Intimate partner violence during COVID-19: systematic review and meta-analysis according to methodological choices.

BACKGROUND: Intimate Partner Violence (IPV) is the most common form of interpersonal violence and a major public health problem. The COVID-19 pandemic might have contributed to an increase in IPV experiences. To evaluate changes in IPV prevalence during the pandemic, it is important to consider studies' methodological characteristics such as the assessment tools used, samples addressed, or administration modes (e.g., face-to-face, telephone or online interviews), since they may influence disclosure and were likely affected by pandemic-imposed mobility restrictions. METHODS: Systematic review and meta-analysis of empirical studies addressing IPV against women, men, or both, during the COVID-19 period. We searched six electronic databases until December 2021, including articles in English, German, Spanish, French or Portuguese languages. We extracted and synthesised characteristics of studies related to sampling (clinical, community, convenience), type assessment tool (standardised questionnaire, specifically created questions), method of administration (online, telephone, face-to-face), and estimates of different forms of IPV (physical, sexual, psychological). IPV estimates were pooled stratified by study characteristics using random-effects models. RESULTS: Of 3581 publications, we included 103 studies. Fifty-five studies used a standardized instrument (or some adaptations) to assess IPV, with the World Health Organisation Questionnaire and the Revised Conflicts Tactics Scales being the most frequent. For 34 studies, the authors created specific questions to assess IPV. Sixty-one studies were conducted online, 16 contacted participants face-to-face and 11 by telephone. The pooled prevalence estimate for any type of violence against women (VAW) was 21% (95% Confidence Interval, 95%CI = 18%-23%). The pooled estimate observed for studies assessing VAW using the telephone was 19% (95%CI = 10%-28%). For online studies it was 16% (95%CI = 13%-19%), and for face-to-face studies, it was 38% (95%CI = 28%-49%). According to the type of sample, a pooled estimate of 17% (95%CI = 9%-25%) was observed for studies on VAW using a clinical sample. This value was 21% (95%CI = 18%-24%) and 22% (95%CI = 16%-28%) for studies assessing VAW using a convenience sample and a general population or community sample, respectively. According to the type of instrument, studies on VAW using a standardized tool revealed a pooled estimate of 21% (95%CI = 18%-25%), and an estimate of 17% (95%CI = 13%-21%) was found for studies using specifically created questions. CONCLUSIONS: During the pandemic, IPV prevalence studies showed great methodological variation. Most studies were conducted online, reflecting adaptation to pandemic measures implemented worldwide. Prevalence estimates were higher in face-to-face studies and in studies using a standardized tool. However, estimates of the different forms of IPV during the pandemic do not suggest a marked change in prevalence compared to pre-pandemic global prevalence estimates, suggesting that one in five women experienced IPV during this period.

Prevalence of suicidality and associated factors of suicide risk in a representative community sample of families in three East African refugee camps.

PURPOSE: To assess the prevalence of suicidality and associated factors of suicide risk in a sample of Burundian refugee families living in three refugee camps in Tanzania. METHODS: Children (n = 230) and their parents (n = 460) were randomly selected and interviewed about suicidality (suicidal ideation, plans, and attempts) and a range of sociodemographic, psychological, and environmental factors. Multinomial logistic regression analyses were conducted to examine factors associated with children and parents' lower and moderate or high current suicide risk. RESULTS: Past-month prevalence of suicidal ideation, plans, and attempts were 11.3%, 0.9% and 0.9%, respectively, among children; 37.4%, 7.4% and 5.2%, respectively, among mothers; and 29.6%, 4.8% and 1.7%, respectively, among fathers. Older age in years (aORlower = 2.20, 95% CI 1.38-3.51; aORmoderate/high = 3.03, 95% CI 1.15-7.99) and higher levels of posttraumatic stress disorder symptoms (aORlower = 1.64, 95% CI 1.05-2.57; aORmoderate/high = 2.30, 95% CI: 1.02-5.16), internalizing (aORmoderate/high = 2.88, 95% CI 1.33-6.26) and externalizing problems (aORlower = 1.56, 95% CI: 1.06-2.31; aORmoderate/high = 3.03, 95% CI 1.42-6.49) were significantly positively associated with children's current suicide risk. For mothers, higher perceived instrumental social support (aORmoderate/high = 0.05, 95% CI < 0.01-0.58) was significantly negatively related to suicide risk, whereas exposure to community violence (aORlower = 1.97, 95% CI 1.30-2.99; aORmoderate/high = 1.59, 95% CI 1.00-2.52), living in larger households (aORlower = 1.74, 95% CI 1.17-2.57), and higher psychological distress (aORmoderate/high = 1.67, 95% CI 1.05-2.67) were significantly positively associated with suicide risk. For fathers, higher perceived instrumental social support (aORmoderate/high = 0.04, 95% CI < 0.01-0.44) and having more years of formal education (aORmoderate/high = 0.58, 95% CI 0.34-0.98) were significantly negatively and exposure to war-related trauma (aORmoderate/high = 1.81, 95% CI 1.03-3.19) was significantly positively associated with suicide risk. CONCLUSION: Prevention programs should target psychopathology, community violence and social support to mitigate children and parents' current suicide risk.

