Current Psychiatry Reports (2024) 26:222–228

https://doi.org/10.1007/s11920-024-01496-2

Psychological Problems in the Context of Political Violence in

Afghan Children
Laura Jobson1 · Daniel McAvoy2 · Sayed Jafar Ahmadi3

Accepted: 27 February 2024 / Published online: 2 April 2024

© The Author(s) 2024

Abstract
Purpose of Review This review provides an overview of recent literature examining psychological problems in the context
of political violence among Afghan children.
Recent Findings Using recent literature (2018–2023) we identified: 1) heightened levels of psychological problems expe-
rienced by children in Afghanistan; 2) the factors associated with these psychological problems, including loss of family
and community members, poverty, continuous risk of injury and death, gender, substance use, war, daily stressors, and poor
access to education; 3) psychological problems have potentially worsened since the 2021 political changes; 4) conflict and
poverty have resulted in violence against children being a serious issue; 5) emerging psychological interventions have been
adapted to Afghan contexts; and 6) there is a desperate need for psychological assistance and further research in the region.
Summary All children in Afghanistan have experienced conflict and political violence. While children are not responsible
for this conflict, it has impacted their mental health. Further research is needed to examine the development and evaluation
of interventions.

Keywords Trauma · Violence · Children · Afghanistan · Adolescent · Youth

Introduction 5, 8, 9]. Compounding matters, in August 2021, Western

Afghanistan has endured over four decades of political vio-
lence, poverty and social injustice [1, 2] and in 2023 was
ranked the least peaceful country in the world for the eighth
consecutive year [3]. Generations of Afghans, and indeed
every child presently in Afghanistan, have experienced the
impacts of war and conflict [4•, 5]. Children – who make up
more than half of the population in Afghanistan [4•] – are
not responsible for political conflict and war, but generally
suffer the most [6, 7]. Conflict and violence have had sig-
nificant impacts on the mental health of Afghan children [2,
* Laura Jobson
Laura.Jobson@monash.edu
* Sayed Jafar Ahmadi
jahmadi@bard.edu
1
Turner Institute for Brain and Mental Health and School
of Psychological Sciences, Monash University, Clayton,
VIC 3800, Australia
2
Centre for Humanitarian Leadership, Deakin University,
Melbourne, VIC, Australia
3
Psychology Faculty, Bard College, New York, NY, USA
forces withdrew and the world watched on as the Taliban
regained control of Afghanistan. The media and the United
Nations were quick to report that “The needs of children
of Afghanistan have never been greater” [10]; “Children
and adolescents are struggling with anxieties and fears, in
desperate need of mental health support” [11] and “Afghan
children are growing up in deprived environments… [and]
are in grave need of mental health support” [12]. Thus, ques-
tions rapidly arose regarding the current mental health of
Afghan children.
Since 2021, the humanitarian situation in Afghanistan
has worsened [3] and many questions related to the current
mental health of Afghan children remain. Conflict related
deaths have declined [3]. However, psychological impacts
on the mental health of Afghan children in the context of
endemic political violence remain significant. Empirically
addressing these questions is an imperative as child men-
tal health has been identified as a humanitarian priority
[13–15] and the needs of children in humanitarian settings
continue to receive insufficient attention in the field of psy-
chology and psychiatry [16]. This review therefore aimed
to provide a current overview of recent literature examining

