Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH)

McEwen, Fiona; Popham, Cassandra; Moghames, Patricia; Smeeth, Demelza; Villiers, Bernadette de; Saab, Dahlia; Karam, Georges; Fayyad, John; Karam, Elie G.; Pluess, Michael

doi:10.1007/s00127-022-02228-8

Cited by 13 publications

(26 citation statements)

References 31 publications

(36 reference statements)

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“…This suggests that the child’s perception of their home environment can influence their academic performance, providing some evidence of plausible future areas for psychological support. The importance of the child’s perception of support has been noted when investigating risk and resilience factors for mental health [ 43 ]. By comparison, there was no association between the Strengths and Difficulties Questionnaire (SDQ) and the SAT.…”

Section: Discussionmentioning

confidence: 99%

“…The number of years of schooling completed by the child is reported by the caregiver, as a key exposure for cognitive function. A short, confidential child questionnaire asks about their perceived level of socioemotional support, which has also been shown to be a key exposure for cognitive function [ 43 ]. Child disability and overall caregiver-reported function are measured using the Washington Group / UNICEF Child Functioning Module [ 44 ].…”

Section: Methodsmentioning

confidence: 99%

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Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox

et al. 2023

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Introduction We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to address the shortage of school-age assessment tools that combine growth, physical and cognitive function. Here we present i) development, acceptability and feasibility of the SAHARAN toolbox; ii) characteristics of a pilot cohort; and iii) associations between the domains measured in the cohort. Methods Growth was measured with anthropometry, knee-heel length and skinfold thicknesses. Bioimpedance analysis measured lean mass index and phase angle. Cognition was assessed using the mental processing index, derived from the Kaufman Assessment Battery for Children version 2, a fine motor finger-tapping task, and School Achievement Test (SAT). Physical function combined grip strength, broad jump and the 20m shuttle-run test to produce a total physical score. A caregiver questionnaire was performed in parallel. Results The SAHARAN toolbox was feasible to implement in rural Zimbabwe, and highly acceptable to children and caregivers following some minor modifications. Eighty children with mean (SD) age 7.6 (0.2) years had mean height-for-age (HAZ) and weight-for-age Z-scores (WAZ) of -0.63 (0.81) and -0.55 (0.85), respectively. Lean mass index and total skinfold thicknesses were related to WAZ and BMI Z-score, but not to HAZ. Total physical score was associated with unit rises in HAZ (1.29, 95% CI 0.75, 1.82, p<0.001), and lean mass index (0.50, 95% CI 0.16, 0.83, p = 0.004), but not skinfold thicknesses. The SAT was associated with unit increases in the mental processing index and child socioemotional score. The caregiver questionnaire identified high levels of adversity and food insecurity. Conclusions The SAHARAN toolbox provided a feasible and acceptable holistic assessment of child growth and function in mid-childhood. We found clear associations between growth, height-adjusted lean mass and physical function, but not cognitive function. The SAHARAN toolbox could be deployed to characterise school-age growth, development and function elsewhere in sub-Saharan Africa.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox

et al. 2023

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“…Participants came from a cohort of 1591 Syrian refugee child-caregiver dyads recruited from informal tented settlements in the Beqaa region of Lebanon for the Biological Pathways of Risk and Resilience in Syrian Refugee Children (BIOPATH) study [35]. An accelerated longitudinal design was used to collect data from multiple developmental stages over a short period of time given the high mobility of refugee populations.…”

Section: Methods Samplementioning

confidence: 99%

“…Caregivers provided written informed consent after receiving a complete description of the study, while children provided assent. For more information see the BIOPATH cohort profile paper [35].…”

Section: Methods Samplementioning

confidence: 99%

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children

et al. 2022

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Altered secretion of cortisol, the primary effector of the hypothalamus–pituitary–adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6–18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.

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“…Settlements across the Beqa'a region were selected to represent a range of levels of vulnerability, based on UNHCR ratings, and 77 small-medium sized settlements were chosen. All eligible families in these settlements were offered inclusion and the resulting sample size for the original study was n = 1,594 child-caregiver dyads at baseline (McEwen, et al, 2022). A follow-up assessment was conducted 12 months later with n = 1,001 families.…”

Section: Participantsmentioning

confidence: 99%

The culturally and contextually sensitive assessment of mental health using a structured diagnostic interview (MINI Kid) for Syrian refugee children and adolescents in Lebanon: Challenges and solutions

Kyrillos¹,

Bosqui

Moghames³

et al. 2022

Transcult Psychiatry

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Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective article aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview. We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N = 119 Syrian refugee children (aged 8–17) resident in ITSs in Lebanon. Qualitative data were derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: (1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); (2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); (3) cultural norms and meaning (impact of different meanings on answers); (4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and (5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improving accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies.

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Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH)

Cited by 13 publications

References 31 publications

Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox

Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children

The culturally and contextually sensitive assessment of mental health using a structured diagnostic interview (MINI Kid) for Syrian refugee children and adolescents in Lebanon: Challenges and solutions

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