Background: Trauma from witnessing events such as bombings and killings as well as direct victimization or
participation in violence has been associated with psychosocial distress and poor mental health among war-exposed
children and adolescents. This study examines the relationship between caregiver mental health and child
internalizing (anxiety and depression) symptoms over a 4-year period in postconflict Sierra Leone. Methods: The
sample included 118 adolescent Sierra Leonean youth (73% male; mean age = 16.5 years at Time 1) and their
caregivers (40% male; mean age = 39.0 at Time 1). To measure depression and anxiety symptoms, the Hopkins
Symptom Checklist–25 was used with adults and the Oxford Measure of Psychosocial Adjustment – previously
validated for use with children and adolescents in the region – was used to assess youth. A multivariate hierarchical
linear model (HLM) for studying change within dyads was implemented to study covariation in internalizing
symptoms among caregivers and youth over time; these models also included covariates at the individual, family and
community levels. The relationship of caregiver mental health to child’s internalizing was tested in a latent variable
extension of the HLM. Results: The latent variable extension estimated that a one standard deviation (SD) change in
caregiver anxiety/depression was associated with a .43 SD change in youth internalizing (p < .01) over the 4-year
period. Family acceptance was negatively related to youth internalizing (p < .001), while community stigma was
positively associated (p < .001). Conclusions: The findings highlight an important interplay between caregiver and
child mental health within the postconflict setting and the need for psychosocial interventions to extend beyond the
individual to account for family dynamics. Keywords: War, depression, anxiety, intergenerational, dyadic analysis.