Intergenerational transmission of mental health risk in refugee families: The role of maternal psychopathology and emotional availability.

To prevent an intergenerational cycle of malfunction, it is crucial to understand how mothers' exposure to traumatic war experiences contributes to their children's vulnerability to mental health problems. This study examined the role of maternal psychopathology and mother-child emotional availability (EA) in the association between mothers' trauma exposure and children's mental health problems in a sample of 222 Burundian mother-child dyads living in refugee camps in Tanzania. Maternal and child EA were assessed through recorded observations of mother-child interactions. In structured clinical interviews, mothers reported on their lifetime exposure to traumatic events and their psychopathology and both mothers and fathers reported on children's emotional and behavioral problems. Structural equation modeling showed that mothers' higher trauma exposure was indirectly associated with higher levels of children's mental health problems through higher levels of maternal psychopathology. Mothers' higher trauma exposure was also directly associated with lower maternal EA in mother-child interactions, which was in turn related to higher levels of children's mental health problems. The findings suggest that trauma exposure independently affects mothers' mental health and their EA, which can contribute to children's mental health problems. Interventions aiming to reduce mothers' psychopathology and strengthen their EA may be beneficial for children's well-being.

The network structure of posttraumatic stress symptoms in war-affected children and adolescents.

Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results: In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion: The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

No association between war-related trauma or PTSD symptom severity and epigenome-wide DNA methylation in Burundian refugees.

Background: War-related trauma is associated with varying posttraumatic stress disorder (PTSD) prevalence rates in refugees. In PTSD development, differential DNA methylation (DNAm) levels associated with trauma exposure might be involved in risk versus resilience processes. Studies investigating DNAm profiles related to trauma exposure and PTSD among refugees remain sparse.Objective: The present epigenome-wide association study investigated associations between war-related trauma, PTSD, and altered DNAm patterns in Burundian refugee families with 110 children and their 207 female and male caregivers.Method: War-related trauma load and PTSD symptom severity were assessed in structured clinical interviews with standardised instruments. Epigenome-wide DNAm levels were quantified from buccal epithelia using the Illumina EPIC beadchip.Results: Controlling for biological confounders, no significant epigenome-wide DNAm alterations associated with trauma exposure or PTSD were identified in children or caregivers (FDRs > .05). Co-methylated positions derived as modules from weighted gene correlation network analyses were not significantly associated with either war-related trauma experience in children or caregivers or with PTSD.Conclusions: These results do not provide evidence for altered DNAm patterns associated with exposure to war-related trauma or PTSD.

The study examines an understudied population in epigenome-wide association studies.Burundian refugees' war-trauma, PTSD, and DNA methylation were studied.Epigenome-wide DNA methylation was not significantly associated with war-trauma or PTSD in the conflict-affected sample.

Welcome, how are you doing? - towards a systematic mental health screening and crisis management for newly arriving refugees.

Background: Compared to the general German population, refugees in Germany are a high-risk group for trauma spectrum disorders. Currently, many barriers exist for the implementation of a screen-and-treat approach for mental disorders as part of the routine health care provision during the early stage of the immigration process.Objective: The aim of the present study was to develop and test a systematic screening approach to identify individual refugees in need of mental health care during the initial immigration phase.Method: 167 newly arrived refugees underwent a screening interview with the Refugee Health Screener (RHS) carried out by Intercultural Therapy Assistants (ITAs). The ITAs were super-vised by psychologists at a reception centre in Bielefeld, Germany. A subsample of 48 persons partici-pated in clinical validation interviews.Results: Findings demonstrated the need for and feasibility of a systematic screening during the initial immigration phase. However, established cut-off values of the RHS had to be adapted and the screening procedure had to be adjusted due to the needs of a significant number of refugees in severe psychological crises.Conclusion: A systematic screening that is applied shortly after arrival facilitates the early identification of refugees at risk of developing mental disorders and may be helpful to prevent chronic symptom development and an aggravation of psychological crises.