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Current Psychiatry Reports (2024) 26:222–228
psychological problems, in the context of political violence,
in Afghan children. We defined children and adolescents
as those aged 0–24 years [17]. First, we outline the main
psychological problems experienced by Afghan children
and adolescents. Second, we provide a review of the recent
literature examining these psychological problems. Third,
we offer personal observations, based on our work. Finally,
we provide a conclusion with recommendations.
Main Psychological Problems Experienced
by Children in Afghanistan
A significant proportion of the Afghan population experi-
ence posttraumatic stress disorder (PTSD), depression and
anxiety [2]. Conflict and insecurity continue to have negative
impacts on children’s mental health in Afghanistan [2, 6,
7]. While the World Health Organization notes adolescents
globally may encounter mental health disorders at a rate of
13% [18], research continues to indicate poor mental health
and heightened psychological distress among Afghan chil-
dren [19]. In one of the earliest investigations, Panter-Brick
and colleagues [8] found that two thirds of Afghan children
reported frequently experiencing trauma and among their
sample 22·2% met the criteria for a probable psychiatric dis-
order, 18.0% met criteria for emotional concerns, 4.8% met
criteria for conduct problems, and 23.9% met criteria for
PTSD. Additionally, psychiatric problems were associated
with female gender and PTSD symptoms were associated
with caregiver mental health, exposure to five or more trau-
matic events and child age [8]. More recent studies, have
similarly demonstrated a significant proportion of Afghan
youth are at substantial risk of psychiatric problems, PTSD,
depression, and anxiety [19, 20•]. Thus, it is important to
examine the current state of the literature relating to psycho-
logical problems in the context of political violence among
Afghan children.
Summary of Recent Literature Relating
to Psychological Problems Among
Afghan Children
While it was not the aim of this article to conduct a system-
atic review, we used several databases (Psycinfo, Medline)
and specified search terms (‘Afghan’, ‘Afghanistan’ ‘child/
ren’, ‘adolescent’, ‘youth’) to examine current literature
assessing psychological problems experienced by Afghan
children. We limited our search to articles published within
the past five years (2018–2023) and focused on psychologi-
cal problems of children living in Afghanistan. We identi-
fied six main areas of focus; 1) prevalence of psychological
problems, 2) factors associated with psychological problems,
223
3) impacts of the Taliban, 4) violence against children, 5)
psychological interventions adapted to Afghan culture and
contexts, and 6) need for psychological support, assistance
and interventions. These are discussed in turn below.
Prevalence of Psychological Problems
Afghan children and adolescents are experiencing height-
ened levels of distress. Recent assessments suggest that over
30% of Afghan children have had exposure to psychological
distress [4•]. Prevalence of single and multiple psychologi-
cal trauma and distress among adolescents is around 28%
[21]. A recent review, highlighted youth in particular were
at greater risk for mental health problems and psychological
distress [22•]. Children and adolescents are struggling with
anxiety, fear, PTSD and depression [3, 23•, 24], which are
causing severe negative outcomes [24]. Among a sample of
school aged children (N = 2707) in eight regions of Afghani-
stan, a total of 52.75% of children were experiencing psy-
chological difficulties, 39.19% emotional difficulties, 51.98%
conduct challenges, and 15.37% hyperactivity/inattention
[25]. Additionally, peer relationship problems were high
and these psychological problems were impacting daily life
[25]. Najm and colleagues [26], whilst establishing a child
and adolescent mental health service in Herat, observed high
prevalence of psychological disorders amongst those chil-
dren and adolescents who presented to the clinic (N = 2448)
over a three-year period. Epilepsy (34.0%) and intellectual
disability (15.1%) were the two most common disorders,
followed by depression (12.9%), and anxiety (12.5%). The
least common disorders were psychotic disorder (1.8%),
obsessive–compulsive disorder (1.5%) and speech disor-
ders (0.9%). Some studies have highlighted post-traumatic
growth (enhanced hope, spiritual wellbeing) achieved by
Afghan adolescents over time [27]. Nevertheless, despite
these findings, review articles have highlighted that evidence
on prevalence rates of mental health disorders in Afghani-
stan is limited [28, 29].
Factors Associated with Psychological Problems
Several factors have been associated with the heightened
levels of psychological problems experienced by Afghan
children and adolescents. These include loss of parent, fam-
ily and community members (particularly if death was trau-
matic) [4•, 27], constant risk of death and injury, lack of
social support [4•], decades of chronic socioeconomic health
crises [24], being female [5, 21], substance use, bullying
victimization, the experience of hunger, truancy [21] and
exposure to terrorist attacks [25]. Additionally, being the
first-born child of the family, daily stressors and greater war
exposure have negative impacts on mental health [5]. Sev-
eral studies focused on the impacts of gender. For instance,
224
girls, when compared to boys, have been found to present
with higher rates of anxiety, depression and daily stressors,
while boys presented with greater rates of war experiences
[5], conduct problems and total psychiatric difficulties [25].
School attendance has been associated with the mental
health of Afghan children [25]. Among 2,707 school-aged
children living in eight regions of Afghanistan, those who
attended school were less likely to have emotional difficulties
