Publications

Read the academic publications which have emerged from our work.

BIOPATH

War Exposure and DNA Methylation in Syrian Refugee Children and Adolescents - 2024

Author: Smeeth et al.
Journal: JAMA Psychiatry
Website: Go to publication website

Abstract:

Importance: Adverse and traumatic experiences can lead to long-lasting DNA methylation changes, potentially mediating the link between adversity and mental health. To date, limited studies have investigated the impact of war on DNA methylation in children or adolescents, hampering our understanding of the biological impact of war exposure.

Objective: To identify salivary DNA methylation differences associated with war exposure in refugee children and adolescents. This cohort study included Syrian refugee children and adolescents, and their primary caregiver were recruited from tented settlements in Lebanon. Data collection was carried out in 2 waves, 1 year apart, from October 2017 to January 2018 and October 2018 to January 2019. Children and their caregiver were interviewed, and children provided saliva samples for DNA extraction. Data analysis was conducted in 2022, 2023, and 2024. Exposure War exposure assessed by interviewing children and their caregivers using the War Events Questionnaire.

Main Outcomes and Measures: Salivary DNA methylation levels were assayed with the Infinium Methylation EPIC BeadChip (Illumina). Epigenetic ageing acceleration was estimated using a set of preexisting epigenetic ageing clocks. A literature search was conducted to identify previously reported DNA methylation correlates of childhood trauma.

Results: The study population included 1507 children and adolescents (mean [SD] age, 11.3 [2.4] years; age range, 6-19 years; 793 female [52.6%]). A total of 1449 children provided saliva samples for DNA extraction in year 1, and 872 children provided samples in year 2. Children who reported war events had a number of differentially methylated sites and regions. Enrichment analyses indicated an enrichment of gene sets associated with transmembrane transport, neurotransmission, and intracellular movement in genes that exhibited differential methylation.

Sex-stratified analyses found a number of sex-specific DNA methylation differences associated with war exposure. Only 2 of 258 (0.8%) previously reported trauma-associated DNA methylation sites were associated with war exposure (B = −0.004; 95% CI, −0.005 to −0.003; Bonferroni P = .04 and B = −0.005; 95% CI, −0.006 to −0.004; Bonferroni P = .03). Any war exposure or bombardment was nominally associated with decreased epigenetic age using the Horvath multitissue clock (B = −0.39; 95% CI, −0.63 to −0.14; P = .007 and B = −0.42; 95% CI, −0.73 to −0.11; P = .002).

Conclusions and Relevance: In this cohort of Syrian refugee children and adolescents, war exposure was associated with a small number of distinct differences in salivary DNA methylation.

Father-separation and well-being in forcibly displaced Syrian children - 2024

Author: Eltanamly et al.
Journal: Attachment & Human Development
Website: Go to publication website

Abstract:

Forcibly displaced children often face separation from their parents, particularly fathers. These children endure the hardships of war, displacement, and the loss of a key attachment figure. Despite the critical role of attachment in children’s well-being during periods of heightened stress, the impact of separation due to war and displacement has received little attention in empirical work. Findings from 1544 Syrian refugee children (Mage = 10.97, SD = 2.27) living in informal settlements in Lebanon with their mothers (Mage = 38.07, SD = 8.49), including 367 father-separated children, show that father-separated children experienced more war-related events and worse refugee environments.

Structural equation modelling showed that beyond the direct relation of war exposure and quality of the refugee environment on well-being, father separation was uniquely related to more depressive symptoms and worse self-development, but not to anxiety, PTSD, or externalising problems in children. Maternal parenting did not explain these outcomes, though it had a protective function for children’s well-being.

The role of environmental sensitivity in the mental health of Syrian refugee children: a multi-level analysis - 2024

Author: May et al.
Journal: Molecular Psychiatry
Website: Go to publication website

Abstract:

Individuals with high environmental sensitivity have nervous systems that are disproportionately receptive to both the protective and imperilling aspects of the environment, suggesting their mental health is strongly context-dependent. However, there have been few consolidated attempts to examine putative markers of sensitivity, across different levels of analysis, within a single cohort of individuals with high-priority mental health needs.