A systematic complementary screening procedure during the initial immigration phase was found to be useful for the identification of refugees in need of mental health care.The procedure could be implemented both safely and efficiently in conjunction with the initial medical check-up for recently arrived refugees.Responding to the needs of the refugees immediately following their arrival in Germany, we adjusted the cut-off of the screening instrument and suggest to explicitly include a detection procedure for severe psychological crises.

A Systematic Review of the Prevalence and Correlates of Emotional Violence by Teachers.

There is increasing evidence for the deleterious impact of emotional violence on children`s well-being and development. This systematic review focused on a) the prevalence and (b) correlates of emotional violence by teachers. A literature search of quantitative and peer-reviewed studies published in English between 1980 and April 2021 was conducted. Eighty-four studies met the inclusion criteria. Studies represented all geographical regions of the world, were predominantly cross-sectional and of moderate quality. Studies were heterogeneous in terms of their samples, conceptualization, and measurement of emotional violence. Results indicated that emotional violence by teachers is prevalent across cultural settings, although large variations within and between regions are noted. It is related to mental health, behavioral and academic problems of children above and beyond physical violence by teachers and victimization by peers and parents. Boys are at higher risk of experiencing emotional violence by teachers than girls. Family dysfunction, low socioeconomic status (of the family or the community), and violent school environments appear to increase risk as well. The observed patterns of co-occurrence of emotional violence with physical violence by teachers and victimization by peers as well as perpetration of violence against peers and teachers lend support to notions of poly-victimization and cycles of violence in the school settings. Future research should use representative surveys, examine antecedents, and consequences of emotional violence by teachers using longitudinal and experimental designs and evaluate interventions to prevent emotional violence by teachers.

Externalizing problems mediate the relation between teacher and peer violence and lower school performance.

BACKGROUND: The association between children's exposure to family violence and poor academic outcomes is well-established. Less is known about how exposure to violence in the school context, i.e., by teachers and by peers, affects academic functioning. Moreover, the role of children's mental health problems in this link has hardly been examined. OBJECTIVES: We examined direct and indirect associations between children's experiences of violence by teachers and peers and children's mental health and school functioning while controlling for children's experiences of parental violence. PARTICIPANTS: Using a multistage random sampling approach, we obtained a representative sample of 914 students (50.5 % girls, Mage = 12.58 years) from 12 primary schools in Tanzania. METHODS: In structured interviews, students' experiences of violence and mental health problems were assessed. Students' academic performance and absenteeism were documented using school records. Associations were examined using structural equation modeling. RESULTS: Experiences of more teacher and peer violence were each significantly associated with higher externalizing problems (teachers: ß = 0.27 [95 %-CI: 0.12, 0.47]; peers: ß = 0.17, [95 %-CI: 0.07, 0.32]). Higher externalizing problems were significantly associated with poorer academic performance (ß = -0.13, [95 %-CI: -0.23, -0.02]), implying significant indirect associations between students' experiences of teacher violence (ß = -0.04, [95 %-CI: -0.08, -0.01]) and peer violence (ß = -0.02, [95 %-CI: -0.05, -0.01]) and their academic performance via externalizing problems. CONCLUSION: Exposure to violence at school may impair children's academic performance indirectly by increasing attention and behaviour problems. Further investigations in longitudinal studies and implementation of interventions to reduce violence in schools are indicated.

Factors Contributing to Violence Against Children: Insights From a Multi-informant Study Among Family-Triads From Three East-African Refugee Camps.

Parental violence poses a considerable, yet mitigable risk for the mental health and well-being of refugee children living in resource-poor refugee camps. However, little is known about potential risk factors for parental violence in these settings. Using an ecological systems perspective and a multi-informant approach, we investigated ontogenic (parental childhood experiences of violence), microsystem (parents' and children's psychopathology) and exosystem (families' monthly household income) risk factors for child-directed parental violence in a sample of 226 Burundian families living in refugee camps in Tanzania. Data were collected through individual structured clinical interviews with mothers, fathers, and children. In the child-report path model [χ2 (6) = 7.752, p = .257, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.036 (p = .562)], children's posttraumatic stress disorder (PTSD) symptoms, externalizing symptoms and paternal PTSD symptoms were positively associated with violence by both parents. Maternal psychosocial impairment was positively associated with child-reported paternal violence. In the parent-report path model [χ2 (6) = 7.789, p = .254, CFI = 0.97, RMSEA = 0.036 (p = .535)], children's externalizing problems as well as a lower monthly household income were positively related to maternal violence. Each parent's childhood victimization was positively linked to their use of violence against children. Maternal psychosocial impairment and paternal alcohol abuse were positively associated with paternal violence. Child and paternal psychopathology, maternal psychosocial impairment, parents' childhood victimization, and families' socioeconomic status may be important targets for prevention and intervention approaches aiming to reduce parental violence against refugee children living in camps.

