Trauma Memories and Mental Health in War-Affected Children

• In Event: War and Children

Abstract

Very few studies have examined the relationships between war exposures, trauma recall, and prospective changes in mental health. For adults, studies have shown that the recollection of trauma events will attenuate over time, and that PTSD has a singular relationship with traumatic memory. In this paper, I present data from a randomly-sampled, gender-balanced, cohort of Afghan child-caregiver dyads, for which my team interviewed 1101 youth and 1101 caregivers to assess war exposures, mental health, and resilience. For a sub-sample of youth living in Kabul and Peshawar (n=331, 11-16 year-old), the study had two main objectives: first, to examine the consistency of trauma recall over time, and second, to analyze how the nature and level of trauma predicted mental health. In this two-wave survey, lifetime exposure to traumatic events was assessed using a Traumatic Events Checklist, to record the number and types of trauma events, and respondents were interviewed to qualitatively appraise the context of traumatic experiences. Child mental health status was assessed using brief psychometric instruments to measure PTSD symptoms, depressive symptoms, and psychiatric difficulties. Data analysis drew on latent transition modelling to examine PTSD and depression trajectories over time and used multinomial logistic regressions to test associations with individual, family, and area-level variables. Key results show that despite living in war zones, a third of the youth reported no trauma exposures, half sustained no distress over the year of study, and only one in eight sustained chronic PTSD symptoms. At baseline, common traumas included having a close relative wounded or killed, witnessing bombardment, and being severely beaten. One year later, children reported fewer traumas related to violence to self or witnessing violence to another person, as if they were putting the past behind them. Those youth with sustained PTSD symptoms were more likely to live in families with ongoing domestic violence. I provide key examples from children’s narratives to illustrate why some trauma memories were rendered more benign or, conversely, remained more salient than others. For example, war-related and domestic violence was reported as trauma when it was experienced as senseless, with social repercussions for child development, learning, and wellbeing. Two key insights from this study are as follows. First, trauma recall will change over time, largely because memories of frightening events have subjective and social significance; second, impacts on mental health depend how youth make sense of both war and post-war experiences. This helps us understand why the literature reports inconsistent relationships between PTSD symptoms and trauma events, for both adult and child populations. It also helps us draw implications for the subjective, physiological, and neurobiological underpinnings of traumatic memory.

Author

• Catherine Panter-Brick, Yale University
  Presenting Author