Here, we examine psychological (self-report), physiological (hair hormones) and genetic (polygenic scores) markers of sensitivity in a large cohort of 1591 Syrian refugee children across two waves of data. Child-caregiver dyads were recruited from informal tented settlements in Lebanon, and completed a battery of psychological instruments at baseline and follow-up (12 months apart). Univariate and multivariate Bayesian linear mixed models were used to examine a) the interrelationships between markers of sensitivity and b) the ability of sensitivity markers to predict anxiety, depression, post-traumatic stress disorder, and externalising behaviour.

Self-reported sensitivity (using the Highly Sensitive Child Scale) significantly predicted a higher burden of all forms of mental illness across both waves, however, there were no significant cross-lagged pathways. Physiological and genetic markers were not stably predictive of self-reported sensitivity, and failed to similarly predict mental health outcomes. The measurement of environmental sensitivity may have significant implications for identifying and treating mental illness, especially amongst vulnerable populations, but clinical utility is currently limited to self-report assessment.

Hair hormone data from Syrian refugee children: Perspectives from a two-year longitudinal study - 2024

Author: May et al.
Journal: Comprehensive Psychoneuroendocrinology
Website: Go to publication website

Abstract:

For numerous issues of convenience and acceptability, hair hormone data have been increasingly incorporated in the field of war trauma and forced displacement, allowing retrospective examination of several biological metrics thought to covary with refugees’ mental health. As a relatively new research method, however, there remain several complexities and uncertainties surrounding the use of hair hormones, from initial hair sampling to final statistical analysis, many of which are underappreciated in the extant literature, and restrict the potential utility of hair hormones. To promote awareness, we provide a narrative overview of our experiences collecting and analyzing hair hormone data in a large cohort of Syrian refugee children (n = 1594), across two sampling waves spaced 12 months apart. We highlight both the challenges faced, and the promising results obtained thus far, and draw comparisons to other prominent studies in this field. Recommendations are provided to future researchers, with emphasis on longitudinal study designs, thorough collection and reporting of hair-related variables, and careful adherence to current laboratory guidelines and practices.

Effects of War Exposure on Pubertal Development in Refugee Children - 2023

Author: Black et al.
Journal: Developmental Psychology
Website: Go to publication website

Abstract:

Increasing research shows pubertal development accelerates following threats while it decelerates following deprivation. Yet, these environmental stressors are unlikely to occur in isolation.

We investigated how war exposure and energetic stress impact pubertal development using data from the longitudinal Biological Pathways of Risk and Resilience in Syrian Refugee Children study. Our sample included 1,600 male and female Syrian refugee children and their caregivers who lived in temporary settlements in Lebanon.

We hypothesized that (a) energetic stress suppresses pubertal development; (b)war exposure accelerates pubertal timing in boys and increases risk of menarche in girls, but only when energetic stress is low; and (c) when energetic stress is elevated, effects of war exposure on pubertal development will be attenuated.

Among boys, we did not find support for Hypothesis 1, but Hypotheses 2 and 3 were supported. Exposure to morbidity/mortality threats accelerated pubertal timing; this effect was attenuated under conditions of elevated energetic stress.

Among girls, we found support for Hypothesis 1, but not for Hypotheses 2 and 3.

Elevated energetic stress decreased the risk ofmenarche in girls. Neither war exposure, nor any interactions with energetic stress, predicted risk of menarche. Sensitivity analyses revealed a significant interaction between bombing exposure and the amount of time since leaving Syria.

Bombing decreased the risk of menarche, but only for girls who had left Syria four or more years prior to data collection. We discuss implications for translational efforts advocating for puberty screening in medical and mental health settings to identify trauma-exposed youth.

Risk and resilience in Syrian refugee children: A multisystem analysis - 2023

Author: Smeeth et al.
Journal: Development and Psychopathology
Website: Go to publication website

Abstract:

Refugee children are often exposed to substantial trauma, placing them at increased risk for mental illness. However, this risk can be mitigated by a capacity for resilience, conferred from multiple ecological systems (e.g., family, community), including at an individual biological level.

We examined the ability of hair cortisol concentrations and polygenic scores for mental health to predict risk and resilience in a sample of Syrian refugee children (n = 1359).

Children were categorized as either at-risk or resilient depending on clinical thresholds for posttraumatic stress disorder, depression, and externalizing behavior problems. Logistic regression was used to examine main and interacting effects while controlling for covariates.

Elevated hair cortisol concentrations were significantly associated with reduced resilience (odds ratio (OR)=0.58, 95%CI [0.40, 0.83]) while controlling for levels of war exposure.