but were more likely to have problems with peer relation-
ships [25]. Blum and colleagues found adolescents reported
highly valuing education but believed boys to benefit more
from education than girls [30]. Over 90% of parents reported
that they expected their children to complete at least second-
ary education, regardless of the child's gender [30]. Trani
and colleagues [31] examined whether an active education
policy in Afghanistan promoting inclusion since 2005 had
been effective. They found access to school and literacy did
not improve between 2005 and 2013 for children and youth
with disabilities (i.e., physical, sensory, mental), particu-
larly for girls with disabilities. They also found evidence to
indicate that school attendance might play a protective role
for children with disabilities in Afghanistan. Thus, school
attendance is important for children's mental health, across
genders. Removing current restrictions on school attendance
imposed since August 2021, particularly for girls, should be
a priority in Afghanistan [25].
Impacts of the 2021 Political Changes
Several studies specifically focused on the impacts of the
2021 political changes in Afghanistan on child and adoles-
cent mental health. There have been additional challenges
associated with these political changes. The majority of
youth noted frustration with the security situation in Afghan-
istan [5]. The humanitarian crisis in Afghanistan worsened
after the US and international allies withdrew [1]. Almost
60% of Afghans have been forced to flee their homes, chil-
dren are facing life-threatening malnutrition, and many chil-
dren have been separated from their families [23•]. Ahmadi
and colleagues [20•] examined mental health among adoles-
cents in the months following the changes in government in
2021. Of their sample (N = 376), 28.2% were at substantial
risk for psychiatric problems and approximately half met
criteria for probable PTSD, depression, or anxiety. Among
girls, 47.5% were at considerable risk of having psychiatric
problems (vs 14% of boys) and more girls (vs boys) met cri-
teria for probable diagnosis of PTSD (79% vs 31%), depres-
sion (79% vs 26%), and anxiety (78% vs 21%). Younger age
was associated with greater likelihood of probable psychi-
atric disorders [20•]. These statistics are generally higher
than that observed in previous studies [8], indicating poten-
tial greater psychological problems among Afghan youth in
recent years [20•].
Current Psychiatry Reports (2024) 26:222–228
Violence Against Children
In the context of decades of poverty and conflict, violence
against children in Afghanistan is a concern, with children
being exposed to multiple forms of violence in the family,
school and community [32–34]. Among a community sam-
ple (N = 145), 71% of children reported having experienced
physical violence in the past year, with home being the
most likely site in which the violence occurred, and physi-
cal violence being used as a means of discipline [33]. Com-
munity leaders, professional groups, and business owners
in three Afghan districts (Kabul, Jalalabad and Torkham)
perceived violence against children to be attributed to lack
of education, poverty, and the impacts of war, with decades
of poverty and armed conflict influencing how violence is
recognized and perceived [34]. Corboz et al. [32] explored,
among school children in Afghanistan, the prevalence of
peer violence and associated factors. They recruited 770
children in 11 schools in Jawzjan province into a baseline
study, which was part of an evaluation of a school-based
peace education intervention. In their sample, 49.7% of boys
and 43.3% of girls reported experiencing violence victimiza-
tion at least once in the past month, and 17.6% of girls and
31.7% of boys reported perpetrating violence at least once
in the past month, with significant overlaps between experi-
ences of perpetration and victimization.
Peer violence was associated with food insecurity, child
exposure to witnessing violence in the family, and child’s
experience of corporal punishment at school and physical
violence at home [32]. Li and colleagues [35] found a minor-
ity of adolescents endorsed violence, reported that specific
circumstances justified violence (e.g., parents hitting chil-
dren) and around a quarter approved of threatening a child
if they spoke out against harmful traditional practices. Thus,
while advocating for physical violence is socially unaccep-
table, under some conditions violence may be perceived by
some as justified [35].
Child marriage is globally recognized as violating
human rights and can impact mental health [24]. A study
conducted in six Afghan provinces with low educational
enrolment, found that, among their sample of 910 adoles-
cents (12–15 years), both boys and girls believed marriage of
girls under age 18-years increased risks of domestic violence
[30]. Qamar and colleagues [36] used nationally representa-
tive data collected by the Demographic and Health Surveys
to examine the relationship between family violence and
child marriage in Afghanistan. They found in their sample
(N = 21,324) that 15% of participants were married under the
age of 15 and 35% were married between 15 and 17 years of
age. After adjusting for age, place of residence, and socioec-
onomic status, the odds of sexual violence were 22% higher
among women who married under 15 years of age compared
to those were married as adults [24]. Dadras et al. [37] found
Current Psychiatry Reports (2024) 26:222–228
in their study that over half of the Afghan women aged 15
to 49 years experienced intimate partner violence in the past
year. Illiteracy and living in rural areas were associated with
a higher risk and there was an elevated risk of mortality and
morbidity among those under five years of age born to moth-
ers exposed to intimate partner violence.
Psychological Interventions adapted to Afghan
