Original article
Caregiver and Adolescent Mental Health in Ethiopian Kunama Refugees Participating in an Emergency Education Program

https://doi.org/10.1016/j.jadohealth.2012.01.001Get rights and content

Abstract

Purpose

To examine the role of caregiver mental health and risk and protective factors in influencing levels of internalizing and externalizing emotional and behavioral symptoms over time among a sample of refugee adolescents.

Methods

Prospective study of 153 Kunama refugee adolescents receiving an emergency education intervention while living in a camp in Ethiopia. Surveys were collected in 2001 (T1) and 2002 (T2). Adolescent and caregiver mental health were assessed using a Kunamenga adaptation of the Youth Self Report; caregiver mental health was assessed using the Hopkins Symptom Checklist-25. Attitudes toward education, satisfaction with education programming, socioeconomic status, and perceptions of access to services were also explored as variables potentially influencing adolescent mental health at follow-up.

Results

Caregiver distress was significantly associated with youth externalizing behavior symptoms (β = 8.34, p < .001) and internalizing symptoms (β = 4.02, p < .05). Caregiver perceived access to services had a protective effect on externalizing behaviors (β = −7.54, p < .05) and internalizing behaviors (β = −13.67, p < .001). Higher socioeconomic status (β = −1.47, p < .05) had a protective effect on internalizing symptoms. In terms of modifying effects, among youth with distressed caregivers, those who were satisfied with the International Rescue Committee education intervention had a lower internalizing score (β = −6.34, p < .001) compared with those who were not satisfied with the program.

Conclusions

This study presents a rare prospective investigation of caregiver–adolescent mental health during an active refugee displacement. Results suggest that programs targeting mental health in refugee children should consider children within the larger family system, including caregiver influence on child and adolescent mental health adjustment over time.

Section snippets

Background

The Kunama ethnic group comprises agro-pastoralists traditionally residing in the Eritrean–Ethiopian border region. When war between Eritrea and Ethiopia broke out in 1998, the Kunama people were caught between both sides. In the early stages of the conflict, small numbers of Eritrean Kunama refugees crossed the Gash River border into Ethiopia to avoid conscription, prompting suspicions within the Eritrean government of the group's disloyalty. During the ensuing years of conflict, fears of

Sample

Baseline assessments were conducted in July and August 2001 (T1). Inclusion criteria for adolescents comprised the following: (1) enrolled in the IRC education program; (2) a Kunama refugee aged <18 years; (3) living in the Walanhiby refugee camp for at least 1 month; and (4) without a severe cognitive disability that limited comprehension of the questionnaire as determined by study social workers (no such cases were identified). Adolescents fulfilling inclusion criteria were screened using a

Results

Table 1 contains descriptive statistics on key sociodemographic adolescent and family characteristics. Most adolescents in the sample (average age 14 years at T1) lived with at least one biological parent. Variables examined did not differ by gender of adolescents, with the exception of family socioeconomic status (SES): female adolescents were significantly more likely to live in a family who owned cattle, a radio, and so forth, when compared with males; females were also less likely to live

Discussion

Evidence from this study suggests that caregiver distress plays an important role in the emotional and behavioral adjustment of Kunama refugee adolescents over time. In our study, caregiver distress was a robust predictor of externalizing and internalizing emotional and behavior problems in adolescents at follow-up, adjusting for all other factors, including baseline adolescent distress. This finding is consistent with a number of other studies that have examined the association between

Acknowledgments

The authors thank Asfaw Yitna (United Nations Economic Commission for Africa) for his assistance in data management and analysis and Marie de la Soudiere (UNICEF) for her unswerving dedication to applied research in war-affected settings. This study was funded by the International Rescue Committee. This work was also supported by the François-Xavier Bagnoud Center for Health and Human Rights at Harvard University, Boston, MA.

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