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.
Click Here to View Abstract

Written by: Peter M Crosta