Culture and Contexts
A small but expanding body of research is developing in the
area of psychological interventions adapted for Afghan cul-
ture and contexts [22•]. A few recent studies have reported
on the use of pharmacotherapy (i.e., anti-epileptics, anti-
depressants, anti-psychotics, mood stabilizers) and psycho-
logical interventions (i.e., counseling, psychoeducation,
cognitive-behavioral therapy, play therapy, group therapy,
parenting interventions, speech therapy and applied behav-
ior analysis) among children and adolescents in Afghani-
stan [26]. Corboz and colleagues [32] evaluated a school-
based peace education and a community-based intervention
to modify social norms and practices relating to violence
in conflict resolution. They found that following the inter-
vention there were significant reductions in violence at the
school level (including peer violence perpetration, corporal
punishment by teachers and peer violence victimization).
Additionally, there were significant reductions in observa-
tions of family violence and experiences of corporal pun-
ishment at home, with a particularly strong effect found for
girls. Both girls and boys had significantly more equita-
ble attitudes towards gender and less violence-supportive
attitudes relating to children's punishment, and significant
reductions in symptoms of depression. Girls' school attend-
ance also improved [32]. Their evaluation indicated the
intervention has the potential to reduce various forms of
violence [32].
Several interventions have targeted trauma and PTSD
among Afghan adolescents. Ahmadi and colleagues [38]
assessed the efficacy, feasibility and acceptability of modi-
fied written exposure therapy (m-WET) in treating PTSD
symptoms among Afghan adolescent girls following a terror-
ist attack. Afghan adolescent girls were randomly assigned
to m-WET (i.e., five daily group sessions whereby adoles-
cents wrote about the terrorist attack), trauma-focused cog-
nitive behaviour therapy (TF-CBT; an intensive five-session
group psychological intervention), or a control group (which
had no further contact). Acceptability and facilitator and
participant satisfaction with m-WET was relatively high. At
post-intervention, the m-WET group had significantly lower
PTSD symptom severity compared to the control group
and these gains were maintained at three-month follow-
up. Moreover, there was no significant difference between
the m-WET and TF-CBT groups. These findings indicate
225
m-WET may have promise as a psychological intervention
for PTSD among adolescent girls in Afghanistan [38].
Ahmadi and colleagues [39•] investigated the efficacy of
Memory Training for Recovery–Adolescent (METRA) in
improving mental health among adolescent girls in Kabul.
The adolescents allocated to METRA received a 10-session
group-intervention comprised of two modules (module 1:
memory specificity training; module 2: trauma writing).
Those in the treatment as usual (TAU) group received 10
adolescent health sessions. At post-intervention the METRA
group had fewer symptoms of PTSD, depression, anxiety
and psychiatric difficulties than those in the TAU group.
These improvements continued to be observed at three-
month follow-up. This trial was conducted in the months fol-
lowing the political changes in Afghanistan in 2021. Despite
this presenting several difficulties for conducting the study
as planned, METRA was able to be delivered to adolescents
by facilitator with minimal training. Next, Ahmadi and col-
leagues [40] examined the feasibility, acceptability, and
efficacy of METRA in improving psychological symptoms
among Afghan adolescent boys in the aftermath of a ter-
rorist attack. Again, they found that those offered METRA
had significantly greater reductions in symptoms of PTSD,
depression, anxiety, Afghan-cultural distress and psychiatric
difficulties than did those in the control group. Additionally,
those who completed METRA reported satisfaction with the
intervention. However, it is worth noting that in this study,
there were challenges in youth participation relating to secu-
rity and competing education demands. Therefore, with
some modifications, METRA appears a feasible psychologi-
cal intervention for adolescents in Afghanistan [39•, 40].
Desperate Need for Psychological Support,
Assistance and Interventions
Finally, studies noted the desperate need for psychological
support, assistance and interventions [4•, 41•]. There are
very few studies investigating psychological interventions
among Afghan children and adolescents, and the evidence
produced is generally low quality [2]. Therefore, there is
an urgent need for culturally appropriate innovative psy-
chological interventions [2]. There is an urgent need for
psychological training, the promotion of mental health ser-
vices, public health awareness campaigns, and initiatives to
assist re-connecting with family and loved ones [24], with a
consideration of innovative systems-level approaches [42].
There is a need for immediate action plans from government
and public health officials [24]. It is imperative that psy-
chological research and the development of psychological
interventions continues in Afghanistan, as the complexities
of conducting research and delivering interventions reflect
the reality of these contexts [39•, 40]. Afghan children and
adolescents are needing, and deserving, of evidence-based
226
psychological interventions, service delivery and psycho-
logical support [39•, 40].
Personal Observations
In conducting the above review, it became apparent that
few articles have focused on the mental health of children
and adolescents in Afghanistan. This is problematic given
the immense poverty, conflict and political violence experi-
enced by children and adolescents in Afghanistan – poten-
tially some of the highest rates experienced by children
globally. Additionally, using our search terms, many of the
