Education as protective factor toward mental health risks among youth living in highly dangerous regions in Afghanistan

Abstract Background: By living in dangerous areas, children in Afghanistan have been exposed to traumatic events and chaotic education; the ongoing Taliban’s comeback continues to jeopardize access to school for girls, hardly secured in the past. Objectives: The objectives were to evaluate children mental health in a high-risk situation and the protective effect of attending to school for girls and boys. Method: The study included 2707 school age children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parent Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location. Results : A total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39,19% for emotional, 51,98% for conduct, 15,37% hyperactivity/inattention; peer relationship problems were high: 82.86%; and 12.38% reported that they impacted daily life. The level of terrorist threat was highly associated with SDQ total difficulties (Adjusted Odds Ratio [AOR]=4.08 P<.0001), with youth in high levels of terrorist threat regions more likely to have problems than youth in regions with low or medium levels of danger, independently of region and ethnicity. School attendance was protective for emotional (AOR=0.65 P<.0001) and mental health difficiulties with impairment (AOR=0.67 P=0.007), but increased risk for peer relationships difficulties (AOR=1.96 P>.0001). Conduct (AOR=1.66 P<.0001) and SDQ total difficulties (AOR=1.22 P=.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health. Conclusion: To attend school is essential for children’s mental health, across gender, and should be supported as a priority in Afghanistan.