The dynamic nature of refugee children's resilience: a cohort study of Syrian refugees in Lebanon.

Aims: Children's responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on cross-sectional data in high-income countries. We aimed to (1) investigate change in resilience across two timepoints in a highly vulnerable sample of Syrian refugee children in Lebanon, and (2) explore predictors of their mental health problems across time.

Methods: In total, 982 Syrian child-caregiver dyads living in refugee settlements in Lebanon completed questionnaires via interview at baseline and follow-up one year later. We categorised children into groups based on their risk for mental health problems across both timepoints (stable high risk/SHR, deteriorating, improving, stable low risk) according to locally validated cut-offs on measures of post-traumatic stress disorder (PTSD), depression and behavioural problems. Analyses of covariance identified how the groups differed on a range of individual and socio-environmental predictors, followed up by cross-lagged panel models (CLPMs) to investigate the directionality of the relationships between significantly related predictors and symptoms.

Results: The sample showed a meaningful amount of change in mental health symptoms from baseline to follow-up. Over half (56.3%) of children met SHR criteria and 10.3% deteriorated over time, but almost one-quarter (24.2%) showed meaningful improvement, and 9.2% were consistently at low risk for mental health problems at both timepoints. Several predictors differentiated the groups, particularly social measures. According to CLPMs, maternal acceptance ( = -0.07) predicted child mental health symptoms over time. Self-esteem ( = -0.08), maternal psychological control ( = 0.10), child maltreatment ( = 0.09) and caregiver depression ( = 0.08) predicted child symptoms and vice versa ( = -0.11, = 0.07, = 0.08, = 0.1, = 0.11). Finally, child symptoms predicted loneliness ( = 0.12), bullying ( = 0.07), perceived social support ( = -0.12), parent-child conflict ( = 0.13), caregiver PTSD ( = 0.07), caregiver anxiety ( = 0.08) and the perceived refugee environment ( = -0.09).

Conclusions: Our results show risk and resilience are dynamic, and the family environment plays a key role in children's response to war and displacement. Conversely, children also have a significant impact on the family environment and caregiver's own mental health. Interventions to promote resilience in refugee children should therefore consider family-wide mechanisms.