For children, wartime evacuation might not be harmful

By Shereen Lehman

Evacuating children during wartime doesn’t necessarily increase their risk of psychiatric problems later on, according to a new study.

That was true overall for the subjects of the study, adults who as children were evacuated from Finland to Sweden in World War II.

But while men who were evacuated as boys were less likely to be admitted to a psychiatric hospital as adults, compared to their siblings who stayed home, girls who were evacuated were more likely to have mood disorders later on.

During World War II, about 45,000 Finnish children were evacuated to Swedish foster families to protect them from the war. A few previous studies suggest these children were more likely to have mental health problems later in life

But Torsten Santavirta, who led the new study, said those other efforts may have been biased. So he and his coauthors decided to re-examine the issue by comparing people who were evacuated as kids to their siblings who remained behind.

“The evacuation policy has been subject to active debate in both Finland and Sweden, with loud criticism by former evacuees,” said Santavirta, a researcher with the Swedish Institute for Social Research at Stockholm University.

“The conventional wisdom seems to be that the evacuation as a rule left substantial scars in the form of childhood trauma,” he told Reuters Health in an email

Santavirta said he and his colleagues wondered why no one seemed to think the opposite might be true – that remaining with their biological family and being exposed to war may have been just as stressful for the children.

For their study, published in The BMJ, the team used Finnish census information to find people who had been born between 1933 and 1944, along with data from a Finnish child evacuee registry.

They also used hospital discharge records to identify 4,441 people who’d been admitted to hospitals for mental disorders between 1971 and 2011, including 2,456 men. About 3 percent of these people had been evacuated to Swedish foster families for an average stay of two years.

Overall, the researchers saw no link between being evacuated and any greater likelihood of being hospitalized for mental disorders later. In fact, it appeared that men who were evacuated were less likely to be hospitalized compared to their siblings who stayed in Finland during the war.

The study team did find that girls who were evacuated were more likely to be admitted to hospitals for mood disorders as adults.

The authors acknowledge some limitations to their study. Follow-up began when the participants were 38 years old, so it’s possible that earlier psychiatric diagnoses were missed. In addition, the authors didn’t look at whether the kids who were evacuated had any special characteristics – for instance, it’s possible those kids tended to be more emotionally resilient.

Nonetheless, Santavirta says, this is so far the most definitive study on the long-term psychiatric consequences of the Finnish Evacuation Policy, and “we think the results have predictive value for contemporary child refugee policy.”

Children currently represent about 5 percent of refugee populations across the world, due to war, natural disasters and abuse. There were more than 21,000 asylum claims made for refugee children in 2012, alone, Santavirta’s team writes.

“Our study suggests that evacuations policies designed in the same manner as the Finnish one may not be more detrimental than being directly exposed to the war itself,” Santavirta said.

He added that gender-specific strategies might need to be considered when confronting situations in which children are exposed to war-related conflict and family separation.

SOURCE: http://bmj.co/1FQKJsD The BMJ, online January 5, 2015.

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