Polygenic scores for depression, self-harm, and neuroticism were not found to have any significant main effects. However, a significant interaction emerged between hair cortisol and polygenic scores for depression (OR=0.04, 95%CI [0.003 0.47]), suggesting that children predisposed to depression were more at risk for mental health problems when hair cortisol concentrations were high.

Our results suggest that biomarkers (separately and in combination) might support early identification of refugee children at risk for mental health problems.

The important role of mothers during displacement: Direct and indirect effects of the refugee context on Syrian refugee children’s mental health - 2023

Author: Popham et al.
Journal: Child Development
Website: Go to publication website

Abstract:

Refugee children are at increased risk for mental health problems, including post-traumatic stress, depression, and externalizing problems. The refugee environment, maternal mental health, and parenting may reduce or exacerbate that risk.

This study investigated their direct and indirect associations with child mental health cross-sectionally in a sample of Syrian refugee child–mother dyads in Lebanon in 2017–19.

Mediating pathways were tested using structural equation modeling with 1446 dyads (child: Mage = 11.39, 52.1% females) and gain 1 year later with 872 (child: Mage = 12.17, 53.1% females) of the original sample.

Mediating pathways from the refugee environment through maternal mental health and parenting to child outcomes were detected, emphasizing the importance of a holistic approach to refugee mental health.

Predictors of psychological risk and resilience among Syrian refugee children - 2023

Author: Popham et al.
Journal: Journal of Child Psychology and Psychiatry
Website: Go to publication website

Abstract:

Objective: War-exposed refugee children are at elevated risk for mental health problems, but a notable proportion appear resilient. We aimed to investigate the proportion of Syrian refugee children who can be considered resilient, and applied a novel approach to identify factors predicting individual differences in mental health outcomes following war exposure.

Method: The sample included 1,528 war-exposed Syrian refugee children and their primary caregiver living in refugee settlements in Lebanon. Children were classed as having low symptoms (LS) if they scored below clinically validated cut-offs for post-traumatic stress disorder (PTSD), depression and externalising behaviour problems. Children scoring above any cut-off were classified as having high symptoms (HS). Each LS child was matched with one HS who reported similar war exposure, to test what differentiates children with similar exposures but different outcomes.

Results: 19.3% of the children met our resilience criteria and were considered LS. At the individual level, protective traits (e.g. self-esteem; OR = 1.51, 95% CI [1.25, 1.81]) predicted LS classification, while environmental sensitivity (OR = 0.69, 95% CI [0.59, 0.82]), poorer general health (OR = 0.71, 95% CI [0.58, 0.87]) and specific coping strategies (e.g. avoidance; OR = 0.90, 95% CI [0.85, 0.96]) predicted HS classification.

Social/environmental predictors included perceived social support (OR = 1.23, 95% CI [1.02, 1.49]), loneliness and social isolation (OR = 0.85, 95% CI [0.80, 0.90]), child maltreatment (OR = 0.96, 95% CI [0.94, 0.97]), and caregiver mental and general health (e.g. caregiver depression; OR = 0.94, 95% CI [0.92, 0.97]).

Conclusions: Future research should take multiple dimensions of functioning into account when defining risk for mental health problems and consider the identified predictors as potential targets for interventions.

Risk and Resilience among Syrian Refugee Children: Findings from the BIOPATH Study - 2022

Prevalence and predictors of mental health problems in refugee children living in informal settlements in Lebanon - 2022

Author: McEwen et al.
Journal: Nature Mental Health
Website: Go to publication website

Abstract:

Millions of people are currently displaced. About half of them are children who are at increased risk of mental health problems. While some risk factors such as war exposure are well established, less is known regarding the effects of the local refugee environment.

Here we show that the prevalence and comorbidity of mental health problems in Syrian refugee children living in settlements in Lebanon are high.

We assessed individual, familial and social factors in a prospective cohort study (N = 1,591 child–caregiver dyads interviewed between October 2017 and January 2018; n = 1,000 interviewed at 1 yr follow-up). Of these children, 39.6% met the criteria for post-traumatic stress disorder, 26.9% for conduct/oppositional defiant disorder, 20.1% for depression and 47.8% for anxiety disorders.

