The role of parental factors in the mental health problems experienced by refugee children

Refugee children have high rates of complex mental health needs and a range of associated risk factors. There has been, however, limited research on the role of family-related factors and the impact of family-oriented interventions. This thesis comprises two interlinked studies to address this knowledge gap. Study I aimed to establish the role of parental factors in the development of mental health problems among Syrian refugee children residing in Turkey. A cross-sectional design involved 322 children aged 8-18 years and 263 parents in Istanbul. Children completed questionnaires on traumatic experiences (SLE), mental health problems (CRIES-8; SDQ), perceived attachment relationships (SS) and parenting styles (EMBU-C); whilst parents reported on their psychopathology (GHQ-12). The results revealed that parenting variables increased the risk of children having PTSD and general mental health problems (GMHP) after the controlling for the effects of pre-migratory trauma. The perceived lower availability of, and higher dependency on, the attachment figure uniquely explained both PTSD and GMHP. Lack of perceived warm and rejecting parenting styles predicted PTSD, whereas parental psychopathology explained GMHP. Study II aimed to evaluate the feasibility of an attachment-focussed intervention, Group Theraplay. Thirty children with possible reactive attachment disorder (RAD) and their mothers were randomly allocated to Group Theraplay or a control group. Five feasibility criteria were assessed using the same measures as in Study I at the pre- and post-intervention stages. In addition, parenting style was assessed by parents and children (PPI), RAD symptoms by parents (RPQ), and feasibility by all participants through open-ended questions. Group Theraplay was, overall, found to be feasible for application with refugee children, showing significant improvement in RPQ scores, although there was limited parental engagement. The findings have implications for practice and service development, in engaging refugee families and integrating child- and parent-focussed interventions. Future research should actively involve parents before designing a substantive evaluation.