Topic 2 Definitions and categories of risk and protective factors for mental health difficulties triggered by health emergencies and crisis situations

Risk factors are factors that make it more likely (or increase probability) that people will experience negative outcomes (NIDA, 2020). Risk factors are measurable and predictive, and many risk factors are modifiable – they are subject to change through intervention (ACAY, 2015).

Protective factors are factors that make it more likely that people will experience a desired outcome. Protective factors promote successful coping and adaptation to life situations and change. Protective factors are not simply the absence of risk factors; rather, they lower the probability of undesirable outcome (e.g., Benard, 2004). They may change, buffer, or reduce outcomes of risk factors (ARACY, 2015). All people have some combination of risk and protective factors.

Risk and protective factor are usually grouped into (https://ctb.ku.edu/en/table-of-contents/analyze/choose-and-adapt-community-interventions/risk-and-protective-factors/main):

  • a. environmental factors – those that occur in the persons’ social and physical environment and are specific to group of people in each community (e.g. household, town, living conditions, friends’ norms and behaviour)
  • b. individual factors – personal experiences or aspects of a person (or group) (e.g. impulsivity, resilience, attachment).

Risk factors are not necessarily causes of a negative outcome, and they must be assessed in conjunction with protective factors. Influence of those factors on human behaviour is interactive (they do not act in isolation) and changes over the life span.

2.1. Crisis situations related risk and protective factors for mental health difficulties in childhood and adolescence

Crisis situation-related protective factors for mental health difficulties in childhood and adolescence

Category Factors
Experience before crises situation
  • Educational curricula which include risk analysis, awareness and reduction, and disaster management (promotion of activities that increase preparedness and reduce risk)
  • Informed public about existing disaster plans at local and/or governmental level
  • Engagement of the community in discussions about risk, disaster plans and response
  • Participation in local disaster drills
  • Having (family) safety plans before a disaster or emergency happens
  • Psychoeducation to children and adults about normal reactions to disasters and stress management techniques
  • Learned relaxations skills
Experience during crisis situation
  • Indirect involvement
  • Giving children responsibility to care for others and encouraging active coping (e.g. took on a caregiver role towards toy)
  • Take action directly related to the disaster (but in safe environment)
Economy
  • Restoration of homes or property
  • Securing permanent accommodation
Emotions
  • Positive self-talk or healthy distraction
  • Directing one’s energy to age-appropriate activities that promote competence
  • Provide children with opportunities to talk about what they went through or what they think about it
  • Giving children opportunity for sharing concerns and asking questions
Health
  • Access to adequate psychosocial or healthcare
Education and Schooling
  • Perceived sense of safety at school and belonging
  • Achievement of competence in the host country’s language
Media
  • Limiting exposure to media coverage of traumatic events and aftermath
  • Providing children with simple and age-appropriate information that they can understand what is going on
  • Credible, current and helpful information
Family
  • Availability of family resources
  • Stable parents and caregivers’ reactions to adverse events
  • Parents and caregivers deal with emergencies with confidence
  • Parents transmit a sense of resilience to their children
  • Good parental mental health, particularly in mothers
  • Family cohesion and perception of high parental support
Society
  • Community resilience ability to respond and recover to adversities
  • Low peer violence and discrimination
  • Living and socialising alongside other people of the same ethnic origin
  • Support of parents, friends, neighbours and the social infrastructure
  • Perception that social support was adequate
  • Adherence to traditional values of family hierarchy according to age and sex
Leisure and recreation
  • Leisure and relaxation activities

Crisis situation-related risk factors for mental health difficulties in childhood and adolescence

Category Factors
Experience before crises situation
  • Lack of information about experiences of migration or exile
  • Previous adverse events (e.g. episode of emergency, exposure to violence)
  • Little connectedness to the neighbourhood
  • Absence of knowledge and awareness of risk or unrealistic risk perceptions
  • Previous adverse, traumatic, or stressful event

Experience during crisis situation

  • Direct involvement
  • Have suffered physical injury (especially head)
  • Higher degree of perceived personal threat during traumatic exposures
  • Direct and indirect exposure to violence
  • Longer duration of exposure

Economy

• Problems with restoration of homes or property
• Continuing to live in temporary accommodation
• Loss of possessions - including items of sentimental value, house, financial aid

Emotions

  • Fear for the loss of a loved one (a family member, close friend, or pet)
  • Fear of the unknown
  • Fear of recurrence of an extreme event
  • Attempt to actively resolve uncontrollable interpersonal stressors (e.g., parental conflict or illness)