Reducing physical and emotional violence by teachers using the intervention Interaction Competencies with Children - for Teachers (ICC-T): study protocol of a multi-country cluster randomized controlled trial in Ghana, Tanzania, and Uganda.

BACKGROUND: Violence has severe and long-lasting negative consequences for children's and adolescents' well-being and psychosocial functioning, thereby also hampering communities' and societies' economic growth. Positive attitudes towards violence and the lack of access to alternative non-violent strategies are likely to contribute to the high levels of teachers' ongoing use of violence against children in sub-Saharan African countries. Notwithstanding, there are currently very few school-level interventions to reduce violence by teachers that a) have been scientifically evaluated and b) that focus both on changing attitudes towards violence and on equipping teachers with non-violent discipline strategies. Thus, the present study tests the effectiveness of the preventative intervention Interaction Competencies with Children - for Teachers (ICC-T) in primary and secondary schools in Tanzania, Uganda, and Ghana. METHODS: The study is a multi-site cluster randomized controlled trial with schools (clusters) as level of randomization and three data assessment points: baseline assessment prior to the intervention, the first follow-up assessment 6 months after the intervention and the second follow-up assessment 18 months after the intervention. Multi-stage random sampling will be applied to select a total number of 72 schools (24 per country). Schools will be randomly allocated to the intervention and the control condition after baseline. At each school, 40 students (stratified by gender) in the third year of primary school or in the first year of secondary/junior high school and all teachers (expected average number: 20) will be recruited. Thus, the final sample will comprise 2880 students and at least 1440 teachers. Data will be collected using structured clinical interviews. Primary outcome measures are student- and teacher-reported physical and emotional violence by teachers in the past week. Secondary outcome measures include children's emotional and behavioral problems, quality of life, cognitive functioning, academic performance, school attendance and social competence. Data will be analyzed using multilevel analyses. DISCUSSION: This study aims to provide further evidence for the effectiveness of ICC-T to reduce teacher violence and to improve children's functioning (i.e., mental health, well-being, academic performance) across educational settings, societies and cultures. TRIAL REGISTRATION: The trial was registered at clinicaltrials.org under the ClinicalTrials.gov identifier NCT04948580 on July 2, 2021.

Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth.

BACKGROUND: The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology. OBJECTIVE: Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning. PARTICIPANTS AND SETTING: We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents. METHODS: Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure). RESULTS: Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (ß = -0.07, p = .02), with a trend towards mediation for short-term memory (ß = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (ß = -0.20, p = .02). CONCLUSIONS: Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.

A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps.

Children and adolescents' mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7-15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children's post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children's vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children's prosocial behavior, just as mothers' social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth's mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.

Preventing Violence by Teachers in Primary Schools: Study Protocol for a Cluster Randomized Controlled Trial in Haiti.

CONTEXT: Although teacher violence at schools is a serious problem in Haiti, there is a lack of systematic evidence on the effectiveness of school-based interventions in reducing teacher violence in this low-income country. OBJECTIVE: To test the effectiveness of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T) aiming to reduce teachers' use of violent disciplinary strategies and to improve their interaction competences with children in the Haitian context. DESIGN SETTING PARTICIPANTS: The study is designed as a two-arm matched cluster randomized controlled trial. The sample consists of 468 teachers and 1,008 children from 36 (community and public) primary schools around Cap-Haïtien (Département du Nord) in Haiti. Data will be collected in three phases, before the intervention, and 6 and 18 months after. INTERVENTION: In the group of intervention schools, ICC-T will be delivered as a 5-day training workshop. Workshop sessions are divided into five modules: 1) improving teacher-student interactions, 2) maltreatment prevention, 3) effective discipline strategies, 4) identifying and supporting burdened students, and 5) implementation in everyday school life. MAIN OUTCOME MEASURE: The main outcome measure is teacher violence assessed in two ways: (i) teachers' self-reported use of violence, and (ii) children's self-reported experiences of violence by teachers. CONCLUSIONS: Prior evaluations of ICC-T had been conducted in sub-Saharan Africa with promising results. This study will test for the first time the effectiveness of this intervention outside the context of sub-Saharan Africa.

Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps.

Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent-child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.

A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents.

