Caregiver-child mental health: a prospective study in conflict and refugee settings
Caregiver-child mental health: a prospective study in conflict and refugee settings
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DOI：
10.1111/jcpp.12167
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发表时间：
2014-04-01
影响因子：
7.6
通讯作者：
Eggerman, Mark
中科院分区：
文献类型：
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作者：
Panter-Brick, Catherine;Grimon, Marie-Pascale;Eggerman, Mark
在人道主义环境中，家庭层面的精神健康驱动因素没有充分的记录；我们用两波阿富汗家庭层面的数据来检验照顾者与儿童之间的联系。方法采用分层随机抽样的方法，在喀布尔的政府学校（364对）和白沙瓦的难民学校（317对）招募了性别平衡的681对照顾者和儿童（n= 1362名）。基线后一年，我们重新采访了64%的喀布尔和31%的白沙瓦队列（n=331对，662名受访者），由于难民遣返，保留了较少的白沙瓦家庭。在调整基线的多变量分析中，我们评估了照顾者心理健康（自我报告问卷，SRQ-20）与儿童创伤后应激（儿童修订事件影响量表，cry）、抑郁（抑郁自评量表，DSRS）、精神困难、影响和亲社会力量（力量与困难问卷，SDQ）的症状评分的关联程度。结果护理人员心理健康与随访时儿童心理健康的所有八项指标均存在前瞻性关联，并根据基线进行调整。对于创伤后应激，照顾者的心理健康具有与经历一到两次终身创伤事件的儿童相当的预测性影响。对于抑郁症，照顾者的心理健康接近女性性别的预测影响。因此，护理人员SRQ-20的一个标准差变化与哭泣的1.04分变化和DSRS的0.65分变化相关。对于多信息的SDQ数据，照顾者与儿童的关联在照顾者评分中是最强的。对于儿童评分的结果，关联被母亲识字调节，这是家庭水平动态的标志。成人和儿童都认为家庭暴力和家庭生活质量是独立的风险和保护因素。结论：在暴力和流离失所的背景下，改善儿童心理健康的努力需要深思熟虑地考虑跨代的心理健康梯级和影响家庭福祉的一系列逆境。我们确定了文化上有意义的杠杆点，以建立家庭层面的复原力，与全球心理健康的预防和干预议程相关。
BackgroundIn humanitarian settings, family-level drivers of mental health are insufficiently documented; we examined the strength of caregiverchild associations with two-wave, family-level Afghan data.MethodsWe recruited a gender-balanced sample of 681 caregiverchild 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).ResultsCaregiver 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, caregiverchild 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.ConclusionsIn 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.