Does war moderate the association between mental wellbeing and its predictors among children? A multi-country cross-sectional study.

BACKGROUND: This study explores how war or conflict influences the established predictors of mental well-being among children, addressing a significant gap in current research. METHODS: Utilizing data from Multiple Indicator Cluster Surveys (MICS6) collected between 2016 and 2021, we examined children aged 5-17 years in four low or middle-low-income countries experiencing war or conflict and compared them to 20 control countries. We employed logistic models to analyze the data, focusing on mental well-being as the outcome. Primary independent variable was exposure to war, with an emphasis on the interaction between this exposure and potential predictors, including age, sex, having a physical disability, enrolled in education, having siblings, living with at least one parent, residence place, and family wealth status. RESULTS: The analysis revealed significant modifications in the association between factors like age, disability, education, economic status, and place of residence and mental well-being due to war (p values < 0.05). Specifically, the impact of war was more pronounced in older children (OR = 1.48, 95%CI = 1.18-1.85) compared to younger ones. Education was found to mitigate anxiety in conflict-affected areas (OR = 0.75, 95%CI = 0.60-0.95), whereas children with disabilities were more vulnerable to mental health challenges (OR = 2.05, 95%CI = 1.65-2.55) in these settings. LIMITATIONS: The mental well-being measure was based on caregiver reports, which may not fully capture the children's experiences. CONCLUSION: Our findings provide crucial insights into the differential impact of war on children's mental well-being. They underscore the need for tailored, context-specific mental health interventions for children in conflict-affected areas and encourage further research into the nuanced effects of war on child and adolescent mental health.