Trauma memories, mental health, and resilience: aprospective study of Afghan youth

BackgroundStudies of war-affected youth have not yet examined how trauma memories relate to prospective changes in mental health and to subjective or social experiences. MethodsWe interviewed a gender-balanced, randomly selected sample of Afghan child-caregiver dyads (n=331, two waves, 1year apart). We assessed lifetime trauma with a Traumatic Event Checklist, past-year events with a checklist of risk and protective events, and several child mental health outcomes including posttraumatic distress (Child Revised Impact of Events Scale, CRIES) and depression. We examined the consistency of trauma recall over time, identified mental health trajectories with latent transition modeling, and assessed the predictors of posttraumatic distress and depression trajectories with multinomial logistic regressions. ResultsFrom baseline to follow-up, reports of lifetime trauma significantly changed (p0.01). A third of the cohort reported no trauma exposure; only 10% identified the same event as their most distressing experience. We identified four CRIES trajectories: low or no distress (52%), rising distress (15%), declining distress (21%), and sustained high distress (12%). Youth with chronic posttraumatic distress were more likely to be girls (OR=5.78, p0.01), report more trauma exposure at baseline (OR=1.55, p0.05) and follow-up (OR=5.96, p0.01), and experience ongoing domestic violence (OR=4.84, p0.01). The risks of rising distress and sustained distress showed a steady increase for youth recalling up to four traumatic experiences. Depression and CRIES trajectories showed weak comorbidity. ConclusionsMemories of violent events are malleable, embedded in social experiences, and present heterogeneous associations with posttraumatic distress. Our study provides insights on resilience and vulnerability to multiple adverse childhood experiences, highlighting research and clinical implications for understanding trauma in conflict-affected youth.