Research review: Psychosocial adjustment and mental health in former child soldiers - A systematic review of the literature and recommendations for future research

Journal of Child Psychology and Psychiatry and Allied Disciplines

Volumn 54, Issue 1, 2013, Pages 17-36

  Betancourt, Theresa S ^a   Borisova, Ivelina ^b   Williams, Timothy P ^c   Meyers Ohki, Sarah E ^a   Rubin Smith, Julia E ^d   Annan, Jeannie ^a   Kohrt, Brandon A ^e  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^b SAVE THE CHILDREN   (United States)

^c University of Bath   (United Kingdom)

^d BEN GURION UNIVERSITY OF THE NEGEV   (Israel)

^e GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE AND HEALTH SCIENCES   (United States)

Author keywords

child soldiers; resilience; risk factors; Violence; war

Indexed keywords

ADOLESCENT; CHILD; COPING BEHAVIOR; FEMALE; HUMAN; MALE; MENTAL HEALTH; POSTTRAUMATIC STRESS DISORDER; PREVALENCE; PSYCHOLOGICAL ASPECT; REVIEW; RISK FACTOR; SOCIAL ADAPTATION; SOCIAL SUPPORT; SOLDIER; VIOLENCE; WAR;

ADOLESCENT; CHILD; FEMALE; HUMANS; MALE; MENTAL HEALTH; MILITARY PERSONNEL; PREVALENCE; RESILIENCE, PSYCHOLOGICAL; RISK FACTORS; SOCIAL ADJUSTMENT; SOCIAL SUPPORT; STRESS DISORDERS, POST-TRAUMATIC; VIOLENCE; WAR;

EID: 84872850019     PISSN: 00219630     EISSN: 14697610     Source Type: Journal    
DOI: 10.1111/j.1469-7610.2012.02620.x     Document Type: Review

References (92)

