Emotional and Behavioral Problems of Afghan Refugees and War-Zone Adolescents

By Rostami, Reza; Babapour-Kheiroddin, Jalil et al. | Iranian Journal of Psychiatry, Winter 2009 | Go to article overview

Emotional and Behavioral Problems of Afghan Refugees and War-Zone Adolescents


Rostami, Reza, Babapour-Kheiroddin, Jalil, Shalch, Behzad, Badinloo, Farzaneh, Hamzavi-Abedi, Fatemeh, Iranian Journal of Psychiatry


Objective: Wars' stress and violence can have tremendous effects on children's and adolescents' health and general well being; it may result in patterns of bio-psychosocial problems. The goal of this study was to compare emotional and behavioral problems in Afghan refugees and war-zone adolescents.

Method: One hundred and eighty high school students (90 students in the refugee group and 90 in the war-zone group) in Harat were included in this research. All participants completed the Youth Self-Report (YSR). War zone and refugee adolescents were compared based on their scores on different scales of behavioral and emotional problems.

Results: War-zone adolescents scored significantly higher on Anxious/Depression, Withdrawn, Somatic Complaints, Attention Problems, and Internalizing Problems scales than refugee adolescents. In this study, no significant difference was found between the two groups on Social Problems, Thought Problems, Delinquent Behavior, Aggressive Behavior, and Externalizing scales .

Conclusion: Findings revealed that although asylum is not an ideal condition for children's and adolescents' psychological development and prosperity, it can have a protective role in comparison with war zone's circumstances. Further investigation is needed, however, to elucidate the lack of significant differences in externalizing scales among war zone and refugee adolescents.

Keywords: Adolescent, Afghanistan, Mental health, Refugees, War

Iran J Psychiatry 2009; 4: 36-40

Children and adolescents are real victims of wars; they experience war-zones' endless stressors and endure a lifetime of suffering as a consequence. Warzones' overwhelming amount of stress can lead to behavioral and emotional problems in children and adolescents (1). These stress-induced psychological problems have been revealed in both longitudinal (2, 3) and cross sectional (4-6) studies. Crick and Gallagher (7) defined children and adolescents' "Behavioral disorders" as sever abnormal behaviors which are inappropriate of individual's age. Achenbach and Edelbrock (8) divided child and adolescent behavioral and emotional problems to eight cluster of withdrawn behavior, anxiety/depression, somatic complaints, social problems, attention problems, thought problems, delinquent behaviors and aggressive behaviors. Normal and abnormal behaviors of children and adolescents can be better explained by two general concepts of externalizing and internalizing behaviors. Externalizing syndrome includes two syndromes of delinquent and aggressive behaviors; internalizing syndrome consists of withdrawn behaviors (anxiety/depression) and somatic complaints. Different studies investigating the relationship between stress, externalizing (9-11) and internalizing syndromes (6, 9) have confirmed significant positive correlations in children and adolescents. Pathological stresses can lead to behavioral and emotional problems such as anxiety and depressive disorders, dissociative states, somatic complaints, sleep problems, nightmares, difficulties in concentration, impulse control problems, social regression and Attention Deficit Hyperactivity Disorder (ADHD) in adolescents (12-14).

At least three models have been proposed to explain the relationship between stress and psychopathology. The stress exposure model assumes that those who experience severe stressors may develop more psychological problems than others (4-6) . The prospective studies' findings of increase in pathological symptoms after stressful life events provide evidence for this model. Stressful life events were able to predict proliferation of depressive symptoms six (6) and nine (3) months later. Mathijcsen, Koot and Vehulst (15) studied a sample of Dutch adolescents referred to mental health clinics. They found that in the following year externalizing behaviors and all problems in Achenbach's child behavior checklist, except for internalizing behavior, increased with stressors. …

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