Compared to children in Nepal who were not forced into military
service, former child soldiers were more likely to present severe
mental health problems such as symptoms of posttraumatic stress
disorder (PTSD) and depression. These findings are reported in the
August 13 issue of JAMA.
As children continue to be exploited by armed groups all over the
world, special mental health interventions for child soldiers are ever
more necessary. There is, however, a paucity of research that
is dedicated to studying the mental health of child soldiers in armed
conflicts. For several reasons, civilian children are more accessible
than child soldiers.
Researcher Brandon A. Kohrt (Emory University, Atlanta) and colleagues
set out to determine the mental health effects of both child soldiers
and children who were never forced into military service. The sample
consisted of 141 former child soldiers and 141 never-conscripted
children in Nepal between March and April 2007. The children were
matched on age, sex, education, and ethnicity, and all participants
experienced at least 1 type of trauma. The former child soldiers were
between 5 and 16 years old at time of conscription, and the average age
of study participants was about 15.75 years old at the time of the
study.
Kohrt and colleagues found that 75 of the child soldiers (52.3%) met
the symptom cutoff score for depression, 65 (46.1%) met the score for
anxiety, 78 (55.3%) met the criteria for PTSD, 55 (39%) met
the criteria for general psychological difficulties, and 88 (62.4%)
were functionally impaired. Statistically adjusting for traumatic
exposures and other possibly confounding variables held that being a
child soldier was significantly associated with depression and PTSD
among girls (2.4 and 6.8 times higher odds, respectively) and PTSD
among boys (3.8 times higher odds). However, there was no statistical
association between being a child soldier and general psychological
difficulties, anxiety, or function impairment.
The authors note that, "The difference in mental health outcomes
between child soldiers and never-conscripted children can be explained
in part by greater exposure to traumatic events among child soldiers,
especially for general psychological difficulties and function
impairment."
"The study has several clinical and programmatic implications. First,
the greater burden of mental health problems among former child
soldiers supports the need for focused programming, which should
include, but not consist solely of, interventions to reduce depression
symptoms and the psychological sequelae of trauma, especially bombings
and torture, as well as incorporate belongingness and income
generation. Second, girl soldiers may require focused attention,
possibly for factors not addressed in this study, such as problems of
sexual violence and reintegration difficulties. Third, the variation in
type and severity of mental health problems highlights the importance
of screening, including locally developed measures of function
impairment, as a base for intervention," suggest the researchers.
They conclude: "Without screening there is a risk of pathologizing
child soldiers as a group rather than providing support to those
individuals most impaired. Finally, the presence of mental health
problems among never-conscripted children illustrates the need for
comprehensive postconflict community-based psychosocial care not
restricted only to child soldiers."
The Comparison of Mental Health Between Former Child Soldiers
and Children Never Conscripted by Armed Groups in Nepal
Brandon A. Kohrt, MA; Mark J. D. Jordans, MA; Wietse A. Tol,
MA; Rebecca A. Speckman, BA; Sujen M. Maharjan, BA; Carol M. Worthman,
PhD; Ivan H. Komproe, PhD
JAMA(2008).
300[6]: pp. 691-702.
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Written by: Peter M Crosta