Social and Biological Mechanisms Driving the Intergenerational Impact of War on Child Mental Health: Implications for Developing Family-Based Interventions

PROJECT SUMMARY
Violence and humanitarian crises are common in the lives of children around the world, particularly in low- and
middle-income countries. Exposure to war-related violence is detrimental to the mental health of parents and
children, but research exploring mechanisms by which emotional and behavioral disruptions are transmitted to
subsequent generations remains nascent, especially in Sub-Saharan Africa. To help address this gap, a study
of war-affected youth has been underway since 2002 following a cohort of war-affected children—many, both
male and female, former child soldiers—in Sierra Leone into young adulthood, and now parenthood. A prior
NICHD-funded R01 (R01HD073349) demonstrated how childhood war-related trauma and loss contributed to
mental health problems in adulthood. In 2017, a cross-sectional sample of intimate partners and biological
offspring was added to the sample to examine linkages between early trauma exposure and both intimate
partner and parent-child relationships. Knowledge to date of how war-related stressors “get under the skin,” to
become heritable biophysical traits and the implications for the mental health of the next generation remain
limited. Of relevance are the Research Domain Criteria-related constructs of self-regulation and stress
reactivity and how they influence emotional, cognitive and social functioning of children. The proposed
research comprises a significant advance in the 20-year history of this study by advancing understanding of
potential biological embedding of stress responses intergenerationally. Building on four prior waves of data
collection, biological measures of stress reactivity and self-regulation (autonomic nervous system reactivity,
inflammation, telomere length) will be collected in a sample of parents exposed to significant trauma in
childhood and extended also to intimate partners and offspring. Strong capacity-building collaborations with
Sierra Leone’s University of Makeni (UNIMAK) and Kenema Government Hospital (KGH) will support the
ethical collection of new stress biomarker data and clinical assessments of parent-child synchrony, health, and
anthropometric data in biological offspring aged 7–24. Key study innovations are (a) rare prospective data on
parental trauma exposure and longitudinal information on risk and protective factors operating across the
social ecology; (b) data on biological embedding of stress responses related to parental trauma; and (c) the
opportunity to examine both mental health and physiological outcomes in biological offspring in war-affected
families over time. Advanced statistical techniques (e.g., latent class growth models, structural equation
models, lagged effects models) will articulate mechanistic pathways and priority targets for intervention.
Collaborations between investigators, UNIMAK, KGH, as well as community advisory boards will inform study
implementation, ensure strong retention of participants, and provide channels for dissemination. Analyses will
inform screening tools to identify families for preventive interventions. Intervention targets identified have
implications not just for war-affected settings, but also for assisting diverse populations affected by violence
and trauma, including migrants and refugees.

Grant Number: 5R01MH128928-05
NIH Institute/Center: NIH
Principal Investigator: Theresa Betancourt