Understanding Social Influences on Child PTSD Among Afghan Refugee Families Affected by Trauma

Context of the Research
Children growing up in war-affected regions in low- and middle-income countries (LMICs) are more susceptible to trauma exposure due to regional conflict, housing insecurity, poverty, and community violence (Hofman et al., 2005). In such high-adversity contexts, ground-level accessible psychological services are extremely limited and members of children's social environment, predominantly parents and peers, are likely to be their key source of support following traumatic events (Saxena et al., 2007).

A large body of research has found that a majority of children exposed to acute traumatic events identify parents as their principal source of emotional support (Dixon et al., 2016), and that parent-child conversations about traumatic experiences and associated emotions are common (Alisic et al., 2017). Parental PTSD is also prevalent among war-affected families, and there is increasing recognition that parental PTSD may influence children's coping strategies and recovery due to impacts on parenting styles (Williamson et al., 2017). Moreover, peer support and good-quality friendships are also important to protect children's mental health in war-affected contexts (Peltonen et al., 2010). The literature suggests negative peer relations may mediate associations between war-related trauma and posttraumatic stress (Diab et al., 2018). In contrast, peer support can promote children's mental health and help them overcome negative outcomes associated with traumatic experiences.

In sum, whereas social support has been established as a key influence on child PTSD in low risk, HICs communities, much less is known about this among vulnerable families in LMIC, conflict-affected contexts where children are likely to be exposed to multiple traumas. As a result of 41 years of war in Afghanistan, Afghan refugees have suffered collective and intergenerational trauma, even several years after resettlement (Roozbeh et al., 2018). This research comprises an investigation of caregiver and peer factors in relation child PTSD and trajectories of posttrauma recovery among Afghan refugees in Iran.


Objectives and Methods
1. To explore perspectives of refugee children and their caregivers on trauma and perceived social support.
2. To examine trauma related aspects of caregiver and peer support as predictors of initial child PTSD symptoms posttrauama, and symptom change over time.
3. To explore pathways from caregiver trauma and PTSD to child symptoms, through parental responding.

Phase one:
Objective 1 will be explored via qualitative interviews with trauma-exposed children, aged 6 to 17, and their primary caregivers living in two provinces of Iran. The interviews will explore refugee caregivers' perceptions of their child's PTSD, parental support, child's perspective on peer support, coping strategies, and ideal ways of support following trauma.
Phase two:
Objectives 2 and 3 will be met through a prospective longitudinal study of Afghan children and their caregivers in two provinces of Iran, where Afghan refugee families face additional difficulties. We aim to recruit children and their primary caregivers via HAMI NGO offices in Khorasan, one of the main board crossing points for newly arrived asylum seekers.


Potential Applications
There is a huge gap between the quality of life for refugees resettled in HICs and those in the LMICs. While 85% of refugees worldwide are hosted in LMICs (UNHCR, 2020), most of our knowledge of social influences on child PTSD comes from HIC communities. This study will make a substantial contribution to our theoretical understanding of PTSD among trauma-exposed refugee families in LMICs. Crucially, the focus on hard-to-reach and understudied groups at extremely high risk will generate new data highly relevant to the development of public policy and novel intervention approaches.