title: Caregiver and adolescent mental health in Ethiopian Kunama refugees participating in an emergency education program.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Global Health and Population, Research Program on Children and Global Adversity, François-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health, Boston, Massachusetts 02115, USA. theresa_betancourt@harvard.edu
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Monica
authors.initials: M
authors.lastname: Yudron
authors.forename: Wendy
authors.initials: W
authors.lastname: Wheaton
authors.forename: Mary C
authors.initials: MC
authors.lastname: Smith-Fawzi
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D017028:Caregivers / Q000523:psychology*; D057189:Checklist; D004630:Emergencies; D019017:Eritrea / Q000208:ethnology; D005002:Ethiopia / Q000208:ethnology; D005260:Female; D006266:Health Education; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008603:Mental Health / Q000208:ethnology*; D011446:Prospective Studies; D012036:Refugees / Q000523:psychology*