Psychological support for children who suffered from violence

The three core beliefs that give children a sense of wellbeing—that the world is kind, it has meaning, and that the self is deserving—are challenged and occasionally destroyed by explosive violence.

Children who have been exposed to violent explosions have been shown to suffer a range of emotions, including grief, rage, self-blame, disbelief, melancholy, and anxiety. Even when the violence has stopped, these consequences are likely to last throughout adulthood.
The type of blast, the circumstances of the conflict, the standard of social care and health services, the direct and indirect effects of the blast on the child or their caregivers, the stability and income of the family, the child’s age, and the state of their mental and physical health prior to the blast, to name a few, all affect how a child reacts to the explosive violence that may enter their young lives.

But it’s not always obvious how such violence will inevitably affect a child in all of its varied ways. There is still much debate on the effects of conflict and violent explosions on children’s psychological health. There are many different types of mental health illnesses, PTSD, and other psychological diseases that children are diagnosed with after experiencing violence, and it has been criticised that we often see children’s experiences with conflict through the prism of western psychoanalysis.

Children who live in conflict are undoubtedly left with “severe mental wounds,” as the UN puts it. However, there is optimism as more and more medical publications report that youngsters are generally robust to the psychological pressures brought on by a bomb, possibly even more so than adults.

Impact from direct exposure
Because explosive violence typically occurs in a conflict environment, it is challenging to identify the psychological repercussions of a blast because they are frequently exacerbated by deprivation, dislocation, and the unpredictability of war. Explosive weapons can have a negative effect on mental health by causing conditions like Post Traumatic Stress Disorder (PTSD), toxic stress, bedwetting, appetite loss, and social disengagement.
One of the most prevalent mental health issues that people who have directly seen or observed incidents of violence and war may suffer is PTSD.
Research on PTSD in combat studies has mainly concentrated on recently-returned veterans, therefore knowledge of the illness has primarily come from the military community. Although PTSD is the most prevalent mental health issue among immigrant children, little study has been done on the condition in this population.

Unquestionably, there is a link between child exposure to violent explosions and PTSD. Following the 2013 Boston Marathon bombings, a study on child mental health found that almost 11% of individuals who were present at the event displayed PTSD symptoms six months later. Only 0.4% of people in a healthy group exhibit the same symptoms.

Children and teenagers who experienced Middle Eastern conflicts were shown to have a significant prevalence of PTSD: 23% – 70% in Palestine, 10% – 30% in Iraq, and 5% – 8% in Israel. According to a study of families in the Gaza Strip, children who had lost their homes as a result of bombardment experienced “severe” to “extremely severe” PTSD compared to a control group who had not.

However, there is no clear evidence to support comparisons of the prevalence of PTSD in children versus adults. According to the available data, youngsters are less likely to display symptoms of trauma or communicate about their experiences after a bomb. Because their diseases are more likely to go unnoticed and their requirements to be disregarded by medical personnel, this can bias research results.

Additionally, gender differences have been noted. Compared to boys, girls had more than a threefold greater risk of developing PTSD, but this difference seems to become more noticeable after adolescence. While physiological or hormonal variations may account for the gender gap, it may also be a result of “socialisation of trauma exposure,” in which females have been “trained” to experience and express stress in ways that are different from boys.

Impacts from indirect exposure to a blast
Even if they are not directly affected by a blast, children can nevertheless suffer psychological effects from explosive violence. When a youngster experiences trauma due to the death of a loved one or caretaker after a blast, this is referred to as “interpersonal exposure.” This is common in lengthy conflicts like the one in Iraq. Save the Children’s fieldwork in 2017 indicated that 90% of the children who had been uprooted from Mosul had lost loved ones and were experiencing toxic stress and nightmares.

Children frequently encounter secondhand exposure to violence, which creates an atmosphere of instability and anxiety. Media coverage of the 2013 Boston Marathon bombing has been found to worsen PTSD symptoms in US youngsters who were not near the explosion. Children who watched the bombs and the ensuing manhunt for more than three hours in the media during the incident displayed PTSD symptoms.

It’s interesting to note that children in Gaza who had not personally experienced bombardments but may have seen explosive violence on local media had higher degrees of fear due to the violence there (39 percent vs 22 percent ).

Trauma may also run in families. Children of parents with PTSD symptoms are more likely to become easily upset or disturbed, and they also seem to have more trouble developing their psychosocial skills than children of parents without PTSD symptoms. Children of parents with PTSD are more likely to need psychiatric care, according to a study of migrants in Denmark. The elevated incidence of mental illness in the offspring of Holocaust survivors are another example of the phenomena of intergenerational transmission.

Longer-term impacts
The cognitive development of a child is significantly impacted by traumatic experiences. Adversity causes the toxic stress response to be triggered. Toxic stress can affect brain and other organ development, leading to an increase in psychopathology and cognitive and emotional impairment. The University of Arizona Department of Pediatrics’ Dr. Hilary Franke claims that toxic stress in youngsters results in “permanent abnormalities to brain architecture.”

A child’s emotional and social development is also impacted by trauma. Mental health issues make it harder for kids to function in daily life, concentrate in class, and form enduring bonds with their peers. For instance, it was discovered that Kuwaiti boys who had experienced more war trauma during the Gulf War were less likely to continue their schooling and more likely to experience PTSD, poor sleep, a high body mass index, and poor self-reported health as adults. Social stigma and society rejection are frequently associated with mental health issues.

Culture and community
Studies have demonstrated that culture and community can help to mitigate trauma by giving a child’s experience of conflict significance and by offering coping tools. However, within the ecology of conflict, trauma and toxic stress can have an impact on parenting, relationships with teachers, and social networks, which can make them less beneficial and even detrimental. According to a 2020 study, parents who worry about their daily survival during armed conflict may become less nurturing and more violent toward their kids.

It is difficult to understand or research the effects of social media, shared violent videos recorded on mobile devices, and the wider community’s reflection and obsession on violent events on youngsters.

What we know about successful interventions
Children’s mental health concerns may persist into adulthood without early intervention. Adverse childhood experiences can increase an adult’s risk of alcoholism, drug abuse, depression, and suicide attempts by up to 12 times compared to an unaffected adult.

Children enduring distress following an explosion have been found to benefit from psychological treatment. A resilience hub was created following the 2017 Manchester bombings in order to identify those who required psychological assistance. The effectiveness of this intervention was demonstrated by the fact that children who registered with the Hub earlier and thus received help more quickly displayed fewer symptoms and made faster progress.

Children frequently lack access to specialised paediatric mental health care, and the widespread effects of explosive weaponry deprive them of any therapeutic setting, such as their homes, schools, or parks. The lack of a “normalising environment… only exacerbates long-term mental health impacts,” claims Dr. Paul Wise, professor of paediatrics and health policy at Stanford University.