Risk of psychiatric diagnoses in children and adolescents of parents with torture and war-trauma.

OBJECTIVE Evidence point to intergenerational effects of trauma in refugee populations. This study estimates the risk of psychiatric diagnoses in children of severely traumatised refugees. The unique clinical sample consisted of refugee parents treated for torture and war-trauma, and outcomes were investigated using population-level data. METHOD A nationwide register study, following all children residing in Denmark. The exposure was parental torture and war-trauma, and outcomes were any psychiatric disorder, mood, neurotic, behavioural and emotional disorders and disorders of psychological development. Children's hazard of being diagnosed was estimated using Cox proportional hazards regression. Study participants were followed from the date of birth or immigration to their 18th birthday. RESULTS The cohort included 3,346,993 children of which 19,294 were identified as offspring to traumatised refugees. During the study period, 205,610 children were diagnosed with a psychiatric disorder. Children with parents from the Middle East and Northern Africa had a hazard ratio of 0.78 (95%CI: 0.72,0.84) for those treated for parental trauma and 0.79 (95%CI: 0.76,0.81) for those not treated compared to children of non-traumatized Danish-born parents. For children of parents from former Yugoslavia, the corresponding estimates were 0.69 (95%CI: 0.58,0.81) and 0.69 (95%CI: 0.65,0.73). CONCLUSION The results suggest that children of parents with and without registered torture and war-trauma have a lower risk of being diagnosed with a psychiatric disorder compared to children of Danish-born parents. These findings contradict research done on the transmission of trauma but supports evidence suggesting mental health services underutilisation by refugee and ethnic minority populations.