & Coatsworth, 2006;Ungar, 2013b). In conclusione, al fine di comprendere in che modo gli individui arrivino ad acquisire funzionamenti resilienti a fronte di avversità, è fondamentale investigare il processo di resilienza in tutta la sua complessità e specificità (Cicchetti, 2013;Giordano et al., 2014). In particolare, la ricerca su processi resilienti in minori vittime di violenza è fondamentale per identificare eventuali meccanismi di risposta che portano a outcome maladattivi o, al contrario, che esitano in funzionamenti adattivi. ...
Article
Children violence is considered one of the most serious human rights problem in Lithuania, because of the lack of resources for the prevention of the phenomenon and the treatment of its effects. This study, related to an international Child Protection program run by BICE and OAK Foundation, is aimed at investigating the relationship between posttraumatic symptoms and resilience, and detecting which resources have an impact on the resilience processes in a group of 87 Lithuanian pre-adolescents and adolescents victims of violence (mean age = 13.03; range = 10-17 years). Study measures consist in the Trauma Symptom Checklist for Children (TSCC; Briere, 1996), measuring post-traumatic stress symptoms, and the Child and Youth Resilience Measure-28 items (CYRM-28; Ungar, 2013a), detecting the resilience dimensions. Results showed that each resilience dimension is associated with low levels of post-traumatic symptoms.
... La resilienza è un processo che scaturisce dall'interazione tra fattori di rischio e fattori protettivi. I fattori di rischio portano a una maggior probabilità di maladattamento, mentre quelli protettivi predicono livelli inferiori di sintomatologia Giordano et al., 2014). Nello specifico, i fattori protettivi associati alla resilienza in minori vittime di violenza includono risorse interne e, al contempo, del contesto sociale, in cui il minore è 1 https://www.state.gov/documents/organization/265654.pdf. ...
... 105-116 Burt, & Coatsworth, 2006Ungar, 2013b). In conclusione, al fine di comprendere in che modo gli individui arrivino ad acquisire funzionamenti resilienti a fronte di avversità, è fondamentale investigare il processo di resilienza in tutta la sua complessità e specificità (Cicchetti, 2013;Giordano et al., 2014). In particolare, la ricerca su processi resilienti in minori vittime di violenza è fondamentale per identificare eventuali meccanismi di risposta che portano a outcome maladattivi o, al contrario, che esitano in funzionamenti adattivi. ...
Article
The research refers to a pilot project set up at the SPTM of Vicenza aimed at monitoring he outcome of abused minors. The work is based on the theoretical model of Complex Trauma. The adolescents from the examined sample have suffered continuous maltreatment conditions and traumatic experiences; they did benefit from a protection and support program for at least one year. Participants have been assigned to two groups according to the criteria for the diagnosis of Complex Post-Traumatic Stress Disorder. Each group has been analyzed on variables related to risk factors, to protective actors, to institutional response factors (care system and judicial system). Data analysis shows participants’ personal resources to be the most incisive protective factors; continuous, long duration and family-involvement interventions have been proven the most effective ones. Keywords: complex trauma, protective factors, risk factors, taking charge factors.
... This 12-item measure contains 12 of the original 28 items and has been reported as a better fit for measuring resilience among refugees [41]. The Arabic version of the CYRM-12 was validated in Jordan [41] and the CYRM-28 was supported for use in this context by other studies [53][54][55][56]. ...
Article
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Refugee populations are at high risk of experiencing trauma and developing negative mental health outcomes. The resilience of Syrian refugee children is not well established as far as modifying the association between trauma and mental illness. A total of 339 Syrian refugee children aged 10 to 17 were surveyed to assess resilience, depression and history of trauma. All children reported exposure to at least one traumatic event, 48.6% reported exposure to highly salient traumatic events such as being held hostage, kidnapping or imprisonment. High rates of suicidal ideation and depression symptomatology were found. Resilience was strongly inversely related to depression. Relational support was found to be the most protective resilience factor and was the most highly correlated with less depressive symptomatology. Empowering children and families to build resilience through social support may be a viable prevention and management approach to other unaffordable or unavailable treatments for mental illnesses.
... Communal resilience does not only involve adaptation with the new environment, but also adapting to the emotional and psychological situation those circumstances have helped shape. The context of displacement, which includes the external environment, relationships, family separations, and persistent social barriers, is a continuous determinant (pre, during, and post-migration) of the adolescents' personal wellbeing ( Sulaiman-Hill and Thompson, 2012 ;Giordano et al., 2014 ). Because of this influence, adolescents claimed personal and shared psychological space as well as the imaginary as elements of their adaptation. ...
