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Background

Although psychiatric comorbidities are common among trauma-exposed individuals with PTSD, their patterns and covariates among refugee adolescents in low-resource settings remain understudied. This study aimed to identify distinct patterns of psychiatric comorbidities and their associated factors among adolescent refugees with PTSD in Nakivale refugee settlement, Uganda.

Methods

In this cross-sectional study, 325 refugee youth were assessed on various PTSD psychiatric comorbidities and covariates of (age, gender, war trauma, post-migration stressors) using MINI International Neuropsychiatric Interview 7.02 and standardized measures of war trauma and post-migration stressors. Latent class analysis (LCA) was used to identify patterns and covariates of comorbidity.

Results

Of 269 adolescents with PTSD, 97% had at least one comorbid disorder: panic disorder (88.9%), generalized anxiety disorder (84%), agoraphobia (75.1%), depressive disorder (62.8%), obsessive compulsive disorder (60.6%), attention deficit disorder (43.9%), oppositional defiant disorder (40.9%), conduct disorder (33.8%), and alcohol use disorder (10.8%). LCA revealed three classes: low-moderate comorbidity (n = 66, 24.5%), high internalizing comorbidity (n = 101, 37.5%) with high probabilities of depression and anxiety disorders, and high overall comorbidity (n = 102, 37.9%) with relatively high probabilities of all disorders. The high overall comorbidity class had more girls than the other two classes. Both high comorbidity classes had higher war trauma and post-migration stressors than the low-moderate comorbidity class.

Conclusions

Adolescent refugees with PTSD exhibit high psychiatric comorbidity that clusters in distinct patterns. These findings highlight the need for interventions that address the identified comorbidity patterns, consider gender disparities, and account for cumulative trauma and post-migration stressors to effectively support traumatized youth.

Background: Growing up in adversity can create enduring deficits in children’s cognitive and socio-behavioral skills that undermine later-life productivity, reduce human capital, and increase social costs. Early interventions that target caregiver mental health offer a promising pathway to strengthen the developmental environment of children exposed to severe stress. Yet, in low-resource humanitarian settings, evidence on scalable approaches that generate such intergenerational benefits remains limited. War-related displacement places mothers and young children at exceptional risk for psychological distress and impaired functioning, with potential long-term consequences for both generations. Self-Help Plus (SH+), a brief, low-intensity WHO group intervention based on Acceptance and Commitment Therapy, has shown promising short-term effects in reducing psychological distress among South Sudanese refugee women in Rhino Camp, Uganda. However, key questions remain regarding the durability of these effects and whether improvements in maternal mental health translate into measurable gains in children’s own well-being and early development.

Methods: This two-arm, parallel-group cluster-randomized controlled trial will enroll 720 mother-preschool-aged child (3–5 years) dyads from 24 villages in Rhino Refugee Settlement, Uganda. Villages are randomized 1:1 to receive either SH+ and Enhanced Usual Care (EUC), or EUC only. Assessments are conducted at baseline (T0), 3 months (T1), and 12 months (T2) post-intervention. The primary outcome is maternal psychological distress (Kessler-6) at 12 months (T2). The key secondary outcome is parent-reported child psychosocial wellbeing (Kiddy-KINDLR) at T2. Secondary outcomes include additional indicators of maternal wellbeing and mental health, parenting practices, and child outcomes assessed across study time points, including psychosocial difficulties and child self-reported well- being. Analyses will follow an intention-to-treat approach, adjusting for clustering and relevant covariates.

Discussion:This trial replicates and extends prior evidence on SH+ in a large refugee population. It will examine whether early mental health gains are sustained, and whether intergenerational benefits emerge for preschool-aged children. Findings will inform scalable intervention strategies to promote psychological resilience and child development in humanitarian contexts.

Trial registration: ClinicalTrials.gov NCT07062341. Prospectively registered on July 11, 2025.

