Family, community bonds help decrease mental health problems of former child soldiers

NIH-funded study documents transition to adulthood of Sierra Leone’s child soldiers.

Acceptance and support from communities and families appear to lessen the toll of mental health conditions experienced by former child soldiers transitioning to early adulthood, according to a study by researchers at the National Institutes of Health and other institutions. The study appears in the Journal of the American Academy of Child and Adolescent Psychiatry.

When civil war broke out in Sierra Leone in 1991, several warring factions abducted children and forced their involvement in armed groups. An estimated 15,000 to 22,000 boys and girls of all ages were subject to repeat sexual violence, forced use of alcohol and drugs, hard physical labor, and acts of violence until the war ended in 2002.

“Sierra Leone’s child soldiers experienced violence and loss on a scale that’s hard to comprehend,” said study author Stephen Gilman, Sc.D., chief of the Social and Behavioral Sciences Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Our study provides evidence that there may be steps we can take to modify the post-war environment to alleviate mental health problems arising from these experiences.”

The study’s first author, Theresa S. Betancourt, Sc.D., of the Boston College School of Social Work in Chestnut Hill, was funded by NICHD’s Child Development and Behavior Branch.

According to the study authors, former child soldiers may face rejection from family and their communities, along with physical injuries and psychological trauma. Previous studies have found former child soldiers have high rates of post-traumatic stress disorder, anxiety and depression.

To conduct the study, researchers analyzed data from the Longitudinal Study of War-Affected Youth, a 15-year study of more than 500 former child soldiers who participated in Sierra Leone’s Civil War. Participants were interviewed four times (in 2002, 2004, 2008 and 2016 to 2017) about their involvement with armed groups, exposure to violence in the war, and about their family and community relationships after the war. Interviewers also asked participants a series of questions to gauge their mental health status and their psychological adjustment at multiple time points.

From the data, researchers were able to group the participants into three developmental trajectories:

A socially protected group, encompassing 66% of the study participants whose members were not heavily stigmatized for their war involvement and had high levels of acceptance from their families and communities. Members of this group also had lower levels of exposure to adverse war events.
An improving social integration group that was initially highly stigmatized and had low community and family acceptance when the study began in 2002, but showed a large decrease in stigma and increase in acceptance by 2004, with slight increases in stigma and acceptance after that. This group had a high level of exposure to war events, was more likely to have been female, and more likely to have been raped.
A socially vulnerable group that was highly stigmatized and had low family and community acceptance in 2002 and only marginal improvements in stigma and acceptance. Compared to the other groups, members of this group were more likely to be male, to have been in fighting forces for longer, and more likely to have injured or killed during the war.
Members of the socially vulnerable group were about twice as likely as those in the socially protected group to experience high levels of anxiety and depression. They were three times more likely to have attempted suicide and over four times more likely to have been in trouble with the police. Those in the improving social integration group had violence exposure similar to that of the socially vulnerable group but were not significantly more likely than the socially protected group to experience any negative outcomes, apart from a slightly higher level of trouble with police.

The authors concluded that efforts to increase social and family acceptance while reducing stigma remain important components of interventions to help former child soldiers adapt to post-conflict life. They added that, in addition to understanding the mental health conditions that may afflict former child soldiers, it is important to monitor their family and community relationships after the war.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit https://www.nichd.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Reference

Betancourt TS, et al. Stigma and acceptance of Sierra Leone’s child soldiers: a prospective longitudinal study of adult mental health and social functioning. Journal of the American Academy of Child and Adolescent Psychiatry 2019.