Health

  • New or continuing health concerns or conditions
  • Lack of access to psychosocial or healthcare
  • Lack of access to prescription medication
Media
  • Conflicting information
  • Repeated exposure to mass media coverage of the emergency and aftermath (e.g., images of a disaster, negative reports)

Family

  • Separation from parents, families and/or caregivers
  • Loss of a family member, close friend, or pet
  • Breakdown of relationships and loss of intimacy
  • Breakdown in familiar routines and living conditions
  • Changes to household composition
  • Physical and mental abuse and neglect of partners or children

Family

  • Sense of uncertainty transmitted by parents and/or caregivers
  • Poor communication within family
  • Parental worries about financial problems

Society

  • Physical separation from friends
  • Disruption to social networks and relationships
  • Reduction in level of social support
  • Big cultural differences
  • Perceived discrimination

Leisure and recreation

  • Disruption to leisure and relaxation activities

Changes in the view of the world or oneself

  • Uncertainty of their own health
  • Change of routine, lifestyle, life conditions
  • Loss of control and agency
  • Loss of aspirations for the future goals

2.2. General risk and protective factors for mental health difficulties in childhood and adolescence

General risk factors for mental health difficulties in childhood and adolescence

EARLY CHILDHOOD

Individual Factors School, neighbourhood, and community

- Difficult temperament: frequent irritability, low adaptability, irregular habits

- Insecure attachment to parents

- Motor, cognitive or language

impairments

- Premature birth

- Social inhibition or hostility to peers

- Head injury

- Aggressive behaviour

- Sexual victimization

- Harsh discipline

- Maternal stress

- Parental substance abuse

- Poor parental mental health

- Parental neglect and abuse

- Cold and unresponsive mother behaviour

- Marital conflict

- Family dysfunction

- Parental loss

- Single parenthood

- Poverty

- Poor-quality childcare services

- Lacking a medical home

- Living in a neighbourhood in poor condition

MIDDLE CHILDHOOD and ADOLESCENCE

Individual Factors School, neighbourhood, and community

- Frequently feeling anxious or scared

- Impulsiveness

- Depressiveness or apathy

- Negative self-image

- Shyness

- Insecure attachment to parents

- Lack of social skills: aggressive, impulsive,

passive, or withdrawn, poor problem-solving

- Poor school achievement

- Poor commitment to school

- Sexual victimization

- Traumatic or stressful events

In middle childhood:

- Deficits in impulse control and behavioural self-control

- Sensation-seeking

- Behaviour problems

- Attention deficit/ hyperactivity disorder

- Substance abuse among parents or siblings

- Poor parental mental health

- Poor parenting (rejection, hostility, lack of warmth, highly criticizing parents, harsh discipline)

- Parental neglect and abuse

- Parental loss

- Marital conflicts or divorce

- Family dysfunction

- Parental overcontrol or permissive parenting

- Parents reinforce threat appraisals and avoidant

behaviours

- Parent-child conflicts

- Peer rejection or alienation from peers

- Deviant peer group

- Poverty

- Stressful community events (e.g., violence)

- School-level stressful events

- Easy availability and access to alcohol

In adolescence:

- Female gender (risk factor for depression)

- Extreme need for approval

- Favourable attitudes toward drugs or early substance use

EARLY CHILDHOOD

Individual Factors School, neighbourhood, and community

- Good self-regulation

- Secure attachment to parents

- Good communication and

language skills

- Ability to make friends and get along with other people

- Parental responsiveness, support, protection from harm and discipline

- Adequate socioeconomic resources for

the family

 

- Support for early learning

- Supplementary services for disadvantaged children (e.g,, feeding, medical screening)

 - Low ratio of caregivers to children

-  Regulating quality and of health and social care

MIDDLE CHILDHOOD and ADOLESCENCE

Individual Factors School, neighbourhood, and community

- Mastery of academic skills

- Ability to make friends and get along with other people

- High self-efficacy

- Optimism

- Emotional self-regulation

- Interpersonal connections in contexts such as school, with peers, in sport clubs, religion groups etc.

- Parental support

-  Authoritative child-raising (involvement, warmth, support of autonomy, clear

rules, expectations, and structure)

- Good family climate

-  Availability of social

support outside the family (e.g., friends, teachers, community groups, sport clubs)

- Healthy peer groups

- Effective classroom management

- School policies and practices against

bullying

- High academic standards