The psychological and medical sequelae of war in Central American refugee mothers and children
C. J. Locke, K. Southwick, L. A. McCloskey and M. E. Fernandez-Esquer
Department of Pediatrics, Steele Memorial Children's Research Center, University of Arizona, Tucson, USA.
OBJECTIVE: To investigate the physical and mainly psychological sequelae of
exposure to war in Central American children and their mothers who
immigrated to the United States on average 4 years before the study began.
DESIGN: Interview study. PARTICIPANTS: Twenty-two immigrant Central
American women caretakers and 1 of their children aged 5 to 13 years. MAIN
OUTCOME MEASURES: Standardized and new measures were administered to assess
children's physical and mental health symptoms and exposure to political
violence. RESULTS: Eighteen of the 22 children had chronic health problems.
Fifteen children and all of the adults had observed traumatic events,
including bombings and homicides. Thirteen of the children showed mental
health symptom profiles above established norms, although only 2 met the
criteria for posttraumatic stress disorder according to their own reports.
Many of the caretakers were unaware of their child's psychological
distress. Four of the mothers exhibited posttraumatic stress disorder, and
their symptoms predicted their child's mental health. CONCLUSIONS:
Pediatricians are sometimes the first and only contacts these families have
with health care providers. Caretakers' reports of children's mental health
are often incomplete. It is therefore important for physicians to probe for
"hidden" symptoms in refugee children. These family members may need
referrals to social and psychological services, and pediatricians can open
the gates to existing community networks of support. Because we found that
maternal mental health influences the child's, the child's interests are
well served when pediatricians also encourage the mother to contact
services for herself if she confides that she is experiencing some of the
severe psychological sequelae reported by the women in this study.
