Street Working Children in the Kurdistan Region of Iraq followed over 16 years : Mental Health and Traumatization

Abstract: The overall aims of the research this thesis is based upon were to assess mental disorders and trauma experiences of street working boys in Duhok (in the Kurdistan region of Iraq), compare them with schoolboys of the same community, follow the street working boys into adulthood, and examine the continuity of mental disorders, as well as their adult perspectives on their previous street work.A group of 100 street working boys was examined in 2004–2005, and 40 of the same group (as adults) in 2021. Psychiatric diagnoses were obtained through structured diagnostic interviews, using the Mini-International Neuropsychiatric Interview for Children and Adolescence (MINI KID) and Mini-International Neuropsychiatric Interview (MINI) instruments at baseline and follow-up, respectively. Behavioural problems and competencies were assessed at baseline by the Child Behaviour Checklist, and experienced traumas were assessed at baseline by the Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C). At follow-up all participants were interviewed about their perspectives and experiences, then their responses in the interviews were subjected to thematic analysis. Schoolboys of the same age from the same city were recruited in 2011, assessed in the same way and compared with the street working boys. The research was presented in four appended papers, designated Papers I-IV. As described in Paper I, 98% of the 100 street children worked to meet economic needs of their families, and there were very high rates of parental illiteracy: 90% of their fathers and 95% of their mothers were illiterate. Mental disorders were common: 61% had at least one mental disorder, most frequently one or more anxiety disorders (57%). In Paper II, types and frequencies of experienced traumas were compared between street working boys and schoolboys. A significantly higher proportion of street working boys had experienced at least one traumatic event than the schoolboys (96% versus 64%, p < 0.001), although both groups lived in a region burdened by conflicts and war. The largest effect size was found for torture, with an odds ratio of (28.4). In the study reported in Paper III, street work was found to have had both positive and negative consequences for the children. The positive consequences included development of work and social skills, being responsible and able to support their families. Negative consequences included impaired adult mental and physical health. In addition, an important identified resilience factor was social support from families, other adults and/or peers. The study reported in Paper IV found that 28 (70%) of the participants met criteria for at least one mental disorder at follow-up. The proportion with any depressive disorder increased from 7.5% at baseline to 40% at follow-up (p=0.002), but proportions with any anxiety disorder or externalizing disorder did not significantly change. Of those with an anxiety disorder in childhood, 42.5% continued to have it in adulthood.