Developing an empirically-based conceptual model of the intergenerational impact of war: a mixed methods study with Syrian refugees in Lebanon
Keywords: Mental health
War
Lebanon
Refugees
Parenting

Background: There is emerging evidence of an “intergenerational impact of war” (Betancourt et al., 2015) among conflict-affected families. However, research on parental and family-level variables that may mediate the relationship between caregiver and child mental health remains scarce. The objective of this DPhil thesis is to elucidate the role of parenting in the transgenerational transmission of war-related trauma and adversity, and investigate the variables that influence parental mental health and parenting behaviour during displacement. Results will provide a theoretical and empirical basis for further development of parenting and psychosocial interventions for Syrian refugees in Lebanon.
Methods: This DPhil thesis is comprised of three interrelated papers from a mixed methods study examining the intergenerational impact of war. The qualitative component of the thesis (DPhil Paper 1) consists of group and individual interviews with Syrian refugee parents (n=39) and children (n=15) in Lebanon. Interviews were transcribed and analysed using a grounded theory approach to examine the pathways linking the effects of war and displacement to parenting and child adjustment. The quantitative component of the thesis (DPhil Papers 2 and 3) consists of a cross-sectional survey with Syrian refugee mothers in Lebanon (n=291). In DPhil Paper 2, structural equation modelling is used to test a conceptual model linking mothers’ exposure to war and daily stressors to maternal mental health problems, harsh parenting, and child psychosocial difficulties. DPhil Paper 3 examines the role of mothers’ perceived social support in promoting their psychological and parenting resilience, defined as better than expected mental health and parenting behaviour given level of exposure to war trauma. Psychological and parenting resilience are operationalised using the residual approach, which assesses the difference between mothers' actual score on mental health and harsh discipline measures, and the score predicted by their level of trauma exposure. Linear regression models are used to test for associations between mothers' perceived social support and their psychological and parenting resilience.
Results: In DPhil Paper 1, qualitative results show three interrelated pathways linking daily displacement stressors to different dimensions of parenting. First, economic hardship prevents parents from meeting their children’s basic needs and forces adaptation strategies that impair positive parent-child interactions; second, parental psychological distress contributes to harsh parenting; and third, perceptions and experiences of insecurity in the community result in increased parental control. Greater economic resources and social support emerged as potential protective factors for maintaining positive parenting despite exposure to war and displacement-related adversity.
In DPhil Paper 2, results from the structural equation model show that greater exposure to war-related events is directly associated with increased maternal post-traumatic stress (PTS) and general psychological distress, as well as indirectly via mother’s experience of daily stressors. Mothers’ general psychological distress, but not PTS, is directly associated with more negative parenting behaviour and child psychosocial difficulties. The combined effects of parental rejection and harsh punishment mediate the association between maternal general psychological distress and child psychosocial difficulties. Model fit statistics indicate that the measurement and structural models provide a good fit to the data.
In DPhil Paper 3, regression analyses show that mothers’ perceived social support is associated with both psychological and parenting resilience, including after controlling for relative socioeconomic disadvantage, maternal education, and age and sex of child. Exploratory analyses further suggest that emotional support, but not instrumental support, is associated with mothers’ psychological resilience.
Conclusion: This DPhil thesis contributes to the growing evidence base on the mechanisms underlying the intergenerational effects of war, focusing on parenting as a crucial link between parental and child psychosocial wellbeing. Results from both the qualitative and quantitative components of the thesis suggest that daily stressors related to displacement, in addition to past exposure to war trauma, have significant deleterious effects on parental mental health, which in turn contribute to negative parenting behaviour and child psychosocial outcomes. Social support may be a potential modifiable factor for promoting positive caregiver mental health and parenting in a context of past war trauma and ongoing displacement. Implications for policy and practice include greater emphasis on psychosocial and parenting support for war-affected caregivers, nested within and alongside structural interventions that improve refugees’ social and material ecology.
This research is particularly timely and relevant given the enormous scale of the Syrian refugee crisis, and the shift in policy and practice towards family-based approaches to child protection and development in humanitarian contexts. Strengths of the thesis include the use of mixed methods to model the mechanisms underlying the intergenerational impacts of war and displacement, as well as the focus on modifiable factors that may promote parental resilience. Results should be viewed in light of several limitations, however, including the reliance on single-informant, self-reported data, and the cross-sectional survey design which precludes causal inference. Further research incorporating multi-method, multi-informant experimental or longitudinal designs is necessary to trace the linkages between family-level variables and children’s developmental trajectories, and inform interventions to support parental, child, and family resilience during displacement.