Article
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Background The conflict in Syria has led to the displacement of 1.5 million refugees into the neighboring country of Lebanon, with a majority that have yet to return to their homeland. Syrian adolescents living in the town of Bar Elias in the Bekaa Valley, Lebanon have lived and grown in the face of resource-limited environments, restricted movement, and a longing for return. Resilience is manifested in the adaptation to such circumstances through close supportive relationships, social engagement, employment, and religion. There is a communal aspect to resilience that is important to the adolescent refugee experience. Methods Fifteen one-to-one interviews and two focus groups, with a total of eighteen Syrian adolescents, were analyzed using an inductive thematic analysis informed by grounded theory principle. Participants were recruited through partnering non-governmental organizations (NGOs) in the area, and ethical approval was granted through UCL and the American University in Beirut (AUB). Results Syrian adolescents highlighted supportive relationships, communal activities and spaces, memories of home, employment, and shared environments as integral elements to their personal adaptation. Methods of resilience involved social cohesion and establishing stability for one's family and close community. Adaptation to the present is intertwined with facing their past displacement in this new context and maintaining aspirations for a bright future. Engaging with the environments they share and help create is an important facet of resilience and occurs through group outings, hobbies, and online communication. Additionally, inner strength is derived from religion and empowers individual resilience and processing. Conclusion This study illuminates the elements and mechanisms embodied in these adolescents’ communities and relationships that allow for adaptation to life in Bar Elias. These factors strengthen their approach to overcome social barriers and practice resilience. These communal aspects of the adolescents’ lives also connect to their memories of home, current environment, and future aspirations.
... Moreover, play has often been correlated with order-making as a central feature of human societies (Henricks 2006). Nonetheless, in crisis-affected settings, while restoring a sense of agency to children, school and community centers are still considered as fundamental protective factors (Giordano et al. 2014). ...
Article
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Focusing on the 2011–2014 forced migration of Syrian refugee children into northern Lebanon, this article examines the child protection strategies of two international and one local NGOs (non-governmental organisations) in the Tripoli Governorate. It explores the psychosocial care programmes and play activities that are meant to heal and integrate the refugee children. It shows how programmes for crisis-affected childhood and the sport-for-development formula predominantly remain universalised models, failing to incorporate local specificities despite increasing campaigns to promote contextualisation approaches.
... 24 In a retrospective study of Syrian refugees in Turkey, 89% of the PTSD cases were found to be chronic (symptoms persisting over 3 months) and 12% of past PTSD cases had spontaneously remitted. 26 Factors associated with PTSD included war-related violence and/or traumatic-related experiences, 24,26,32,35,40,45,48 cumulative trauma exposure, 45 displacement in a camp, 20 trauma centrality (degree to which experienced trauma lends meaning and identify), 32 lower self-e cacy, 32 personal 20,26,40 or family 26 history of mental health problems, poor physical health and previous chronic conditions (unspecified), 24,26,34 being a housewife or student, 20,26 lack of coverage of basic needs, 45 unavailability of medication, 27 and being unemployed. 27 Female gender was associated with higher PTSD rates in two studies 20,26 but not in others. ...
Article
Full-text available
Background: Exposure to conflict, violence and forced displacement can increase poor mental health among affected populations. Our aim was to examine evidence on the burden of mental disorders and access to and effectiveness of mental health and psychosocial support (MHPSS) services in Syria and among Syrian refugees in neighboring countries. Methods: A systematic review was done following systematic review criteria. Twelve bibliographic databases and additional gray literature sources were searched for quantitative and qualitative studies. Descriptive analysis and quality assessment were conducted. Results: Twenty-eight eligible studies were identified, of which two were with conflict-affected populations within Syria. Levels of post-traumatic stress disorder ranged from 16 to 84%, depression from 11 to 49%, and anxiety disorder from 49 to 55%. Common risk factors were exposures to trauma and having a personal or family history of mental disorder. Financial and socio-cultural barriers were identified as the main obstacles to accessing MHPSS care. Evaluations of MHPSS services, albeit from predominantly nonrandomised designs, reported positive treatment outcomes. Conclusions: The MHPSS burden was high, but with considerable variation between studies. There are key evidence gaps on: MHPSS burden and interventions-particularly for those living within Syria; access and barriers to care; and implementation and evaluation of MHPSS interventions.
