Trauma memories, mental health, and resilience: a prospective study of Afghan youth.
BACKGROUND
Studies of war-affected youth have not yet examined how trauma memories relate to prospective changes in mental health and to subjective or social experiences.


METHODS
We interviewed a gender-balanced, randomly selected sample of Afghan child-caregiver dyads (n = 331, two waves, 1 year apart). We assessed lifetime trauma with a Traumatic Event Checklist, past-year events with a checklist of risk and protective events, and several child mental health outcomes including posttraumatic distress (Child Revised Impact of Events Scale, CRIES) and depression. We examined the consistency of trauma recall over time, identified mental health trajectories with latent transition modeling, and assessed the predictors of posttraumatic distress and depression trajectories with multinomial logistic regressions.


RESULTS
From baseline to follow-up, reports of lifetime trauma significantly changed (p ≤ 0.01). A third of the cohort reported no trauma exposure; only 10% identified the same event as their most distressing experience. We identified four CRIES trajectories: low or no distress (52%), rising distress (15%), declining distress (21%), and sustained high distress (12%). Youth with chronic posttraumatic distress were more likely to be girls (OR = 5.78, p ≤ 0.01), report more trauma exposure at baseline (OR = 1.55, p ≤ 0.05) and follow-up (OR = 5.96, p ≤ 0.01), and experience ongoing domestic violence (OR = 4.84, p ≤ 0.01). The risks of rising distress and sustained distress showed a steady increase for youth recalling up to four traumatic experiences. Depression and CRIES trajectories showed weak comorbidity.


CONCLUSIONS
Memories of violent events are malleable, embedded in social experiences, and present heterogeneous associations with posttraumatic distress. Our study provides insights on resilience and vulnerability to multiple adverse childhood experiences, highlighting research and clinical implications for understanding trauma in conflict-affected youth.
Department of Anthropology, Yale University, New Haven, CT, USA.
Catherine
C
Panter-Brick
Department of Economics, Duke University, Durham, NC, USA.
Marie-Pascale
MP
Grimon
Department of Political Science, Yale University, New Haven, CT, USA.
Michael
M
Kalin
MacMillan Center for International and Area Studies, Yale University, New Haven, CT, USA.
Mark
M
Eggerman
D000293:Adolescent; D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000208:ethnology; D057189:Checklist; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D011939:Mental Recall; D008960:Models, Psychological; D010154:Pakistan; D011446:Prospective Studies; D065840:Protective Factors; D012036:Refugees / Q000523:psychology*; D055500:Resilience, Psychological; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology*
Adverse childhood experiences; Afghanistan; PTSD; Pakistan; depression; trauma; violence