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EMOTIONAL PROBLEMS OF CHILDREN LIVING IN WAR ZONES NOT RECOGNISED (PP 1790, 1801)

May 22, 2002

Health professionals need to be trained in the detection and treatment of the emotional disturbances associated with   children's exposure to war zones and political violence, conclude authors of a study in this week's issue of THE LANCET.

Children living in war zones are at a high risk of developing post-traumatic stress and other emotional disorders, but little is known about the effect of traumatic events during war. Panos Vostanis from the University of Leicester, UK, Abdel Aziz Mousa Thabet from Al-Quds University, Gaza Strip, Palestine, and colleagues aimed to assess the nature and severity of emotional problems in Palestinian children whose homes had been bombarded and demolished during the crisis in Palestine, compared with children living in other parts of the Gaza strip.

91 children exposed to home bombardment and demolition and 89 controls who had been exposed to other types of traumatic events related to political violence (such as witnessing bombardment by helicopters or by watching television, and hearing about the conflict in the media) completed self-report measures of post-traumatic stress, anxiety, and fears.

More than twice as many directly exposed children (59%) reported post-traumatic stress disorder compared with children not directly exposed (25%). Children exposed to other events, mainly through the media and adults, reported more anticipatory anxiety and cognitive expressions of distress than children who were directly exposed.

Panos Vostanis comments: "several conclusions and implications can be drawn from the findings. Children's emotional responses to different kinds of exposure to political violence are acute and severe. These emotional responses do arise not only in children known to have been exposed to traumatic events, therefore perceived as vulnerable, but also in supposed non-exposed children, who may not receive special attention. In communities affected by war and other forms of political violence, children's emotional problems can be detected early by professionals and volunteers working in health care, and relief operations and education, rather than by specialists in mental health. Training of such agencies should include ways of communicating with children and basic aspects of child mental health problems, such as post-traumatic stress disorder. Systematic interventions through educational programmes or brief psychological techniques need development and assessment coordinated by international organisations, such as WHO or UNICEF."

In an accompanying Commentary (p 1790), Joop de Jong and Ivan Komproe from Vrije Universiteit, Amsterdam, Netherlands, discuss a public mental-health approach to support people with emotional disturbance in war zones. They conclude: "In a few years, a programme can train hundreds of professionals and para-professionals and thousands of community leaders in tailored training programmes. Such large-scale building of a human-resource capacity allows the community to restore the social fabric that is disrupted or destroyed by the ongoing cycles of violence in many parts of the world."

Lancet