studies focused on Afghan refugees resettled in high-income
countries or the children of US veterans who had served
in Afghanistan. This again highlighted a concerning gap in
research; few studies have examined the prevalence of psy-
chological problems, factors associated with these problems
and the development and evaluation of psychological inter-
ventions for children and adolescents in Afghanistan. Again,
this stands in contrast to the immense research on these top-
ics among high-income countries – regions in which youth
are experiencing immeasurably less poverty, war and politi-
cal violence. This imbalance is exceptionally problematic
and draws attention to the urgent need for greater research
in this area to inform practice and policy.
Over the past few years our team has conducted several
trials in Kabul, Afghanistan examining psychological inter-
ventions for adolescents with PTSD. In this work, we had a
clearly structured, registered trial to be conducted in Kabul
and Herat. However, just prior to our study commencing,
the US and its allies withdrew from Afghanistan and the
Taliban regained control. It is hard to articulate our feelings
as we witnessed communities and research teams, whom
we had worked closely with for decades, being at risk and
the political, health and education systems quickly unravel-
ling. We contemplated ceasing our work. However, based
on discussions with community, we were urged to continue.
Very few adolescents in Afghanistan receive mental health
interventions due to limited health services, high costs, and
a shortage of skilled mental health professionals [39•, 40].
Moreover, once the US and its allies withdrew, almost all
mental health agencies ceased providing services in Afghan-
istan. Thus, to ensure some psychological interventions were
being made available to youth, we continued our work. In
continuing our work, we significantly shifted our design
(e.g., shortening assessment sessions and treatment deliv-
ery). This highlighted to us the flexibility needed when con-
ducting research and delivering an intervention in humani-
tarian contexts. We also ensured all interventions could be
sustained and delivered beyond the life of the project.
Based on clinical observations, due to the prohibition
of adolescent girls attending school by the Taliban and the
Current Psychiatry Reports (2024) 26:222–228
restriction of mental health projects, it seems the psychologi-
cal problems of adolescent girls have intensified. In individ-
ual and occasional group counseling sessions in early 2023,
it was observed that girls deprived of education were experi-
encing high levels of depression, and suicidal thoughts were
present. Reports on social media indicate suicide attempts,
especially among women who have been liberated from Tal-
iban abuse and torture. Many girls contemplating suicide
have mentioned that, firstly, suicide is considered a grave and
unforgivable sin in Islam, and secondly, they refrain from it
to preserve the honour of their families.
Another concern expressed by adolescent girls is forced
marriage. After the ban on attending school and the encour-
agement by the Taliban for early marriages, families are
inclined to marry off their daughters at an early age. Parents,
sometimes due to poverty or fear of the Taliban, are will-
ing to arrange early marriages for their daughters. Another
concern related to forced marriage and the prohibition of
education is that it creates conditions for human traffick-
ing, especially sex trafficking. In a study by Saramad and
Ahmadi [43] on the areas and causes of trafficking of women
and children, one of the most significant factors was forced
marriage. When teenage girls are not allowed to go to school
and are pressured by the.
Taliban and their families into early marriages, it becomes
a conducive environment for human trafficking. The fear of
forced marriage and the lack of education may trap girls in
human trafficking; human trafficking option may offer an
escape from forced marriage or perceived opportunities to
continue education outside of Afghanistan.
Conclusion
In conclusion, each child born and raised in Afghanistan
has experienced impacts of political violence and conflict
[5]. Children, while not responsible for political conflict and
war, generally suffer the most [6, 7]. Conflict and violence
have had significant negative impacts on the mental health
of Afghan children. Prevalence studies indicate heightened
psychological problems among Afghan children and ado-
lescents, but also highlight a lack of research in this area.
Factors associated with heightened levels of psychologi-
cal problems include distress due to the persistent threat of
injury and death, loss of family and community members,
lack of social support, chronic socioeconomic health crises
and poverty, gender, substance use, violence and war, daily
stressors and poor access to education. There have been
additional hardships following the changes in government in
2021, which have had further detrimental effects on mental
health. In the context of decades of entrenched conflict, and
a deteriorating humanitarian situation, violence against chil-
dren and adolescents in the family and in the community is a
Current Psychiatry Reports (2024) 26:222–228
serious issue. Emerging research indicates potential success
of culturally-informed low-intensity psychological interven-
tions. Yet, there remains a desperate need for further psy-
chological research, support, assistance and interventions.
Funding Open Access funding enabled and organized by CAUL and
its Member Institutions
Declarations
Conflict of Interest Laura Jobson, Daniel McAvoy, and Sayed Jafar
Ahmadi each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent This article does not
contain any studies with human or animal subjects performed by any
of the authors.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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