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Border village children suffering psychological issues due to civil war: Local study

10 May 2022

BY Ruwan Laknath Jayakody The majority of children living in border villages report different exposures related to the civil war that could cause considerable and long-lasting psychological impact, due to them having a significantly higher risk of showing borderline abnormal values on most of the scales and total difficulty scores of the Strengths and Difficulties Questionnaire (SDQ), compared to children not from border villages, a local study found. Hence, the researchers point out that it is probable that this is due to the effect of the war and the impact of the war on the mental health of the children of border villages. These findings were made in a research article on the “Mental health of children from a war affected border village: A cross sectional comparative study” which was authored by P.H.G.J. Pushpakumara (attached to the Rajarata University’s Medicine and Allied Sciences Faculty’s Family Medicine Department) and W.A.J.C. Chandrakumara (attached to the same Faculty’s Paediatrics Department) and published in Anuradhapura Medical Journal 12 (1) in December, 2018. “The ethnic conflict escalated into a full-scale war in 1983, between the Sri Lankan Government and a group of Tamil separatist terrorists, the Liberation Tigers of Tamil Eelam (LTTE). Thereafter, over three decades, the violence resulted in the deaths of tens of thousands of Sri Lankans of all ethnicities, as noted by the Defence Ministry in their ‘Humanitarian operation factual analysis: July, 2006, to May, 2009’.  “Through a combination of terrorist tactics and conventional forces, the LTTE carried out the massacres of innocent civilians, attacked economic targets and vital infrastructure, and created a fear psychosis that crippled everyday life for at least three generations of Sri Lankans, as elaborated in the above-mentioned analysis. Over the course of the conflict, the LTTE frequently exchanged control of territory in the North and the East with the Government military, with the two sides engaging in fierce military confrontations, which had devastating effects on the daily activates of the residential communities within and bordering the territory, irrespective of their ethnicity,” Pushpakumara and Chandrakumara added. The adverse effects of the war, per an African study, extend to the whole community, especially the most vulnerable members of the society, such as children. In addition to the ways that war affects adults, it, according to J. Santa Barbara’s “Impact of war on children and the imperative to end war”, affects children in different ways. Studies (A. Sadeh, S. Hen-Gal and L. Tikotzky’s “Young children’s reactions to war related stress: A survey and assessment of an innovative intervention” and W.P. Fremont’s “Childhood reactions to terrorism induced trauma: A review of the past 10 years”) have shown that exposure to war and terror leads to severe stress reactions and anxiety in children.  Additionally, Santa Barbara found higher rates of post-traumatic stress disorder (PTSD) and depressive disorder among affected children. There is also an association between the mental health of children and exposure to conflicts (C. Siriwardhana, G. Pannala, S. Siribaddana, A. Sumathipala, and R. Stewart’s “Impact of exposure to conflict, tsunami and mental disorders on school absenteeism: Findings from a national sample of Sri Lankan children aged 12–17 years”) and internal displacement (“Prolonged internal displacement and common mental disorders in Sri Lanka: The Common Mental Disorders and Resilience Among the Internally Displaced in Sri Lanka” study by C. Siriwardhana, A. Adikari, G. Pannala, S. Siribaddana, M. Abas, A. Sumathipala, and R. Stewart). However, evidence on interventions are, as noted by J. Sritharan and A. Sritharan in “Post-conflict Sri Lanka: The lack of mental health research and resources among affected populations”, limited. Therefore, Pushpakumara and Chandrakumara planned a study to describe the war-related trauma exposure of children in a war affected border village and to compare the mental health of children in a war-affected border village, with the mental health of similar-aged children from a village not affected by the war. Padaviya is a rural agricultural area located in the Anuradhapura District. It was bordering the territory captured by the LTTE for more than one-and-a-half decades, until the end of the war in 2009. The community that lived in the area, according to the aforementioned Defense Ministry analysis, faced frequent and brutal attacks during the three decades of the war. Pushpakumara and Chandrakumara conducted the study about two-and-a-half years after the civil war, in September, 2011. The sample of 148 students was selected from Grades Eight and Nine in a Government school (1C category) in Padaviya. The comparison group (138) was selected from a 1C category Government school in Anuradhapura, an area which is socio-economically similar but not affected by the war as a border village. The demographic details, the degree of exposure to the conflict, life experiences, and perception regarding the effect of the war on their lives were collected through a self-administered questionnaire. The validated, self-reported Sinhalese version of the SDQ was used to assess mental health. The SDQ asked about 25 attributes, some positive and others negative. These 25 items are divided between five scales: one – emotional symptoms, two – conduct-related problems, three – hyperactivity and inattention, four – peer relationship related problems, and five – pro-social behaviour.  