In the past decade, millions of children and adolescents have been forced to flee from protracted or newly erupted violent conflicts. Forcibly displaced children are particularly vulnerable for developing mental health problems. However, a timely and systematic review of the current evidence is lacking. We conducted a systematic review of factors contributing to the mental health of refugee children across different socio-ecological levels (individual, family, community, sociocultural). We systematically searched the databases Medline, PsycINFO, Web of Science, and Cochrane for English studies published in peer-reviewed journals between August 2010 and May 2020. Of the 2413 identified studies, 63 were included in the analyses. Only 24 studies were considered to be of high quality. Pre-migration individual (risk: exposure to war-related trauma, female gender) and post-migration family factors (risk: parental mental health problems and impaired parenting, protective: family cohesion) currently have the best evidence base. Post-migration community (protective: school connectedness, support by peers) and sociocultural factors (risk: discrimination and acculturative stress, protective: integrative acculturation) have gained some support in high-income settings. Prevention and intervention approaches should integrate factors across different socio-ecological levels. More longitudinal studies and research in low- and middle-income countries are needed to advance our knowledge on causal mechanisms behind factors contributing to refugee youth's mental health.

Prevalence and co-existence of morbidity of posttraumatic stress and functional impairment among Burundian refugee children and their parents.

Background: Although the family constitutes the prime source of risk and resilience for the well-being of children growing up in adverse conditions, the mental health of children living in refugee camps has rarely been investigated in conjunction with their parents' mental health. Objectives: To examine the prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among Burundian refugee children and their parents living in Tanzanian refugee camps and to identify patterns of comorbidity among children and their parents based on PTSD symptom levels and functional impairment. Methods: We recruited a representative sample of 230 children aged 7-15 years and both of their parents (n = 690) and conducted separate structured clinical interviews. Latent Class Analysis was applied to identify patterns of comorbidity. Results: Children and parents were exposed to multiple traumatic event types. In total, 5.7% of children fulfilled DSM-5 criteria for PTSD in the past month and 10.9% reported enhanced levels of other mental health problems. 42.6% indicated clinically significant functional impairment due to PTSD symptoms. PTSD prevalence was higher among mothers (32.6%) and fathers (29.1%). Latent Class Analysis (LCA) revealed a familial accumulation of PTSD symptoms as children with high symptom levels and impairment were likely to live in families with two traumatized parents. Conclusions: Although the number of children who need support for trauma-related mental health problems was relatively low, taking into account parental trauma could aid to identify at-risk children with elevated PTSD symptom levels and impairment even in the face of existing barriers to mental health care access for children in refugee camp settings (e.g. lack of targeted services, prioritization of managing daily stressors).

Antecedentes: Aunque la familia constituye la principal fuente de riesgo y resiliencia para el bienestar de los niños que crecen en condiciones adversas, la salud mental de los niños que viven en campamentos de refugiados rara vez se ha investigado en conjunto con la salud mental de sus padres.Objetivos: Examinar la prevalencia del trastorno de estrés postraumático (TEPT) y otros problemas de salud mental entre los niños refugiados de Burundi y sus padres que viven en campamentos de refugiados de Tanzania e identificar patrones de comorbilidad entre los niños y sus padres en función de los niveles de síntomas de TEPT y el deterioro funcional.Método: reclutamos una muestra representativa de 230 niños de 7 a 15 años y sus dos padres (n = 690) y realizamos entrevistas clínicas estructuradas por separado. El análisis de clases latentes (LCA en su sigla en inglés) se aplicó para identificar patrones de comorbilidad.Resultados: Los niños y los padres estuvieron expuestos a múltiples tipos de eventos traumáticos. En total, el 5.7% de los niños cumplieron con los criterios del DSM-5 para TEPT en el mes pasado y el 10.9% informó niveles elevados de otros problemas de salud mental. El 42,6% indicó deterioro funcional clínicamente significativo debido a síntomas de TEPT. La prevalencia de TEPT fue mayor entre las madres (32,6%) y los padres (29,1%). El LCA reveló una acumulación familiar de síntomas de TEPT ya que los niños con altos niveles de síntomas y discapacidad probablemente vivían en familias con dos padres traumatizados.Conclusiones: Aunque el número de niños que necesitan apoyo para problemas de salud mental relacionados con el trauma fue relativamente bajo, tener en cuenta el trauma de los padres podría ayudar a identificar a los niños en riesgo con niveles elevados de síntomas de TEPT y discapacidad incluso ante las barreras existentes para el acceso a la atención en salud mental para niños en entornos de campamentos de refugiados (por ejemplo, falta de servicios específicos, priorización del manejo de estresores diarios).