In one of the very few studies of children during actual exposure to war conditions, Maureen Allwood, Debora Bell-Dolan, and Syed Arshad Husain (2002) assessed 791 Bosnian children during the siege of Sarajevo.

Interviewers obtained children’s scores on the PTSD Reaction Index, the War Experience Questionnaire, the Impact of Events Scale, and the Children’s Depression Inventory. Teachers completed the Bosnian version of the Teacher’s Report Form (TRF). The largest correlations found for specific wartime experiences with any psychological or behavioral measures were between being threatened with direct violence and TRF Anxious/Depressed scores and also between witnessing killing and TRF Delinquent Behavior (now called Rule-Breaking Behavior) scores.

Furthermore, children who were not exposed to direct violence, deprivation, or relocation obtained significantly lower scores on all TRF scales than children who were exposed to violence, deprivation, or relocation. Children with the largest number of violent trauma experiences obtained significantly higher scores on the TRF Anxious/Depressed, Somatic Problems, and Delinquent Behavior syndromes than other children. However, children who had the most numerous nonviolent trauma experiences obtained significantly higher scores than other children on the TRF Withdrawn syndrome. Because not only direct exposure to violence but indirect exposure and exposure to nonviolent deprivation were associated with higher TRF problem scores, the authors concluded that “. . . children may be best served by efforts to reduce the compounded effects of multiple traumas.

For example, reducing exposure to indirect violence, such as graphic media coverage of war atrocities, and providing comfort from fears of starvation and freezing, may be functionally as helpful to children’s adjustment as reducing their direct exposure to violence” (p. 457).

Reference: Allwood, M.A., Bell-Dolan, D., & Husain, S.A. (2002). Children’s trauma and adjustment reactions to violent and nonviolent war experiences. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 450-457.