BackgroundGrowing up in adversity can create enduring deficits in children's cognitive and socio-behavioral skills that undermine later-life productivity, reduce human capital, and increase social costs. Early interventions that target caregiver mental health offer a promising pathway to strengthen the developmental environment of children exposed to severe stress. Yet, in low-resource humanitarian settings, evidence on scalable approaches that generate such intergenerational benefits remains limited. War-related displacement places mothers and young children at exceptional risk for psychological distress and impaired functioning, with potential long-term consequences for both generations. Self-Help Plus (SH+), a brief, low-intensity WHO group intervention based on Acceptance and Commitment Therapy, has shown promising short-term effects in reducing psychological distress among South Sudanese refugee women in Rhino Camp, Uganda. However, key questions remain regarding the durability of these effects and whether improvements in maternal mental health translate into measurable gains in children's own wellbeing and early development.MethodsThis two-arm, parallel-group cluster-randomized controlled trial will enroll 720 mother-preschool-aged child (3-5 years) dyads from 24 villages in Rhino Refugee Settlement, Uganda. Villages are randomized 1:1 to receive either SH+ and Enhanced Usual Care (EUC), or EUC only. Assessments are conducted at baseline (T0), 3 months (T1), and 12 months (T2) post-intervention. The primary outcome is maternal psychological distress (Kessler-6) at 12 months (T2). The key secondary outcome is parent-reported child psychosocial wellbeing (Kiddy-KINDLR) at T2. Secondary outcomes include additional indicators of maternal wellbeing and mental health, parenting practices, and child outcomes assessed across study time points, including psychosocial difficulties and child self-reported wellbeing. Analyses will follow an intention-to-treat approach, adjusting for clustering and relevant covariates.DiscussionThis trial replicates and extends prior evidence on SH+ in a large refugee population. It will examine whether early mental health gains are sustained, and whether intergenerational benefits emerge for preschool-aged children. Findings will inform scalable intervention strategies to promote psychological resilience and child development in humanitarian contexts.Trial registrationClinicalTrials.gov NCT07062341. Prospectively registered on July 11, 2025.

Background

Climate extremes in Africa threaten the food security of war-affected refugees, who often experience mental health challenges that hinder their capacity for agricultural adaptation. Cost-effective, climate-smart farming interventions are crucial for addressing food insecurity in humanitarian contexts, yet evidence on their effectiveness is limited, and the potential benefits of integrating them with mental health interventions remain unexplored. We hypothesize that the success of agricultural interventions, especially under adversity, is influenced by mental health and psychological functioning.

Methods

This study employs a three-arm, parallel-group, cluster-randomized controlled trial (cRCT) in the Nakivale refugee settlement, Uganda. Thirty villages within the settlement will be randomized in a 1:1:1 allocation ratio to one of three conditions: Enhanced Usual Care, a Home Gardening Intervention (HGI) or HGI combined with the peer-delivered psychosocial intervention Self-Help Plus (SH + HGI). A total of 900 refugee mothers and their children (aged 3–4 years) will be enrolled, with 30 dyads per village. The primary outcome is food insecurity at 12 months post-intervention, assessed using the Food Insecurity Experience Scale (FIES). Secondary outcomes include dietary diversity, child malnutrition and mothers’ psychological distress. Data will be collected at baseline, 3-month and 12-month follow-ups. Primary analyses will use an intention-to-treat (ITT) approach.

Discussion

This study will shed light on the role of mental health in agricultural adaptation for food security, evaluating the efficacy of scalable, cost-effective interventions in a refugee setting. The findings will have implications for the design and implementation of integrated food security and mental health programs in humanitarian and other resource-constrained settings.

Trial registration

ClinicalTrials.gov NCT06425523. Registered on 24 May 2024.

Background

Suicide is a leading cause of death among young people globally. Although suicidality has been studied in various populations, limited research has focused on refugee youth in low and middle-income countries. This study aimed to assess the prevalence of suicidal ideation, suicide attempts, and methods of attempted suicide among refugee children and adolescents in southwestern Uganda. We also examined risk factors associated with suicidal ideation in this population.

Methods

We conducted a cross-sectional study of 325 refugee children and adolescents selected through simple random sampling in Nakivale Refugee Settlement, southwestern Uganda. Suicidal behavior and post-traumatic stress disorder (PTSD) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, version 7.02 (MINI-KID). Additional variables—including war-related trauma and post-migration experiences were measured using structured checklists administered through KoboCollect. The data were then exported to STATA 17 for analysis. Descriptive statistics were used to calculate the prevalence of suicidal ideation, attempts, and means, while bivariate and multivariate logistic regression analyses were conducted to identify factors associated with suicidal ideation.

Results

Of 325 participants, 129 (40%) reported suicidal ideation, and among these, 70 (54%) had formulated a suicide plan. Of those with a plan, 13 (19%; (4.3% of the total sample)) had attempted suicide. The most common method of attempted suicide was self-poisoning (4/13, 31%), followed by hanging or drowning (3/13, 23%), self-stabbing (2/13, 15%), and self-imposed accidents (1/13, 8%). In multivariate analyses, suicidal ideation was significantly associated with exposure to war-related trauma (OR = 2.30, 95% CI: 1.35–3.94, p = 0.002), PTSD (OR = 5.47, 95% CI: 2.15–13.94, p < 0.001), and being an unaccompanied minor (OR = 6.14, 95% CI: 2.13–17.68, p = 0.001).

Conclusion

Suicidal ideation is highly prevalent among refugee children and adolescents in Nakivale Refugee Settlement. Prevention efforts should prioritize trauma-related factors, PTSD, and the specific needs of unaccompanied minors.

