# Fleeing the war: A socio-ecological perspective on the mental health of internally displaced and refugee children and adolescents living in the Kurdistan region of Iraq

## TL;DR

This study explores the mental health of displaced children in Iraq's Kurdistan region, showing how war and displacement affect them and what factors increase their risk of trauma and mental health issues.

## Contribution

The study identifies risk factors for psychopathology in displaced children using a socio-ecological framework, focusing on the Kurdistan region of Iraq.

## Key findings

- Internally displaced minors showed higher trauma exposure and psychopathology compared to refugees.
- Risk factors included higher age, greater trauma exposure, and family violence.
- Community-level interventions are needed to support displaced children's mental health.

## Abstract

Over the past decade, the number of children forced to flee their homes worldwide has increased twofold. The accumulative experiences of war, displacement, and flight can have a devastating impact on the mental health of affected minors. Although more than half of all displaced minors are internally displaced within their countries of origin, little is known about the psychopathology of these displaced children living in regions of ongoing or recent conflict. Employing a socio-ecological perspective, this study aims to identify risk factors contributing to psychopathology among internally displaced and refugee minors living in camps for displaced families in the Kurdistan region of Iraq. A total of 332 displaced children and adolescents, aged between 8 and 16 years, were interviewed by trained paraprofessionals in a cross-sectional study in 2019. Trauma and mental health symptoms, including posttraumatic stress disorder, depression, and internalizing and externalizing problems, were assessed. The findings highlighted elevated rates of trauma exposure and psychopathology among the participating minors. Using multiple linear regression analyses we identified risk factors across all mental health outcomes at the individual level (e.g., higher age, greater trauma exposure) and the family level (e.g., greater family violence). Moreover, an analysis at the community level, dividing the study sample by legal status (internally displaced vs. refugee) revealed significantly higher rates of trauma exposure and psychopathology among internally displaced minors. These findings have implications for developing appropriate support for the healthy development of forcibly displaced children and adolescents living in areas of ongoing conflict. Prevention and intervention strategies should take into account various socio-ecological levels, including trauma-focused psychotherapy at the individual level, measures to prevent violence at the family level, and community-level actions that consider context-specific responses, such as adapting camp conditions to meet the needs of vulnerable displaced children.