Washington, DC, June 2, 2020 - A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that many of the former child soldiers of Sierra Leone have been accepted by their families and communities as they try to overcome their childhood trauma, according to a team led by Boston College School of Social Work Salem Professor in Global Practice, Theresa S. Betancourt.
The report that also included contributions by co-authors from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Harvard's T. H. Chan School of Public Health, and Child Trends of Bethesda, MD, USA, and reported that it may take a greater focus on family- and community-based approaches to help former child soldiers achieve social reintegration.
Former child soldiers experience mental health problems as a result of their experiences, but acceptance from families and communities shapes the lives of these men and women and shows promise to help them to continue to improve emotionally and socially, according to the "Longitudinal Study of War-Affected Youth", which follows former child soldier into adulthood.
"Not only were child soldiers exposed to horrors during the war, but when they returned to their families and communities, stigma was one of the biggest barriers to overcome. We set out to study the effects of the post-war environment on these already-vulnerable youth," said Dr. Betancourt.
During the 11-year civil war, 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 subjected to repeated sexual and physical violence, forced use of alcohol and drugs, hard physical labor and acts of violence until the war ended in 2002.
Since 2002, researchers interviewed more than 500 former child soldiers periodically until 2016-2017, when the most recent assessment took place. The average age of the respondents was 28 in 2016-2017. Over 25 percent of respondents reported they had killed or injured others while conscripted; nearly half of the women surveyed and five percent of the men reported the experience of rape. Thirty-two percent reported the death of a parent.
"Sierra Leone's child soldiers experienced violence and loss on a scale that's hard to comprehend," said co-author Stephen Gilman of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
Nearly half the respondents detailed symptoms of anxiety and depression, with 28 percent suffering from symptoms of post-traumatic stress disorder at a level associated with clinical disorder.
A deeper examination of the respondents' lives - particularly the stigma they are subject to and the level of acceptance by family and community - led to the classification of three groups:
- A Socially protected group, nearly two-thirds of the respondents, reported they were not heavily stigmatized for their war involvement and had high levels of acceptance from their families and communities
- An Improving social integration group included respondents who in 2002 reported high levels of stigmatization and low rates of acceptance but have since reported a decrease in community stigma and increase in acceptance by families and communities. This group was largely female and more likely to have been raped.
- A Socially vulnerable group, whereby roughly 10 percent of the respondents were highly stigmatized and had low family and community acceptance. This group was largely male, spent more time in fighting forces and were more likely to have killed (or injured) others during the war.
Those in the Improving social integration group made gains, though they reported problems such as getting in trouble with local police. In contrast, members of the Socially vulnerable group showed many indicators of concern compared to the Socially protected group, including: 1) they were about twice as likely to experience high levels of anxiety and depression; 2) they were three times more likely to have attempted suicide; and 3) they were over four times more likely to have been in trouble with the police.
The authors concluded that efforts to address family and community relationships with particular attention to improving social supports and reducing stigma remain critical ingredients of interventions to help former child soldiers adapt and thrive in their post-conflict lives. "There is healing power in the relationships young people build in their families and communities," said Dr. Betancourt. "What these latest findings indicate is that just as much attention should be paid to family and community relationships as to the traumatic events of their past. Efforts to alleviate mental health problems, enhance opportunities and improve life outcomes for former child soldier need to focus much more on family and community relationships."
Co-author and statistician, Robert T. Brennan added that, "Conducting a study like this over so many years in Sierra Leone is a real challenge. Addresses are approximate, birthdays, even ages, are often unknown, and natural disasters displace whole communities. For instance, we had to postpone data collection due to the Ebola outbreak of 2014-2015."
The authors state further research is needed because the study design did not allow them to establish a causal link between stigma and poor mental health outcomes. However, the study suggests change is possible.
"Because this study follows a single cohort of former child soldiers - some as young as 10 years old - into young adulthood, it is certain to be a landmark in the study of the exploitation of children by armed groups," said Boston College School of Social Work Dean Gautam N. Yadama.
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Notes for editors
The article is "Stigma and Acceptance of Sierra Leone's Child Soldiers: A Prospective Longitudinal Study of Adult Mental Health and Social Functioning," by Theresa S. Betancourt, ScD, Dana L. Thompson, PhD, Robert T. Brennan, EdD, Cara M. Antonaccio, MSPH, Stephen E. Gilman, ScD, and Tyler j. VanderWeele, PhD (https://doi.org/10.1016/j.jaac.2019.05.026). It appears in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 59, issue 6 (June 2020), published by Elsevier.
Dr. Betancourt is the Salem Professor in Global Practice at the Boston College School of Social Work and Director of the Research Program on Children and Adversity. Her central research interests include the developmental and psychosocial consequences of concentrated adversity on children, youth and families; resilience and protective processes in child and adolescent mental health and child development; refugee families; and applied cross-cultural mental health research.
Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at support@jaacap.org or +1 202 587 9674. Journalists wishing to interview the authors may contact Theresa S. Betancourt, ScD, at rpcalab_ssw@bc.edu.
About JAACAP
Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.
The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families. http://www.jaacap.org
About Elsevier
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