Thesis
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Suriyeli mülteci çocukların (11-18 yaş) psikolojik sağlamlıkları ve kültürlenme stratejilerinin (ayrışma, bütünleşme, asimilasyon ve marjinalleşme) incelendiği bu araştırmada karma yöntemlerden biri olan yakınsayan paralel desen kullanılmıştır. Araştırmanın çalışma grubu, nicel verilerin toplandığı 957 Suriyeli mülteci çocuk ile nitel verilerin toplandığı Suriyeli mülteci çocuklarla çalışma deneyimi olan altı kişiden oluşmuştur. Veri toplama aracı olarak “Çocuk ve Genç Psikolojik Sağlamlık Ölçeği-12”, “Vancouver Kültürlenme İndeksi”, “Sosyal Temas Ölçeği- R”,“Çok Boyutlu Algılanan Sosyal Destek Ölçeği”,“Okula Aidiyet Alt Ölçeği”,“Genel Öz Yeterlik Ölçeği”, “Çocuklarda Umut Ölçeği”, “Türkçe Yeterlik Düzeyi Anketi” ve “Kişisel Bilgi Formu” ile odak grup görüşmesi için hazırlanan “Görüşme Formu”kullanılmıştır. Veri toplama araçlarından “Vancouver Kültürlenme İndeksi” Türkçe ve Arapçaya; “Sosyal Temas Ölçeği-R” ile “Okula Aidiyet Alt Ölçeği” ise Arapçaya uyarlanmıştır. Araştırmanın sonucuna göre Suriyeli mülteci çocukların umut, aileden algılanan sosyal destek, sosyal temas sıklığı ve okula aidiyet düzeyleri arttıkça psikolojik sağlamlık düzeyleri de artmaktadır. Bütünleşme stratejisi referans kategori olarak alındığında; sosyal temas niteliği, sosyal temas sıklığı, arkadaştan algılanan sosyal destek ve umut düzeyi azaldıkça, özel birinden algılanan sosyal destek düzeyi ise yükseldikçe Suriyeli mülteci çocuklar, ayrışma stratejisini kullanmaktadırlar. Arkadaştan algılanan sosyal destek, aileden algılanan sosyal destek ve umut düzeyi düştükçe, sosyal temas sıklığı ise yükseldikçe Suriyeli mülteci çocuklar asimilasyon stratejisini; umut, sosyal temas niteliği, aileden algılanan sosyal destek ve okula aidiyet düzeyi düştükçe Suriyeli mülteci çocuklar marjinalleşme stratejisini tercih etmektedir. Araştırmanın nitel verileri de bu sonuçları desteklemektedir. Araştırmada elde edilen bulgular, alanyazın çerçevesinde tartışılmış; araştırmacı, uygulayıcı ve politika yapıcılara yönelik çeşitli öneriler sunulmuştur.
Article
Humanitarian research with Syrian refugees can be difficult to conduct in-person, due to COVID-19 containment, security, and logistics issues. We assessed whether the online implementation of a brief, culturally grounded resilience measure would yield reliable responses for use with children and adolescents in the Middle East region. We implemented an online survey screening for socio-economic status, insecurity, prosocial behaviour, and resilience (using the Child Youth Resilience Measure, CYRM) with 119 Syrian refugees (14–18 years old; 74 male, 45 female) living in Jordan. Responses were compared with in-person data, available for a separate cohort of 324 Syrian refugees, previously sampled in Jordan with the same survey instruments. The online CYRM produced reliable and valid responses, as shown by analyses of internal reliability, convergent and divergent validity, and 7-day test-retest consistency. We reflect on logistic, ethical, and methodological challenges of online surveys, and suggest ways to plan and execute online research with hard-to-reach, crisis-affected communities.
