News

Young Afghans suffer violence and stress, not just related to war

(21 August 2009)

One in five schoolchildren in northern Afghanistan is likely to suffer from a psychiatric disorder, suggests research.

The Durham University-led study, published in The Lancet, carried out the first large-scale survey of children’s mental health in Afghanistan.

The survey revealed that day-to-day violence and stress were as much the cause of the children’s suffering as the war-related brutalities they witnessed. The researchers say effective mental health interventions, which are holistic and not solely focused on war-related trauma, are vital in helping children and their families get well.

The researchers, who surveyed more than 1,000 children, say the evidence shows that Afghan children experience violence that is ongoing and not necessarily confined to the war.

One in ten children surveyed identified accidents, being beaten by relatives or neighbours, or painful medical treatments as the most traumatic injury in their lives. Only a handful of children referred to a war-related injury as their most distressing experience, although children were also traumatised by the loss of relatives in the war and being displaced from home.

Children showed a range of mental health problems, including extreme anxiety, depression and symptoms of post-traumatic stress disorder, the latter a condition commonly found among soldiers returning from war zones.

Poverty and poor quality education are the source of huge day-to-day pressures placed on children, according to the Durham scientists whose research was funded by the Wellcome Trust.

The findings of the research, which was carried out by Durham University, the University of Peshawar in Pakistan, and ALTAI Consulting in Kabul, Afghanistan, are being fed back to government departments in Afghanistan to provide solid evidence on child mental health and awareness of their needs.

Lead author, Professor Catherine Panter-Brick from Durham University’s Anthropology Department, explains: “Huge numbers of children live in families where the father is struggling to make ends meet and many relatives are squeezed into inadequate housing. Many children have to work before and after school to help put food on the table. They walk long distances to school, have overcrowded classes, and can’t do homework at night because there is no electricity. The war-related suffering comes on top of all that.”

Although Afghanistan’s society cannot be ‘fixed’ overnight, the researchers say mental health programmes targeting families and schools are vital and have been proven to be successful in Pakistan, the West Bank and Gaza. Raising the quality of education, through pay rises for teachers and better supplies of textbooks, would also be a significant step in alleviating stressors and improving the lives of children, say the scientists.

The researchers found incredible resilience among the children they interviewed and say if access to basic services was improved, the children and their families could thrive.

Professor Panter-Brick said: “What is remarkable are the high aspirations and the determination children show, despite great poverty and day-to-day hardship. Their hopes are high, and based on sheer effort and perseverance. They see hard work and education as the key to success. In that sense, children think about the future, not so much about the past.

“We found that children reported great distress and hardship in their lives. But they also had remarkable strength to function, to get on with their lives, to help their families, and to work and study.

“Their distress is focused on frustrations associated with poverty, which lead to violence in the family and the community. We would recommend that mental health interventions include efforts to stop persistent violence and lessen day-to-day stressors, rather than focus just on trauma related to war.”

The research team interviewed 1011 children and their parents or caregivers, along with 358 teachers at schools in Kabul, Bamyan, and Mazar-e-Sharif in Afghanistan to assess child mental health and life adversity from different viewpoints. The children were between 11 and 16 years old. Using assessments, questionnaires and blood pressure readings, the researchers screened for children with likely psychiatric disorders and symptoms of depression and severe psychological distress.

The findings also show that children who had experienced more than five traumatic events, such as domestic, community and war-related violence, were more than twice as likely to have mental health problems. The likelihood of psychiatric disorder was twice as common among schoolgirls compared with schoolboys, and more common in Kabul than in other areas. Having a mother, father or carer who suffered from poor mental health was an important risk factor, demonstrating that suffering is cascaded from one generation to the next.

Case study

A sixteen year old girl saw the beheaded body of her grandfather whom she said was ‘killed in a rocket attack in Kabul during the Taliban’. Her father was also killed in a rocket attack.

The most distressing event in her lifetime, however, was an operation to remove a lump in her right breast, for which she had been taken to Pakistan four months earlier. She was very upset that the operation had prevented her from taking her final-year school exams. This meant that she had ‘lost everything’ she had worked for – particularly frustrating given her ambition to go on to university and become a medical doctor.

Her drive to complete schooling was clearly shaped by a sense of duty towards her parents, and her wish to improve her family’s financial prospects. Her 25-year old brother was unemployed, living at home and addicted to opium.

She reported ongoing symptoms of psychological distress and severe emotional problems consistent with a probable psychiatric disorder. She identified her trauma with the operation, rather than with the brutal deaths of her close relatives. The operation was painful, frightening and had devastating consequences on her home and school life. Because she was 16 years old, she would probably not be allowed to repeat her school year, and would be married without gaining a school-leaving certificate.