Emotion regulation and PTSD risk among internally displaced Sudanese children: a community-based cross-sectional study

Abstract

Internally displaced children are among the most vulnerable populations affected by armed conflict, often enduring psychological trauma that may lead to emotional dysregulation and post-traumatic stress disorder [PTSD]. This study aimed to assess emotion regulation among internally displaced children in Sudan and evaluate its relationship with PTSD symptoms. A cross-sectional, community-based study was conducted between July and September 2024, including 703 internally displaced children aged 8–18 across five Sudanese cities. Data were collected through structured caregiver-reported and child-reported instruments, including the Children’s Emotional Management Scales [CEMS] and the Children’s Revised Impact of Event Scale [CRIES-8]. Associations between emotion regulation subscales and PTSD symptoms were statistically analyzed using Wilcoxon Rank Sum, Welch’s Anova, and Chi-square tests, followed by multivariable logistic regression to identify independent predictors of PTSD. The prevalence of PTSD symptoms was 74.4%, with the highest rates observed in Atbara and Al-Gedaref states. In bivariate analysis, anger dysregulation was significantly associated with gender ( p = 0.002), and significantly lower among children with PTSD symptoms ( p = 0.007). In multivariable analysis, children whose mothers were free workers or unemployed had 4.6-fold and 3.3-fold higher odds of PTSD ( p < 0.001), respectively, compared to children of employed mothers. Children originally from outside Khartoum had 2.9-fold higher odds of PTSD ( p = 0.004), and those currently residing in Atbara and Gedaref had 3.1-fold ( p <0.001) and 2.8-fold ( p = 0.012) higher odds, respectively, compared to Port Sudan. Despite considerable emotional distress, children demonstrated relatively preserved coping strategies, especially in sadness regulation. This study reveals a high prevalence of PTSD symptoms among internally displaced Sudanese children, with emotional dysregulation and inhibition posing risks for long-term mental health. These findings highlight the urgent need for culturally sensitive, scalable mental health interventions that promote emotional expression and caregiver involvement. Integrating school- and community-based psychosocial support programs into humanitarian response frameworks in displacement settings is critical to mitigate long-term mental health consequences among affected children.