title: The intergenerational impact of war: longitudinal relationships between caregiver and child mental health in postconflict Sierra Leone.
abstract: BACKGROUND
  Trauma from witnessing events such as bombings and killings as well as direct victimization or participation in violence has been associated with psychosocial distress and poor mental health among war-exposed children and adolescents. This study examines the relationship between caregiver mental health and child internalizing (anxiety and depression) symptoms over a 4-year period in postconflict Sierra Leone.
  
  
  METHODS
  The sample included 118 adolescent Sierra Leonean youth (73% male; mean age = 16.5 years at Time 1) and their caregivers (40% male; mean age = 39.0 at Time 1). To measure depression and anxiety symptoms, the Hopkins Symptom Checklist-25 was used with adults and the Oxford Measure of Psychosocial Adjustment - previously validated for use with children and adolescents in the region - was used to assess youth. A multivariate hierarchical linear model (HLM) for studying change within dyads was implemented to study covariation in internalizing symptoms among caregivers and youth over time; these models also included covariates at the individual, family and community levels. The relationship of caregiver mental health to child's internalizing was tested in a latent variable extension of the HLM.
  
  
  RESULTS
  The latent variable extension estimated that a one standard deviation (SD) change in caregiver anxiety/depression was associated with a .43 SD change in youth internalizing (p < .01) over the 4-year period. Family acceptance was negatively related to youth internalizing (p < .001), while community stigma was positively associated (p < .001).
  
  
  CONCLUSIONS
  The findings highlight an important interplay between caregiver and child mental health within the postconflict setting and the need for psychosocial interventions to extend beyond the individual to account for family dynamics.
authors: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.|François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA, USA.
authors: Theresa S
authors: TS
authors: Betancourt
authors: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors: Ryan K
authors: RK
authors: McBain
authors: François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA, USA.|School of Psychology, The University of Western Australia, Perth, WA, Australia.
authors: Elizabeth A
authors: EA
authors: Newnham
authors: François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA, USA.
authors: Robert T
authors: RT
authors: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D002648:Child; D003863:Depression / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005195:Family Relations / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D000067073:Psychological Trauma / Q000523:psychology*; D012807:Sierra Leone; D057545:Social Stigma; D000068336:Warfare and Armed Conflicts / Q000523:psychology*
keywords: War; anxiety; depression; dyadic analysis; intergenerational