Blog 3; Children’s mental health following the war in Bosnia and Herzegovina

Between 1992 and 1995, armed conflict engulfed Bosnia and Herzegovina as war caused suffering and trauma across the population. Due to the war many famlies typical life was disrupted, almost half of the population had to leave their homes and seek refuge elsewhere for long periods of time, often in conditions of poverty [1]. During this difficult time many children witnessed a number of traumatic experiences, including death, torture and loosing loved ones [2]. Additionally, the disruption to everyday life resulted in poor schooling, maternal depression and poor living conditions; these factors all contributed to poor mental health outcomes for the children ². Early childhood interventions have been shown to be vital for promoting the well being of the children who have experienced these traumatic effects and have attempted to prevent the development of mental health problems.

How the war effected children’s mental health

The effect of war on children has been investigated in many in previous studies around the world. Of these studies, some specifically look at the effects in Bosnia and Herzegovina and other former Yugoslavian countries, they have shown some of the serious impacts of war on many areas of mental well being. One study found that 94% of Bosnian children surveyed following the war met the diagnostic criteria for post-traumatic stress disorder (PTSD) and 95% showed significant signs of anxiety ². Additionally, sleeping and eating disorders, separation fears, and withdrawal or aggression were reported in former Yugoslavian refugee children [3].

The negative impacts of war on the children is repeatedly shown to be related to the degree of exposure to traumatic was events and the quality of accommodation while displaced from their homes [4] [5]. Additionally, children whose mothers struggled coping with the stress of the events showed significantly higher stress related psychological symptoms ³. Furthermore, suicides in boys aged 14 and bellow increased in the country in the years following the war, while suicides decreased for those aged 15-19 [6], this highlights the importance of protecting the mental health of the youngest members of the population during traumatic times.

It has been disputed among the literature how traumatic war experiences effect very young children, due to reduced memory retention up to the age of three. However, research has shown that preschool children do suffer PTSD symptoms after exposure to displacement and traumatic war events in the first three years of life [7]

The role of early childhood interventions

The effects of the Bosnia and Herzegovina war are unquestionably detrimental to young children’s mental health, and childhood mental illness is known to be a strong predictor of lifelong issues and psychiatric disorders [8]. Therefore, the role of early interventions which target the prevention and treatment of child mental illness and stress related behaviours are crucial for promoting childhood well being. A closer look at interventions which have been implemented in Bosnia and Herzegovina can help work towards helping develop future interventions for children and families of conflict zones.

Early childhood interventions often fit in to one of the following- parenting programmes, centre-based programmes, educational programmes or community/institution strengthening. However most previous research has been focused on intervention delivery during times of peace, not war. When applied to environments experiencing war usual considerations for respect for local culture and the involvement of existing infrastructure and resources are taken, but extra consideration must be made to systematically assess the trauma experienced by the children and the extent of loss and disruption to everyday life [9].

A parenting intervention which implemented weekly group sessions with mothers lasting for five months was implemented in Bosnia and Herzegovina in 1996. Children aged 5-6 were targeted, meaning the children were preschool age during the war. During the session’s mothers were taught child development, awareness of child, methods of promoting parent-child sensitive and stimulating interactions and strategies to cope with trauma and stress. This intervention resulted in significantly reduced sadness and anxiety seen in the children and positive effects on the mother’s mental health [10].

A Centre-based intervention was delivered in two schools in Bosnia and Herzegovina following the war. Children were given psychosocial-support, meaning they were taught coping strategies and given opportunities to explore the emotional impacts of the trauma they experienced in a safe environment. When compared to children from the same schools who had not received the intervention, the children showed significant reductions of severity and occurrence of PTSD symptoms [11].

Learning from children’s mental health in Bosnia and Herzegovina

One clear theme shown from the literature which has been described here is the importance of maternal well being on children’s mental health following the war in Bosnia and Herzegovina. This should be considered when developing interventions to help promote mental health of children in conflict zones. When the mother is able to cope with the stressors faced, the child has greater chances of reduced negative impacts.

A second re-emerging theme how the nature and severity of the trauma influences the children’s mental health. When working with children who have experienced traumatic war events, it would be appropriate to screen for the nature of the trauma experienced before implementing the intervention. This could help ensure children receive the appropriate targeted intervention content.

It is apparent that the children of Bosnia and Herzegovina felt the negative effects of the war and that the interventions which were put in place helped reduce the severity of their mental health problems. The importance of recognising how all children, even those below the age of 3 during wartime, can develop PTSD symptoms including anxiety and sadness is crucial for ensuring compassionate and appropriate care is given. This in turn will protect their long term mental health, and is best done through the early use of childhood interventions.

Conclusions

Investigations into the mental health of children who experienced traumatic events during the war in Bosnia and Herzegovina, and the interventions which have been developed to reduce the negative impacts of the trauma, show a range of reasons for the importance of quality interventions. Furthermore, they can teach us about important things to consider when developing interventions in other countries experiencing similar issues.

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[1] UNHCR. (1995). Information notes on former Yugoslavia (1). United Nations High Commissioner for Refugees.

[2] Goldstein, R. D., Wampler, N. S., & Wise, P. H. (1997). War experiences and distress symptoms of Bosnian children. PEDIATRICS, 100(5), 873-878. doi:10.1542/peds.100.5.873

[3] Ajduković, M., & Ajduković, D. (1993). Psychological well-being of refugee children. Child Abuse & Neglect, 17(6), 843-854. doi:10.1016/s0145-2134(08)80014-2

[4] Kuterovac, G., Dyregrov, A., & Stuvland, R. (1994). Children in war: A silent majority under stress. British Journal of Medical Psychology, 67(4), 363-375. doi:10.1111/j.2044-8341.1994.tb01804.x

[5] Porter, M., & Haslam, N. (2001). Forced displacement in Yugoslavia: A meta-analysis of psychological consequences and their moderators. Journal of Traumatic Stress, 14(4), 817-834. doi:10.1023/a:1013054524810

[6] Fajkic, A., Lepara, O., Voracek, M., Kapusta, N. D., Niederkrotenthaler, T., Amiri, L., … Dervic, K. (2010). Child and adolescent suicides in Bosnia and Herzegovina before and after the war (1992–1995). Crisis, 31(3), 160-164. doi:10.1027/0227-5910/a000021

[7] MACKSOUD, M. S. (1992). Assessing war trauma in children: A case study of lebanese children. Journal of Refugee Studies, 5(1), 1-15. doi:10.1093/jrs/5.1.1

[8] Fryers, T., & Brugha, T. (2013). Childhood determinants of adult psychiatric disorder. Clinical Practice & Epidemiology in Mental Health, 9(1), 1-50. doi:10.2174/1745017901309010001

[9] Saltzman, W. R., Layne, C. M., Steinberg, A. M., Arslanagic, B., & Pynoos, R. S. (2003). Developing a culturally and ecologically sound intervention program for youth exposed to war and terrorism. Child and Adolescent Psychiatric Clinics of North America, 12(2), 319-342. doi:10.1016/s1056-4993(02)00099-8

[10] Dybdahl, R. (2001). Children and mothers in war: An outcome study of a psychosocial intervention program. Child Development, 72(4), 1214-1230. doi:10.1111/1467-8624.00343

[11] Hasanovic, M. (2011). Psychosocial assistance project decreases posttraumatic stress disorder and depression amongst primary and secondary schools students in post-war Bosnia-Herzegovina. Acta Medica Academica, 40(2), 122-131. doi:10.5644/ama2006-124.15