Article
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Background Individuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources. The objective of the study was understanding common psychosocial problems faced by families and communities, and the associated risk and protective factors, so that practical and effective community based interventions can be recommended to rebuild strengths, adaptation, coping strategies and resilience. Methods This qualitative, ecological study is a psychosocial ethnography in post-war Northern Sri Lanka obtained through participant observation; case studies; key- informant interviews; and focus groups discussions with mental health and psychosocial community workers as well as literature survey of media and organizational reports. Qualitative analysis of the data used ethnography, case studies, phenomenology, grounded theory, hermeneutics and symbolic interactionism techniques. Quantitative data on suicide was collected for Jaffna and Killinochchi districts. Results Complex mental health and psychosocial problems at the individual, family and community levels in a post-war context were found to impair recovery. These included unresolved grief; individual and collective trauma; insecurity, self-harm and suicides; poverty and unemployment; teenage and unwanted pregnancies; alcoholism; child abuse and neglect; gender based violence and vulnerability including domestic violence, widows and female headed-household, family conflict and separation; physical injuries and handicap; problems specific for children and elderly; abuse and/or neglect of elderly and disabled; anti-social and socially irresponsible behaviour; distrust, hopelessness, and powerlessness. Protective factors included families; female leadership and engagement; cultural and traditional beliefs, practices and rituals; and creative potential in narratives, drama and other arts. Risk factors that were impeding community rehabilitation and recovery included continuing military governance, depletion of social capital particularly lack of trust, hope and socio-economic opportunity structures for development that would engender a sense of collective efficacy. Conclusions In view of the widespread trauma at the individual, family and collective levels, community based programmes to increase local awareness, knowledge and skills to deal with common mental health and psychosocial issues; and training of community level workers and others in basic mental health and psychosocial problem solving are recommended to rebuild family and community agency and resilience. The use of cultural practices and school based programmes would rekindle community processes.
Book
War leads not just to widespread death but also to extensive displacement, overwhelming fear, and economic devastation. It weakens social ties, threatens household survival and undermines the family's capacity to care for its most vulnerable members. Every year it kills and maims countless numbers of young people, undermines thousands of others psychologically and deprives many of the economic, educational, health and social opportunities which most of us consider essential for children's effective growth and well being. Based on detailed ethnographic description and on young people's own accounts, this volume provides insights into children's experiences as both survivors and perpetrators of violence. It focuses on girls who have been exposed to sexual exploitation and abuse, children who head households or are separated from their families, displaced children and young former combatants who are attempting to adjust to their changed circumstances following the cessation of conflict. In this sense, the volume bears witness to the grim effects of warfare and displacement on the young. Nevertheless, despite the abundant evidence of suffering, it maintains that children are not the passive victims of conflict but engage actively with the conditions of war, an outlook that challenges orthodox research perspectives that rely heavily on medicalized notions of 'victim' and 'trauma.'
Article
Over the past two years, Syria went from being the third largest refugee hosting country in the world to the largest refugee producing country. This article provides the findings of a systematic literature review on the mental health and psychosocial support context, and the mental health profile of refugees (primarily Iraqi) and civilians in Syria. This review covers two periods: the complex refugee emergency that started in 2006 as a result of war in Iraq, and the current internal displacement and acute complex emergency starting in 2011. The systematic review of the published and grey literature on the mental health profiles of Iraqi and Syrian refugees and those Syrians who have been internally displaced includes complementing analyses of the needs and resources of different affected populations, using assessment results from Syria and surrounding refugee hosting countries. The problematic lack of recent literature is noted, and the need for more rigorous assessments, applied research and accessible grey literature identified.
Aim: This study aimed at establishing the mental health profile among 322 Arab children living in the Gaza strip. Method: Children were selected in four age bands, i.e. 3,6,11 and 16 years of age. The relevant forms of the Strengths and Difficulties Questionnaire (SDQ) was completed by parents, teachers and 16-year-olds. Results: Factor analyses of the parent-related questionnaires identified similar general factors as in the UK-based studies of validating the SDQ. Certain items did not load as highly on the general factors, i.e. distractability, feeling scared, feeling unhappy, stealing, and being picked or bullied. Emotional problems items were rated differently in the pre-school group (aches, nervousness-clinging, worries) than in previous studies. Using previous optimal cut-off scores, parent SDQs revealed higher rates of children with emotional and conduct problems falling above the 90th centile established in the UK sample, but lower rates according to self-report SDQs by 16-year-olds. Conclusions: Western categories of mental health problems did not clearly emerge from the factor analysis. The main difference from western epidemiological studies appeared to operate in parents' perceptions of emotional problems in pre school children. The SDQ is very promising as a screening measure or rating scale in different cultural populations. However, future research should identify and establish indigenously meaningful constructs within this population and culture, and subsequently revise measures of child mental health problems.