The first four scales were added together to generate a total difficulties score. The scores were categorised into three categories depending on clinical importance: one – a score close to average – clinically significant problems in the particular area are unlikely; two – a slightly raised score – may reflect clinically significant problems; and three – a high score – substantial risk of clinically significant problems in the particular area. However, scores that represented the second and third categories were considered as having a risk of clinically significant problems for the analysis. Both the groups completed the same questionnaires at school during school time. War trauma-related exposures were described by calculating the percentage of the exposure. The prevalence of mental illnesses was calculated in both groups and compared. In this investigation, the subject group consisted of 76 (51%) males and 72 (49%) females. The comparison group consisted of 67 (48.5%) males and 71 (51.5%) females. The age ranged between 12-16 years (median [the middle number in a sorted, ascending or descending, list of numbers or data set] 14) in both the groups. The majority (85 [57%]) of the children living in a border village experienced some kind of an extremely terrifying incident related to the war. Only 24 (17%) children in the comparison group experienced an extremely terrifying incident related to the war. Nearly one-third (45 [30.4%]) of the children living in a border village experienced an invasion by the terrorists. Bodily injuries to themselves and bodily injuries to a family member due terrorist attacks were reported by 21 (14.2%) and 40 (27%) of the children living in the border village, respectively. Nearly one-fifth (26 [17.6%]), who are living in the border village, had lost at least one immediate family member due to terrorist attacks.  Moreover, 51 (34.5%) living in the border village had lost at least one very close friend who is significant to them. In the comparison group, 20 (14.5%) reported the same. A significant damage to the house due to a terrorist attack was reported by 12 (8.1%) children in the border village. The majority of the border village children (94 [63.5%]) believed that the war had a significant negative impact on their lives. Age and sex matched, randomly selected, 138 (93.2%) subjects and all in the comparison group were included in the present analysis. The mental health problems that were considered in the study are conduct-related problems, hyperactivity and inattention, problems with regard to peer relationships, emotional problems, and pro-social problems. Children who lived in the border village reported significantly higher mental health issues compared to the comparison group. Nearly one-fourth (36 [24.7%]) of the subjects had the risk of clinically significant conduct-related problems. Living in a border village carried three times excess risk for conduct-related problems. About one third (46 [31.5%]) of the subjects had a risk of clinically significant peer relationship-related problems. Children living in the border village showed two-fold excess risk for peer relationship-related problems. Living in a border village carried a two-fold excess risk for hyperactivity and inattention-related problems. The majority (126 [86.3%]) of the children living in the border village reported a total difficulties score that amounted to a clinically significant mental health problem. Children living in the border village showed a 2.5-fold excess risk for a mental health problem. Though a higher proportion of border village children reported clinically significant emotional problems, the differences were not statistically significant. The present study focused on the traumatic exposures of the civil war and its associations with mental health problems of a sample of school children aged 12–16 years in a selected border village, Padaviya. Children’s mental health, Pushpakumara and Chandrakumara observed, determines their future social mobility and socio-economic status. Siriwardhana and Pannala et al., in their sub-analysis done on the Sri Lankan National Mental Health Survey in 2006-2007, reported that school absenteeism was present in 36.2% of those reporting conflict-related exposure. Students with emotional problems, conduct-related problems, and hyperactivity-related problems had a 51.2%, 48.6%, and 44.4% prevalence of school absenteeism. However, Siriwardhana and Pannala et al. failed to show a significant association between school absenteeism and mental health in relation to conflict exposure.  Siriwardhana and Adikari et al., whose study investigated the mental health impact of prolonged forced displacement in 2012 showed that the prevalence of somatoform disorder (a group of psychiatric disorders that cause unexplained physical symptoms) and major depression were considerably higher than national estimates.

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