Daily bread: a novel vehicle for dissemination and evaluation of psychological first aid for families exposed to armed conflict in Syria.

BACKGROUND: Risks to the mental health of children and families exposed to conflict in Syria are of such magnitude that research identifying how best to deliver psychological first aid is urgently required. This study tested the feasibility of a novel approach to large-scale distribution of information and data collection. METHODS: Routine humanitarian deliveries of bread by a bakery run by a non-governmental organisation (NGO) were used to distribute parenting information leaflets and questionnaires to adults looking after children in conflict zones inside Syria. Study materials were emailed to a project worker in Turkey. Leaflets and questionnaires requesting feedback were transported alongside supplies to a bakery in Syria, and then packed with flatbreads. Three thousand bread-packs were distributed, from three distribution points to which questionnaires were returned, and then taken to Turkey and dispatched to the UK. FINDINGS: Notwithstanding delays, 3000 leaflets and questionnaires were successfully distributed over 2 days. Questionnaire return yielded 1783 responses, a 59.5% return rate. Overall ratings of the usefulness of the leaflet were 1060 (59.5%) 'quite a lot' and 339 (19.0%) 'a great deal'. Content analysis was used to code 400 respondent comments. Four themes emerged; positive comments about the leaflet, suggestions for modifications, descriptions of children's needs and the value respondents placed on faith. INTERPRETATION: Findings indicate the willingness of NGO staff and volunteers to assist in research, the remarkable willingness of caregivers to respond and the value of brief advice. It demonstrates the scope for using existing humanitarian routes to distribute information and receive feedback even in high-risk settings.

Establishing the feasibility of assessing the mental health of children displaced by the Syrian conflict.

BACKGROUND: In the humanitarian crisis context of conflict zones, collecting data is essential for identifying and addressing the mental health needs of refugee children to avoid mass suffering. This study tested the feasibility of recruiting refugees caring for children and using established and brief parent-report questionnaires in a challenging context to collect mental health data on refugee children displaced by Syria's conflict. METHODS: Caregivers of 4-10-year olds attending primary schools run by non-governmental organisation (NGO) Generation Freedom in and near refugee camps on the Syrian-Turkish border were invited to complete the Pediatric Emotional Distress Scale (PEDS) and Strengths and Difficulties Questionnaire (SDQ). RESULTS: It was possible to reach 144 adult refugees caring for children with research participation information and use informed consent procedures. A total of 106 caregivers completed the questionnaires yielding a good return rate (74%). Eighty-two (77.4%) caregivers had complete data on the PEDS and 61 (57.5%) on the SDQ. Almost half (49%) of the children met the clinical cut-off for being anxious/withdrawn and 62% for being fearful rated using the PEDS and 45% for SDQ rated emotional symptoms. More than a third had clinical levels of behavioural problems on both scales. CONCLUSIONS: It proved feasible to collect child mental health data in challenging conditions in the context of the Syrian crisis with support from a local NGO providing humanitarian assistance. The PEDS performed better than the SDQ in this context. High levels of emotional distress and behavioural problems in children reiterate the urgent need for evidence-based psychosocial support.