Exposure to daily stressors was the factor most strongly associated with children’s mental health problems. Interventions and policies addressing ongoing daily stressors are as important as scaling up mental health services for refugee families.

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children - 2022

Author: Smeeth et al.
Journal: Molecular Psychiatry
Website: Go to publication website

Abstract:

Altered secretion of cortisol, the primary effector of the hypothalamus–pituitary–adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents.

Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6–18 years) and their caregiver.

This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon.

The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of warrelated events experienced.

This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.

The dynamic nature of refugee children’s resilience: a cohort study of Syrian refugees in Lebanon - 2022

Author: Popham et al.
Journal: Epidemiology and Psychiatric Sciences
Website: Go to publication website

Abstract:

Aim: Children’s responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on cross-sectional data in high-income countries. We aimed to (1) investigate change in resilience across two timepoints in a highly vulnerable sample of Syrian refugee children in Lebanon, and (2) explore predictors of their mental health problems across time.

Method: In total, 982 Syrian child–caregiver dyads living in refugee settlements in Lebanon completed questionnaires via interview at baseline and follow-up one year later. We categorised children into groups based on their risk for mental health problems across both timepoints (stable high risk/SHR, deteriorating, improving, stable low risk) according to locally validated cut-offs on measures of post-traumatic stress disorder (PTSD), depression and behavioural problems.

Analyses of covariance identified how the groups differed on a range of individual and socio-environmental predictors, followed up by cross-lagged panel models (CLPMs) to investigate the directionality of the relationships between significantly related predictors and symptoms.

Results: The sample showed a meaningful amount of change in mental health symptoms from baseline to follow-up. Over half (56.3%) of children met SHR criteria and 10.3% deteriorated over time, but almost one-quarter (24.2%) showed meaningful improvement, and 9.2% were consistently at low risk for mental health problems at both timepoints. Several predictors differentiated the groups, particularly social measures.

According to CLPMs, maternal acceptance (β = −0.07) predicted child mental health symptoms over time. Self-esteem (β = −0.08), maternal psychological control (β = 0.10), child maltreatment (β = 0.09) and caregiver depression (β = 0.08) predicted child symptoms and vice versa (βse = −0.11, βb = 0.07, βmpc = 0.08, βcm= 0.1, βcd = 0.11). Finally, child symptoms predicted loneliness (β = 0.12), bullying (β = 0.07), perceived social support (β = −0.12), parent–child conflict (β = 0.13), caregiver PTSD (β = 0.07), caregiver anxiety (β = 0.08) and the perceived refugee environment (β = −0.09).

Conclusion: Our results show risk and resilience are dynamic, and the family environment plays a key role in children’s response to war and displacement. Conversely, children also have a significant impact on the family environment and caregiver’s own mental health. Interventions to promote resilience in refugee children should therefore consider family wide mechanisms.

Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH) - 2022

Author: McEwen et al.
Journal: Social Psychiatry and Psychiatric Epidemiology
Website: Go to publication website

Abstract:

The BIOPATH cohort was established to explore the interplay of psychosocial and biological factors in the development of resilience and mental health problems in Syrian refugee children. Based in Lebanon, a middle-income country significantly impacted by the refugee crisis, it is the first such cohort of refugees in the Middle East.

Families were recruited from informal tented settlements in the Beqaa region using purposive cluster sampling. At baseline (October 2017–January 2018), N = 3188 individuals participated [n = 1594 child–caregiver dyads; child gender, 52.6% female; mean (SD) age = 11.44 (2.44) years, range = 6–19].

Re-participation rate at 1-year follow-up was 62.8%. Individual interviews were conducted with children and primary caregivers and biological samples collected from children.

Measures included:

(1) children’s well-being and mental health problems (using tools validated against clinical interviews in a subsample of the cohort);
(2) psychosocial risk and protective factors at the level of the individual (e.g. coping strategies), family (e.g. parent–child relationship), community (e.g. collective efficacy), and wider context (e.g. services);
(3) saliva samples for genetic and epigenetic (methylation) analyses;
(4) hair samples to measure cortisol, dehydroepiandrosterone (DHEA) and testosterone.

This cohort profile provides details about sampling and recruitment, data collection and measures, demographic data, attrition and potential bias, key findings on resilience and mental health problems in children and strengths and limitations of the cohort. Researchers interested in accessing data should contact Professor Michael Pluess at Queen Mary University of London, UK (e-mail: m.pluess@qmul.ac.uk).

