Emotional and behavioral disturbances among war-affected school-aged children in Ethiopia

Children residing in conflict-affected regions are frequently subjected to violence, forced displacement, and traumatic experiences, which are associated with a heightened risk of developing emotional and behavioral disorders. These adverse exposures commonly manifest as anxiety, depression, aggression, and post-traumatic stress symptoms, with significant implications for the psychological well-being of affected children and the broader social fabric. Despite the substantial burden, empirical research investigating these outcomes within the Ethiopian context remains scarce. This study aims to examine the psychological impact of war on Ethiopian school-aged children by identifying risk and protective factors related to emotional and behavioral disturbances (EBD) to guide evidence-based interventions.

A community-based cross-sectional study was conducted from May 25 to June 23, 2022, to assess emotional and behavioral disturbances among school-aged children (7-18 years) living in a conflict-affected region of Ethiopia. A total of 876 participants were selected using a multistage stratified sampling method to ensure representative coverage. Emotional and behavioral issues were assessed using the parent-reported 25-item Strengths and Difficulties Questionnaire (SDQ-25), with scores ≥14 on the total difficulties scale indicating clinically significant disturbances. Multivariable logistic regression analysis was conducted to identify independent predictors of EBD, with statistical significance determined at a two-tailed p-value of ≤0.05.

Of the 869 school-age children, 552 (63.5 %) were aged 7-13 years and 317 (36.5 %) were aged 14-18 years, with a mean age of 12.06 ± 3.28 years. The overall prevalence of emotional and behavioral disturbances (EBD) was 36.7 % (95 % CI: 34.63-43.47), affecting 210 (38 %) younger school-age children and 109 (34.4 %) older school-age children. Multiple factors were identified as significant predictors of these disturbances, including larger family size (OR = 1.36, 95 % CI: 1.23-1.84), exposure to severe human suffering, such as shootings or killings (OR = 2.31, 95 % CI: 1.36-3.91), both parental loss (OR = 3.48, 95 % CI: 1.81-6.7), and caregiver mental distress (OR = 2.29, 95 % CI: 1.59-3.29). Furthermore, active participation in acts resulting in life-threatening illness or injury or fatality another individual (OR = 1.41, 95 % CI: 1.22-1.61) was also found to be a significant risk factor for EBD.

This study demonstrates a high prevalence of EBD among school-aged children in conflict-affected Ethiopian regions, reflecting the profound psychological impact of war-related adversity. Key risk factors-such as exposure to violence, parental loss, caregiver mental distress, and reduced household size illustrate the multifactorial nature of vulnerability. The findings highlight the urgent need for contextually adapted, evidence-based mental health interventions aimed at mitigating long-term psychopathology and strengthening resilience in conflict-affected populations.