Gaze following in infancy allows triadic social interactions and a comprehension of other individuals and their surroundings. Despite its importance for early development, its ontology is debated, with theories suggesting that gaze following is either a universal core capacity or an experience-dependent learned behavior. A critical test of these theories among 809 nine-month-olds from Africa (Uganda and Zimbabwe), Europe (Sweden), and Asia (Bhutan) demonstrated that infants follow gaze to a similar degree regardless of environmental factors such as culture, maternal well-being (postpartum depression, well-being), or traumatic family events (related to war and/or climate change). These findings suggest that gaze following may be a universal, experience-expectant process that is resilient to adversity and similar across a wide range of human experiences-a core foundation for social development.

The Syrian conflict accounts for the largest number of refugees in modern history (>13 million), the vast amount of which are children. Lack of data has made revealing the effects of war and displacement on children's development difficult, implicating that potential risk factors have yet to be revealed. Household chaos (i.e., home environments high in disorganization and instability, and low in regularity and routines) has been implicated as a risk factor for child development in the broader literature but has yet to be explored in a war-related context. The current study explores potential determinants of household chaos in 100 Syrian refugee families resettled in Turkish communities. This was examined through multiple linear regressions investigating the impact of parental education, fluid intelligence, socioeconomic status in country of origin, post-traumatic stress symptoms, potentially traumatic events, downward mobility, literacy environment and housing conditions on the level of household chaos as rated by mothers and fathers respectively. Data was gathered through a battery of experimental tasks and a series of questionnaires. The results showed that maternal ratings of housing conditions (p = .040), maternal post-traumatic stress symptoms (p = .003) and paternal ratings of literacy environment (p = .005) were predictive of household chaos. Worse housing conditions, higher levels of post-traumatic stress symptoms and poorer literacy environment were associated with higher levels of household chaos. These results suggest that directing focus towards improvements of maternal mental health, as well as introducing interactive reading interventions may benefit Syrian refugee children's continued development.

The detrimental impacts of wars on human development are well documented across research domains, from public health to micro-economics. However, these impacts are studied in compartmentalized silos, which limits a comprehensive understanding of the consequences of conflicts, hampering our ability to effectively sustain human development. This article takes a first step in addressing this gap by reviewing the literature on conflict impacts through the lens of an inter-disciplinary theoretical framework. We review the literature on the consequences of conflicts across 9 dimensions of human development: health, schooling, livelihood and income, growth and investments, political institutions, migration and displacement, socio-psychological wellbeing and capital, water access, and food security. The study focuses on both direct and indirect impacts of violence, reviews the existing evidence on how impacts on different dimensions of societal wellbeing and development may intertwine, and suggests plausible mechanisms to explain how these connections materialize. This exercise leads to the identification of critical research gaps and reveals that systematic empirical testing of how the impacts of war spread across sectors is severely lacking. By streamlining the literature on the impacts of war across multiple domains, this review represents a first step to build a common language that can overcome disciplinary silos and achieve a deeper understanding of how the effects of war reverberate across society. This multidisciplinary understanding of conflict impacts may eventually help to reconcile divergent estimates and enable forward-looking policies that minimize the costs of war.

Credence goods, such as repair and healthcare services, are characterized by profound information asymmetries between less-informed customers and better-informed expert sellers. These information asymmetries open the door for fraudulent behavior on the seller side. In a preregistered natural field experiment, we vary in one dimension the seller’s perception of whether the service is an ordinary or a credence good service and in the second dimension whether the customer is a member of a minority or a member of the majority. This allows us to measure the size of the induced credence goods markup and to address the question whether it interacts systematically with discrimination. We document the existence of a large credence goods markup, on average. Moreover, we find that members of the minority pay a sizeable discriminatory markup if the good is perceived as a credence good but not if it is perceived as an ordinary good. Our results show that sellers engage in sophisticated discrimination where informational asymmetries are used to hide discriminatory (fraudulent) behavior. With the help of an ex post survey, we derive a possible explanation for our results.

Existing behavioral studies of affective partisan polarization only capture a subset of decision-making preferences and strategies. We apply an innovative experimental design, the Equality Equivalency Test (EET), to investigate a broader range of affective behavior toward partisan others. Based on data from yearly nationwide surveys between 2019 and 2022 with over 6000 observations, we find that affective polarization is expressed through strong malevolent, and to a lesser degree, benevolent deviations from rational expected-utility maximization. The rising preponderance of spitefulness towards political opponents supports negative partisanship as the dominant mechanism governing affective polarization. In addition, we find evidence of growing negative partisanship among independents, who are turning increasingly spiteful toward members of both parties. We argue that the EET should be utilized by scholars as a next-generation design innovation to deepen our understanding of affective polarization.