Does war moderate the association between mental wellbeing and its predictors among children? A multi-country cross-sectional study

TL;DR

This study shows that war changes how factors like age and education affect children's mental well-being, highlighting the need for targeted mental health support in conflict zones.

Contribution

The study reveals how war modifies the relationship between mental well-being predictors and outcomes in children from conflict-affected regions.

Findings

War significantly alters the impact of age, disability, education, and economic status on children's mental well-being.

Education reduces anxiety in conflict-affected areas, while children with disabilities face higher mental health risks.

Older children experience a stronger negative effect of war on mental well-being compared to younger children.

Abstract

This study explores how war or conflict influences the established predictors of mental well-being among children, addressing a significant gap in current research.

Utilizing data from Multiple Indicator Cluster Surveys (MICS6) collected between 2016 and 2021, we examined children aged 5–17 years in four low or middle-low-income countries experiencing war or conflict and compared them to 20 control countries. We employed logistic models to analyze the data, focusing on mental well-being as the outcome. Primary independent variable was exposure to war, with an emphasis on the interaction between this exposure and potential predictors, including age, sex, having a physical disability, enrolled in education, having siblings, living with at least one parent, residence place, and family wealth status.

The analysis revealed significant modifications in the association between factors like age, disability, education, economic status, and place of residence and mental well-being due to war (p values < 0.05). Specifically, the impact of war was more pronounced in older children (OR = 1.48, 95%CI = 1.18–1.85) compared to younger ones. Education was found to mitigate anxiety in conflict-affected areas (OR = 0.75, 95%CI = 0.60–0.95), whereas children with disabilities were more vulnerable to mental health challenges (OR = 2.05, 95%CI = 1.65–2.55) in these settings.

The mental well-being measure was based on caregiver reports, which may not fully capture the children’s experiences.

Our findings provide crucial insights into the differential impact of war on children’s mental well-being. They underscore the need for tailored, context-specific mental health interventions for children in conflict-affected areas and encourage further research into the nuanced effects of war on child and adolescent mental health.

The online version contains supplementary material available at 10.1186/s12888-025-06795-3.