THE PSYCHOLOGICAL AND MEDICAL SEQUELAE OF WAR IN CENTRAL-AMERICAN REFUGEE MOTHERS AND CHILDREN

Objective: To investigate the physical and mainly psychological sequel ae of exposure to war in Central American children and their mothers w ho immigrated to the United States on average 4 years before the study began. Design: Interview study. Participants: Twenty-two immigrant Ce ntral American women caretakers and 1 of their children aged 5 to 13 y ears. Main Outcome Measures: Standardized and new measures were admini stered to assess children's physical and mental health symptoms and ex posure to political violence. Results: Eighteen of the 22 children had chronic health problems. Fifteen children and all of the adults had o bserved traumatic events, including bombings and homicides. Thirteen o f the children showed mental health symptom profiles above established norms, although only 2 met tile criteria for posttraumatic stress dis order according to their own reports. Many of the caretakers were unaw are of their child's psychological distress. Four of the mothers exhib ited posttraumatic stress disorder, and their symptoms predicted their child's mental health. Conclusions: Pediatricians are sometimes the f irst 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'' symp toms in refugee children. These family members may need referrals to s ocial and psychological services, and pediatricians can open the gates to existing community networks of support. Because we found that mate rnal mental health influences the child's, the child's interests are w ell served when pediatricians also encourage the mother to contact ser vices for herself if she confides that she is experiencing some of the severe psychological sequelae reported by the women in this study.