Article
The objective of this study is to analyze the effects of the disorganization of the collective envelopes (deficit of social time, of socialization, of group memory, of a common future, etc.) on the psychological envelopes supporting the organization of time, space, thought, memory and dream in the child. The study proposes that it is not war in itself that is the cause of the child's trauma, but rather the destruction of social envelopes, and in particular the destructuring of the symbolic. When the anxiety of the present is what determines the future, when space-time dimensions are in chaos, when the social field is fraught with turbulence, what happens to the child? Using semi-structured clinical interviews with 30 Lebanese children aged 9 to 13 years (who were 6 to 10 years old during the 2006 conflict), exhibiting post-war symptoms, we have analyzed the disruption of certain collective envelopes, namely, temporality, cultural space and cross generational encystment. We were able to observe the following: wartime has a particular rhythm. Explosions replace the clock, noise replaces words. A rift occurs between external time (street time) that can no longer constitute a functional envelope, and internal time (shelter time) that is relegated to a vegetative state. The space of the Lebanese community is a space of conflict. The collective memory is fragmented in the absence of institutions supporting historical archiving. An identity by disavowal is thus established in the sub-group. The child is literally caught between two fires: withdrawal into oneself or community rifts. War, coupled with migration, leads to a loss of the symbolic through mourning and misapprehension. In the memory of the family, these circumstances create confusion and lack of differentiation, transforming the child into a support of this distress, leading him to be set in pathological violence as a form of self-defence. Two children drawings are presented, illustrating their perception of war.
Article
In recent times, research has been conducted into childhood resilience, a term which, according to Masten, Best and Garmezy (1990) is defined as the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Rutter (1990, p. 181) suggests the term refers to 'the positive pole of the ubiquitous phenomenon of individual difference in people's responses to stress and adversity'. This paper presents a brief review and critique of the most influential literature in the area which includes work by, for example, Rutter (1994), Garmezy (1994), Garmezy and Rutter (1983), Werner and Smith (1988, 1990) and others. In particular, the way in which the concept of resilience has been taken up in the educational literature will be examined (e.g. Benard, 1991, 1993; Winfield 1994; Comprehensive Training to Assure Resiliency in Students, 1996; Wang, 1995). The paper concludes by suggesting that while the twin concepts of risk and resilience have been carefully explored in the research reviewed, there is room for further work in the area. Future studies, especially those which are to have an applied focus, should be guided by three important principles. First, they should adopt a theoretical and practical ecological framework (Bronfenbrenner, 1979); secondly, they should be extremely mindful of the social context within which the research is carried out; and thirdly, they should take account of children's understanding of the key concepts which may well differ from those of the adult researchers.
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Background Researchers focused on mental health of conflict-affected children are increasingly interested in the concept of resilience. Knowledge on resilience may assist in developing interventions aimed at improving positive outcomes or reducing negative outcomes, termed promotive or protective interventions.Methods We performed a systematic review of peer-reviewed qualitative and quantitative studies focused on resilience and mental health in children and adolescents affected by armed conflict in low- and middle-income countries.ResultsAltogether 53 studies were identified: 15 qualitative and mixed methods studies and 38 quantitative, mostly cross-sectional studies focused on school-aged children and adolescents. Qualitative studies identified variation across socio-cultural settings of relevant resilience outcomes, and report contextually unique processes contributing to such outcomes. Quantitative studies focused on promotive and protective factors at different socio-ecological levels (individual, family-, peer-, school-, and community-levels). Generally, promotive and protective factors showed gender-, symptom-, and phase of conflict-specific effects on mental health outcomes.Conclusions Although limited by its predominantly cross-sectional nature and focus on protective outcomes, this body of knowledge supports a perspective of resilience as a complex dynamic process driven by time- and context-dependent variables, rather than the balance between risk- and protective factors with known impacts on mental health. Given the complexity of findings in this population, we conclude that resilience-focused interventions will need to be highly tailored to specific contexts, rather than the application of a universal model that may be expected to have similar effects on mental health across contexts.
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Reviews research on the influence of external environments on the functioning of families as contexts of human development. Investigations of the interaction of genetics and environment in family processes; transitions and linkages between the family and other major settings influencing development, such as hospitals, daycare, peer groups, school, social networks, the world of work (both for parents and children), and neighborhoods and communities; and public policies affecting families and children are included. A 2nd major focus is on the patterning of environmental events and transitions over the life course as these affect and are affected by intrafamilial processes. External systems affecting the family are categorized as meso-, exo-, and chronosystem models. Identified as areas for future research are ecological variations in the expression of genotypes, relations between the family and other child settings, relations between family processes and parental participation in other settings of adult life, and families in broader social contexts. (4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)