Psychological Resilience in Response to Adverse Experiences - 2020

The role of epigenetics in psychological resilience - 2021

Author: Smeeth et al.
Journal: Lancet Psychiatry
Website: Go to publication website

Abstract:

There is substantial variation in people’s responses to adversity, with a considerable proportion of individuals displaying psychological resilience. Epigenetic mechanisms are hypothesised to be one molecular pathway of how adverse and traumatic events can become biologically embedded and contribute to individual differences in resilience.

However, not much is known regarding the role of epigenetics in the development of psychological resilience. In this Review, we propose a new conceptual model for the different functions of epigenetic mechanisms in psychological resilience.

The model considers the initial establishment of the epigenome, epigenetic modification due to adverse and protective environments, the role of protective factors in counteracting adverse influences, and genetic moderation of environmentally induced epigenetic modifications.

After reviewing empirical evidence for the various components of the model, we identify research that should be prioritised and discuss practical implications of the proposed model for epigenetic research on resilience.

Mental health research among Syrian refugees in Lebanon: challenges and solutions - 2018

Author: Moghames et al.
Journal: Humanitarian Exchange
Website: Go to publication website

Abstract:

More than 5.4 million Syrian refugees are registered in countries surrounding Syria, including an estimated 1.5m in Lebanon.

1. Psychological and social distress among refugees is common, resulting in a wide range of emotional, cognitive, physical and behavioural problems.

2. High-quality research on the mental health needs of Syrian refugees should play an important role in planning and providing services, yet conducting mental health research to a high standard in a refugee setting is particularly challenging.

This article describes two research studies with Syrian refugees in the Beqaa region of Lebanon, setting out some of the challenges faced and the lessons learned in the process of conducting the research.

t-CETA

Delivering therapy over telephone in a humanitarian setting: a pilot randomized controlled trial of common elements treatment approach (CETA) with Syrian refugee children in Lebanon - 2024

Author: Pluess et al.
Journal: Conflict & Health
Website: Go to publication website

Abstract:

Background: In recent years, the number of forcibly displaced persons has risen worldwide, with approximately 40% being children and adolescents. Most of them are hosted in low- and middle-income countries (LMICs). Many individuals meet the criteria for mental health issues, which can also be exacerbated by a number of risk factors, including low socioeconomic status, displacement, and stressors linked to conflicts in their country or region of origin. However, the vast majority never receive treatment for their psychological problems due to multiple reasons, including a shortage of mental health professionals in LIMCs, transportation challenges in accessing clinics, and clinic hours conflicting with family commitments. In the current study we investigated whether individual psychotherapy delivered by trained lay counsellors over telephone to Syrian refugee children living in Lebanon is effective and overcomes barriers to treatment access.

Methods: After adaptation of Common Elements Treatment Approach (CETA) to remote delivery over telephone (t-CETA), preliminary effectiveness of the treatment modality was assessed with a pilot single blind randomised controlled trial including a total sample of 20 refugee children with diagnosed mental health problems. Data was analysed applying a Bayesian approach.

Results: There was a significant session-by-session decrease in self-reported mental health symptoms over the course of treatment. Independent assessments showed that t-CETA resulted in a greater reduction of symptoms than standard in-person treatment as usual. There was no difference between groups for impairment. Importantly, the majority of children allocated to t-CETA completed treatment whilst no children in the treatment as usual condition were able to do so.

Conclusion: The study provides preliminary evidence that telephone-delivered psychotherapy in a humanitarian setting, delivered by lay counsellors under supervision, works and significantly increases access to treatment compared to traditional in-person treatment. However, findings remain to be replicated in larger trials.

Feasibility and acceptability of phone‑delivered psychological therapy for refugee children and adolescents in a humanitarian setting - 2024

Author: McEwen et al.
Journal: Conflict & Health
Website: Go to publication website

Abstract:

Refugee children are at high risk of mental health problems but face barriers to accessing mental health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers.

This is the first study to explore feasibility and acceptability of telephone-delivered therapy with refugee children in a humanitarian setting. Methods An evidence-based intervention, Common Elements Treatment Approach, was adapted for telephonedelivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements in the Beqaa region of Lebanon.

