The review, which searched PubMed and Google Scholar for English-language research on children, adolescents, armed conflict, forced displacement, and mental health outcomes, organized its findings along two intersecting axes. The first is temporal, following harm from the acute crisis through protracted displacement into adulthood. The second is mechanistic, specifying five pathways through which war damages developing psyches: direct trauma exposure, including injury, witnessed violence, bereavement, and forced participation in hostilities; disruption of caregiving through separation, caregiver death, and the erosion of parenting capacity under survival conditions; loss of educational and social structure as schools are destroyed and peer networks fragment; chronic deprivation spanning food insecurity, unsafe water, inadequate shelter, and entrenched poverty; and barriers to care arising from health system collapse, workforce scarcity, and stigma. Critically, the authors emphasize that these mechanisms are not phase-specific—each operates across the entire temporal arc, changing in character rather than resolving.

In the immediate phase, children face sudden and chaotic disruption: penetrating injuries, blunt trauma, crush injuries, and burns from shelling and explosions, alongside acute stress reactions marked by fear, hyperarousal, sleep disturbances, and somatic complaints. Armed conflict has been linked to a three-fold increase in infant and child mortality, largely from shortages of food, clean water, and nutrition that worsen malnutrition and weaken immune systems. Young children often regress, become clingy, aggressive, or withdrawn, and the destruction of caregiving structures compounds the damage. Many caregivers are preoccupied with basic survival, leaving children to process distressing experiences without emotional support—a pattern that disrupts attachment and can produce heightened fear, aggression, dependency, and psychosomatic symptoms. Forced displacement also creates unaccompanied minors who must navigate refugee camps, orphanages, or distant relatives alone, conditions that carry significant psychological stress and vulnerability to mental health disorders.

In the months and years that follow, the same mechanisms persist but change form. Displacement becomes protracted rather than sudden, caregiver separation hardens into prolonged absence or permanent loss, and deprivation becomes chronic rather than episodic. What distinguishes this phase is the added burden of adaptation: children must negotiate unfamiliar languages, cultures, legal statuses, and schooling systems at precisely the point when the family and community structures that would ordinarily support that adaptation are themselves degraded. Across studies, exposure to armed conflict and displacement was consistently associated with elevated rates of post-traumatic stress disorder, depression, anxiety, behavioral disturbances, sleep problems, and impaired social functioning. Displacement interrupts immunization schedules and continuity of primary care, contributing to excess child mortality well after active hostilities subside, while refugee mothers face higher risks of preterm birth and stillbirth—outcomes that degrade the caregiving environment available to surviving children.

The long-term picture is equally sobering. Prolonged exposure to stress during early development can disrupt corticolimbic circuits implicated in threat appraisal, emotion regulation, and executive function, with documented alterations in amygdala–prefrontal connectivity and hypothalamic–pituitary–adrenal axis reactivity. Chronic mental health conditions such as PTSD, anxiety, and depression persist into adulthood, alongside impaired cognitive functioning, disrupted learning, memory, and reasoning abilities, and difficulties with relationships and social integration. Disrupted education and weakened economic systems contribute to a cycle of poverty that further compromises health, nutrition, and future opportunities. Post-conflict data reveal disturbing realities among former child soldiers: nearly a quarter report having killed someone, including family members, and a third of girls report having been raped. An audience effect, in which adolescents internalize violence as performance, further fuels ongoing aggression in affected communities, embedding war’s legacy into the next generation.

On the question of intergenerational trauma, the review draws careful distinctions between pathways that differ substantially in evidential support. The best-supported mechanisms are psychological, familial, and sociocultural: parental post-traumatic symptoms, altered parenting behaviors, disrupted family communication, and the transmission of narratives and silences about the traumatic past are consistently associated with offspring adjustment across multiple populations. Danieli’s model describes how initial trauma, post-trauma family adaptational styles, and the surrounding sociocultural environment interact across generations, with reported patterns including emotional numbness and overprotectiveness in the exposed generation and social withdrawal, difficulty trusting others, and heightened anxiety among their children. A meta-analysis of 32 samples of Holocaust survivor offspring found evidence of secondary traumatization in clinical samples but not in adequately designed non-clinical samples, indicating that offspring risk depends on additional stressors rather than following inevitably from parental exposure. Biological mechanisms occupy a different tier: while differences in DNA methylation at glucocorticoid-related loci have been reported in trauma-exposed individuals and, in smaller studies, in their offspring, human studies are small, largely cross-sectional, and unable to separate germline transmission from prenatal exposure, postnatal caregiving, and shared environment. Claims of inherited epigenetic effects in war-exposed families should accordingly be read as hypotheses under investigation rather than established findings.

