Social and Biological Mechanisms Driving the Intergenerational Impact of War on Child Mental Health: Implications for Developing Family-Based Interventions

项目总结 暴力和人道主义危机在世界各地儿童的生活中很常见，特别是在低收入和低收入国家 中等收入国家。暴露在与战争有关的暴力中对父母和 儿童，但研究探索情绪和行为障碍传播到 后代仍处于萌芽状态，尤其是在撒哈拉以南非洲地区。为了帮助解决这一差距，一项研究 自2002年以来，在一批受战争影响的儿童--许多都是--之后，一直在开展受战争影响的青年 男性和女性，前儿童兵--在塞拉利昂进入青壮年，现在是为人父母。一位副院长 NICHD资助的R01(R01HD073349)展示了童年与战争有关的创伤和损失是如何促成 成年后的心理健康问题。2017年，亲密伴侣和生物样本的横断面样本 将后代加入样本中，以检查早期创伤暴露和亲密接触之间的联系 伴侣关系和亲子关系。到目前为止，关于战争相关的压力是如何“深入皮肤”的知识，到 成为可遗传的生物物理特征，对下一代心理健康的影响仍然存在 有限的。相关的是与自我调节和压力的研究领域标准相关的结构 反应性及其如何影响儿童的情绪、认知和社会功能。建议数 这项研究在这项研究的20年历史上取得了重大进展，通过促进对 潜在的代际应激反应的生物学嵌入。以之前的四波数据为基础 收集应激反应和自我调节的生物学指标(自主神经系统反应性， 炎症、端粒长度)将从暴露于严重创伤的父母中收集 儿童时期，并延伸到亲密伴侣和后代。强大的能力建设协作，与 塞拉利昂的马凯尼大学(Unimak)和凯内马政府医院(KGH)将支持 对新的压力生物标志物数据和亲子同步性、健康和临床评估的伦理收集 7-24岁生物后代的人体测量学数据。主要的研究创新是：(A)罕见的关于 父母创伤暴露以及有关风险和保护因素的纵向信息 社会生态学；(B)关于与父母创伤有关的压力反应的生物嵌入的数据；和(C) 在受战争影响的生物后代中检查心理健康和生理结果的机会 随着时间的推移，家庭。高级统计技术(例如，潜在班级增长模型、结构方程 模型、滞后效应模型)将阐明干预的机械路径和优先目标。 调查人员、Unimak、KGH以及社区咨询委员会之间的合作将为研究提供信息 执行，确保强有力地留住参与者，并提供传播渠道。分析将 通知筛查工具，以确定要进行预防性干预的家庭。已确定的干预目标已 不仅对受战争影响的环境有影响，而且对援助受暴力影响的不同人群也有影响 和创伤，包括移民和难民。

PROJECT SUMMARY Violence and humanitarian crises are common in the lives of children around the world, particularly in low- and middle-income countries. Exposure to war-related violence is detrimental to the mental health of parents and children, but research exploring mechanisms by which emotional and behavioral disruptions are transmitted to subsequent generations remains nascent, especially in Sub-Saharan Africa. To help address this gap, a study of war-affected youth has been underway since 2002 following a cohort of war-affected children—many, both male and female, former child soldiers—in Sierra Leone into young adulthood, and now parenthood. A prior NICHD-funded R01 (R01HD073349) demonstrated how childhood war-related trauma and loss contributed to mental health problems in adulthood. In 2017, a cross-sectional sample of intimate partners and biological offspring was added to the sample to examine linkages between early trauma exposure and both intimate partner and parent-child relationships. Knowledge to date of how war-related stressors “get under the skin,” to become heritable biophysical traits and the implications for the mental health of the next generation remain limited. Of relevance are the Research Domain Criteria-related constructs of self-regulation and stress reactivity and how they influence emotional, cognitive and social functioning of children. The proposed research comprises a significant advance in the 20-year history of this study by advancing understanding of potential biological embedding of stress responses intergenerationally. Building on four prior waves of data collection, biological measures of stress reactivity and self-regulation (autonomic nervous system reactivity, inflammation, telomere length) will be collected in a sample of parents exposed to significant trauma in childhood and extended also to intimate partners and offspring. Strong capacity-building collaborations with Sierra Leone’s University of Makeni (UNIMAK) and Kenema Government Hospital (KGH) will support the ethical collection of new stress biomarker data and clinical assessments of parent-child synchrony, health, and anthropometric data in biological offspring aged 7–24. Key study innovations are (a) rare prospective data on parental trauma exposure and longitudinal information on risk and protective factors operating across the social ecology; (b) data on biological embedding of stress responses related to parental trauma; and (c) the opportunity to examine both mental health and physiological outcomes in biological offspring in war-affected families over time. Advanced statistical techniques (e.g., latent class growth models, structural equation models, lagged effects models) will articulate mechanistic pathways and priority targets for intervention. Collaborations between investigators, UNIMAK, KGH, as well as community advisory boards will inform study implementation, ensure strong retention of participants, and provide channels for dissemination. Analyses will inform screening tools to identify families for preventive interventions. Intervention targets identified have implications not just for war-affected settings, but also for assisting diverse populations affected by violence and trauma, including migrants and refugees.