Effects of Refugee Caregiver Trauma on Child Emotional and Behavioral Health: A Longitudinal Examination of Vietnamese and Cambodian Families

Purpose: Numerous studies have found elevated risk of trauma-based mental illness among refugees, yet the long-term effects of refugee trauma on family relationships and child outcomes have not been examined extensively. Emerging evidence on secondary traumatization has described consequences of caregiver trauma on children, suggesting that caregiver psychological disorder indirectly influences child adjustment problems by way of impaired parent-child interactions and family functioning. Furthermore, less is understood about whether an “immigrant advantage” in health is found among children in refugee and forced-migrant families. Drawing from a sample of Southeast Asian refugee families, the aims of the current study are to: (1) Examine effects of caregiver trauma on family functioning, child depression, and antisocial behaviors over time, and (2) Explore group invariance in these relationships by child nativity.  

 

Methods: Data were collected for the Cross Cultural Families Project, a longitudinal study of Cambodian and Vietnamese caregivers and their children in the Pacific Northwest.

Sample. Participants were randomly drawn from a sample of families with children enrolled in an urban school district between grades 3-6 (85% consent rate). The current analysis includes 327 female caregivers and their children (n=163 Vietnamese, n=164 Cambodian) across three waves of data, collected at one-year intervals. All caregivers were immigrants or refugees and their average age was 42 years (SD=7.64). Among children, the average age at Wave 1 was 12 years (SD=1.1), 51% were female, and 38% were born outside the U.S.

Measures. Caregiver trauma at Wave 1 was measured with the Harvard Trauma Questionnaire (Mollica et al., 1992). Family functioning was assessed by parents’ reporting of the following measures at Wave 2: Parent-child communication (Loeber et al., 1997; Prinz, 1976), family cohesion (Olson et al., 1986), parental warmth (Robinson et al., 1995), and prosocial involvement (Dishion et al., 1984). Child-reported behavioral outcomes at Wave 3 included depressive symptoms (Angold et al., 1995) and measures of antisocial, delinquent, and problem behavior (Greenberg & Kusche, 1990; Hawkins & Catalano, 1990; Kusche et al., 1988).  

Analysis. Structural equation modeling in MPlus was used to examine the direct and indirect (through Wave 2 family context) effects of Wave 1 caregiver trauma on Wave 3 child outcomes. We also tested group differences across child nativity and controlled for age, gender, and family structure.     

 

Results: Results indicated Wave 1 caregiver trauma, though its effect on Wave 2 family functioning, indirectly influenced Wave 3 child outcomes, but only for foreign-born children [χ²(464)=635.48, p<.001; CFI=.95; RMSEA=.05]. Specifically, regardless of child nativity, Wave 2 family context was associated with Wave 3 child depression and behavioral outcomes; however, only for foreign-born children was Wave 1 caregiver trauma negatively associated with Wave 2 family functioning.  

Implications: Findings suggest Southeast Asian refugee caregiver trauma, though its negative effect on the family context, can in turn negatively affect child mental and behavioral health, particularly for foreign-born children. Interventions that address the role of caregiver trauma and support positive intergenerational family relationships may serve as promising avenues for enhancing child well-being within refugee families and others affected by secondary traumatization.