Protective factors emerge clearly from the synthesized literature: stable caregiving relationships, educational continuity, social support, and access to community-based psychosocial services. Bronfenbrenner’s ecological framework helps explain how conflict reaches the child through cascading disruptions to family, school, community, and societal systems—caregiver mental health, family cohesion, peer relationships, school climate, and community resources each independently predict child outcomes, and their simultaneous degradation during conflict amplifies risk in non-additive ways. This framework underscores why narrowly clinical interventions, however evidence-based, are insufficient in the absence of broader system-level repair. Schools are increasingly adopting trauma-informed approaches that foster safe, supportive environments and equip educators with tools to recognize and respond to trauma, creating opportunities for healing and academic success even amid ongoing precarity.

On interventions, the review finds a striking paradox: the modalities with the strongest evidence are the least scalable in active conflict. Trauma-focused cognitive behavioral therapy and narrative exposure therapy adapted for children, known as KIDNET, have both been tested in randomized trials with conflict-affected and refugee youth and produce moderate to large reductions in PTSD symptoms in meta-analyses spanning diverse settings. But TF-CBT typically requires eight to sixteen sessions, a trained therapist, ongoing supervision, and structured caregiver involvement, whereas KIDNET can be delivered in roughly four to ten sessions and does not depend on an available caregiver—an advantage where family structures have been destroyed or separated. An intermediate tier of school-based and group-delivered programs such as Teaching Recovery Techniques and Writing for Recovery shows more variable results: an individual participant data meta-analysis of focused psychosocial interventions in low-resource humanitarian settings found overall benefit for PTSD symptoms, functional impairment, hope, coping, and social support, but the improvement in PTSD symptoms was concentrated among adolescents aged 15 to 18, non-displaced children, and children in smaller households—subgroups showing least benefit are frequently the ones humanitarian programs are designed to reach. A third tier of creative arts modalities, caregiver-focused parenting interventions, and community-level activities such as child-friendly spaces rests on a thinner evidence base but is widely implemented for acceptability, reach, and low delivery cost.

The authors argue that these considerations favor stepped and layered delivery, in which non-specialist and group-based approaches provide broad coverage while scarce specialist capacity is reserved for children with severe or persistent impairment—an approach consistent with the WHO–UNHCR mhGAP Humanitarian Intervention Guide but not yet adequately tested at scale. Cultural adaptation introduces further tension: surface adaptations such as translation and locally contextualized examples are routinely undertaken and do not appear to compromise effects, whereas deeper adaptations to explanatory models of distress, help-seeking norms, and the acceptability of narrating traumatic experience aloud are less often documented and almost never evaluated as adaptations in their own right. Implementation constraints in active conflict compound both problems: attrition from renewed displacement, insecurity for participants and providers alike, absent referral pathways for children who deteriorate during treatment, and humanitarian funding cycles that end programs before gains consolidate. Even where effective interventions exist, the treatment gap remains profound—in many low- and middle-income countries hosting most displaced children, child and adolescent mental health specialists number in the single digits per million population, and dedicated child-focused services within humanitarian responses are routinely under-prioritized and under-funded relative to physical health and shelter.

The review’s conclusion is a call for a fundamental shift away from narrow, deficit-focused, single-modality approaches toward a sustained, interdisciplinary, and rights-based response embedded within schools, families, healthcare systems, and child protection frameworks. Mental health and psychosocial support must be treated as a core component of humanitarian response rather than an optional add-on, with dedicated funding lines, indicators, and accountability mechanisms aligned with the Inter-Agency Standing Committee guidelines and Sphere standards. Durable solutions for displaced children—safe family reunification, regularized legal status, school enrollment, and economic inclusion of caregivers—are themselves mental health interventions, and policies that prolong precarity should be recognized as health-harming. Closing the evidence gaps will require prospective longitudinal cohorts tracking developmental trajectories from acute exposure through adulthood and across generations, culturally validated assessment tools, pragmatic trials of stepped-care and task-shifted interventions at scale, and participatory research that meaningfully involves children, adolescents, caregivers, and affected communities in defining priorities. The authors stress that resilience is supported through sustained investment, allowing war-affected children not only to survive, but to heal and thrive.

Subject of Research: Psychological impact of armed conflict and forced displacement on children and adolescents

Article Title: Psychological impact of armed conflict and forced displacement on children and adolescents

Article References: Masoomi, M., Saeidi, M., Salehi, M., Prasad, S., Alzein, O., Roy, D., Joshi, M., & Gunturu, S. (2026). Psychological impact of armed conflict and forced displacement on children and adolescents. Frontiers in Child and Adolescent Psychiatry, 5, Article 1912159. https://doi.org/10.3389/frcha.2026.1912159

Image Credits: AI Generated

DOI: 10.3389/frcha.2026.1912159

Keywords: Psychological, impact, armed, conflict, forced, displacement, children, adolescents, scientific research