Following delivery of t-CETA, semi-structured interviews were conducted with counsellors (N = 3) and with children who received t-CETA (N = 11, 45% female, age 8–17 years) and their caregivers (N = 11, 100% female, age 29–56 years) (N = 25 interviews).

Thematic content analysis was conducted separately for interviews with counsellors and interviews with families and results were synthesized. Results Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them.

Synthesized themes were: counselling over the phone both solves and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship between the counsellor and the child and caregiver is extremely important; the family’s attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed.

Counselling over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children.

Challenges included access to phones and poor network coverage, finding an appropriate space, and communication challenges over the phone. Conclusions Despite some challenges, telephone-delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services by hard-to-reach populations. Approaches to addressing challenges of telephone-delivered therapy are discussed.

What drives change in children receiving telephone-delivered Common Elements Treatment Approach (t-CETA)? A multiple n = 1 study with Syrian refugee children and adolescents in Lebanon - 2023

Author: Bosqui et al.
Journal: Child Abuse and Neglect
Website: Go to publication website

Abstract:

Background: Although the evidence-base for mental health and psychosocial support (MHPSS) interventions in humanitarian settings is growing rapidly, their mechanisms of change remain poorly understood despite the potential to improve the effectiveness and reach of interventions.

Objective: This study aimed to explore the mechanisms or factors that drive change in a modular transdiagnostic telephone-delivered mental health intervention, Common Elements Treatment Approach (t-CETA).

Participants: Participants were Syrian refugee children and adolescents living in tented settlements in Lebanon.

Methods: We used a multiple n = 1 design, drawing on secondary data from 9 children who completed t-CETA during a pilot randomized controlled trial.

Results: Children with historical war-related trauma were more likely to show significant improvement across symptom clusters by the end of treatment compared to children presenting with depression related to daily living conditions. Children also showed fluctuating symptoms during the early stages of treatment (engagement and cognitive restructuring) but significant decline in symptoms after the trauma module (prolonged imaginal exposure) and depression module (behavioral activation).

Salient external life events identified were starting or dropping out of school, working, change in living conditions, family conflict and the October Revolution; and interpersonal factors of parental engagement (with or without full attendance) and counsellor skills in building rapport were also identified as having an impact on treatment success.

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC - 2020

Author: Tol et al.
Journal: Conflict & Health
Website: Go to publication website

Abstract:

Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research.

As a significant portion of R2HC’s research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field.

Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field.

Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP.

All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions.

Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making.

Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

VaST 3EA Report

The culturally and contextually sensitive assessment of mental health using a structured diagnostic interview (MINI Kid) for Syrian refugee children and adolescents in Lebanon: Challenges and solutions - 2022

Author: Kyrillos
Journal: Transcultural Psychiatry
Website: Go to publication website

Abstract:

Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings.

This reflective article aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview.

We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N=119 Syrian refugee children (aged 8–17) resident in ITSs in Lebanon. Qualitative data were derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content.

Five themes were identified: (1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options);
(2) Validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers);
(3) Cultural norms and meaning (impact of different meanings on answers);
(4) Contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress);
(5) Co-morbidity and formulation (interconnected and complex presentations).

The findings suggest thatwhile structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improving accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies.

Other Publications

Supporting the Mental Health of Forcibly Displaced Children - 2025

Author: Michael Pluess, Felicity L. Brown and Catherine Panter-Brick.
Journal: Nature Reviews Psychology
Website: Go to publication website

Abstract:

Close to 50 million children under 18 years of age are currently forcibly displaced from their homes because of armed conflict and other emergencies. Displaced children and adolescents are at increased risk of developing poor mental health. However, knowledge about how best to support their mental health and well-being is limited. In this Review, we consolidate knowledge on the prevalence of mental disorders in settings of forced displacement, discuss individual differences in response to war and displacement, and review existing mental health and psychosocial support approaches. Critical assessment of this literature indicates a substantial mental health burden among displaced children and supports a broad range of risk and resilience mechanisms. Although some specific mental health and psychosocial support interventions have positively influenced forcibly displaced children’s mental health, there is a need for more culturally and contextually relevant, accessible and evidence-based services that also address family and community factors during displacement. We discuss recommendations to ensure that these services are linked to strategies that target adverse conditions and structural barriers and strengthen the socio-ecological resources that contribute to children’s positive development and well-being.

Publications

BIOPATH

t-CETA

VaST 3EA Report

Other Publications

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