1. Allden, K., Jones, L., Weissbecker, I., Wessells, M., Bolton, P., Betancourt, T.S.,. &, Sumathipala, A., (2009). Mental Health and Psychosocial Support in Crisis and Conflict: Report of the Mental Health Working Group.
2. Amone-P'Olak, K., (2005). Psychological impact of war and sexual abuse on adolescent girls in Northern Uganda. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 3, 33-45.
3. Amone P'Olak, K., Garnefski, N., &, Kraaij, V., (2007). The impact of war experiences and physical abuse on formerly abducted boys in northern Uganda. South African Psychiatry Review, 10, 76-82.
4. Annan, J., Blattman, C., &, Horton, R., (2006). The state of youth and youth protection in northern Uganda: Findings from the survey of war affected youth. New York: UNICEF.
5. Annan, J., Blattman, C., Mazurana, D., &, Carlson, K., (2011). Civil war, reintegration, and gender in northern Uganda. Journal of Conflict Resolution, 55, 877-908.
6. Annan, J., Brier, M., &, Aryemo, F., (2009). From "rebel" to "returnee": Daily life and reintegration for young soldiers in northern Uganda. Journal of Adolescent Research, 24, 639-667.
7. Bayer, C.P., Klasen, F., &, Adam, H., (2007). Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers. The Journal of the American Medical Association, 298, 555-559. (Pubitemid 47204939)
8. Betancourt, T.S., (2011). Attending to the mental health of war-affected children: The need for longitudinal and developmental research perspectives. [Editorial]. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 323-325.
9. Betancourt, T.S., Agnew-Blais, J., Gilman, S.E., Williams, D.R., &, Ellis, B.H., (2010). Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Social Science and Medicine, 70, 17-26.
10. Betancourt, T.S., Borisova, I.I., Brennan, R.B., Williams, T.P., Whitfield, T.H., de la Soudiere, M.,. &, Gilman, S.E., (2010). Sierra Leone's former child soldiers: A follow-up study of psychosocial adjustment and community reintegration. Child Development, 81, 1077-1095.
11. Betancourt, T.S., Borisova, I., de la Soudière, M., &, Williamson, J., (2011). Sierra Leone's child soldiers: War exposures and mental health problems by gender. Journal of Adolescent Health, 49, 21-28.
12. Betancourt, T.S., Brennan, R.T., Rubin-Smith, J., Fitzmaurice, G.M., &, Gilman, S.E., (2010). Sierra Leone's former child soldiers: A longitudinal study of risk, protective factors, and mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 606-615.
13. Betancourt, T.S., &, Ettien, A., (2010). Transitional justice and youth formerly associated with armed forces and groups in Sierra Leone: Acceptance, marginalization and psychosocial adjustment innocenti working paper (vol. 2010-17). Florence, Italy: UNICEF Innocenti Research Centre.
14. Betancourt, T.S., &, Khan, K.T., (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20, 317-328. (Pubitemid 351882969)
15. Betancourt, T.S., McBain, R., Newnham, E.A., &, Brennan, R.T., (2012). Trajectories of internalizing problems in war-affected Sierra Leonean youth: Examining conflict and post-conflict factors. Child Development.
16. Betancourt, T.S., Meyers-Ohki, S.E., Stevenson, A., Ingabire, C., Kanyanganzi, F., Munyana, M.,. &, Beardslee, W.R., (2011). Using mixed-methods research to adapt and evaluate a family strengthening intervention in Rwanda. African Journal of Traumatic Stress, 2, 32-45.
17. Betancourt, T.S., Newnham, E.A., &, Brennan, R., (under review). A follow-up study of risk and protective factors influencing the trajectories of post-traumatic stress reactions in Sierra Leonean war-affected youth.
18. Betancourt, T.S., Newnham, E.A., Brennan, R.T., Verdeli, H., Borisova, I., Neugebauer, R.,. &, Bolton, P., (2012). Moderators of treatment effectiveness for war-affected youth with depression in northern Uganda. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, doi:10.1016/j.jadohealth.2012.02.010.
19. Betancourt, T.S., Simmons, S., Borisova, I., Brewer, S.E., Iweala, U., &, de la Soudiere, M., (2008). High hopes, grim reality: Reintegration and the education of former child soldiers in Sierra Leone. Comparative Education Review, 52, 565-587.
20. Betancourt, T.S., &, Williams, T., (2008). Building an evidence base on mental health interventions for children affected by armed conflict. Intervention: International Journal of Mental Health, Psychosocial Work and Counseling in Areas of Armed Conflict, 6, 39-56.
21. Bissouma, A.C., Te Bonle, D.M., Yeo-Tenena, J.M.Y., Moke, B.L., &, Kipre-Koiho, A., (2010). Profil psychopathologique des enfants associés au combat à l'ouest de la Côte d'Ivoire. Neuropsychiatrie de l'Enfance et de l'Adolescence, 58, 410-415.
22. Blattman, C., (2009). From violence to voting: War and political participation in Uganda. American Political Science Review, 103, 231-247.
23. Blattman, C., &, Annan, J., (2010). The consequences of child soldiering. Review of Economics and Statistics, 92, 882-898.
24. Bolton, P., Bass, J., Betancourt, T.S., Speelman, L., Onyango, G., Clougherty, K.F.,. &, Verdeli, H., (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: A randomized controlled trial. Journal of the American Medical Association, 298, 519-527. (Pubitemid 47204935)
25. Boothby, N., (2006). What happens when child soldiers grow up? The Mozambique case study. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 4, 244-259.
26. Boothby, N., Crawford, J., &, Halperin, J., (2006). Mozambique child soldier life outcome study: Lessons learned in rehabilitation and reintegration efforts. Global Public Health, 1, 87-107.
27. Breslau, N., &, Davis, G.C., (1992). Posttraumatic stress disorder in an urban population of young adults: Risk factors for chronicity. American Journal of Psychiatry, 149, 671-675.
28. Burman, M.E., &, McKay, S., (2007). Marginalization of girl mothers during reintegration from armed groups in Sierra Leone. International Nursing Review, 54, 316-323.
29. Bush, H.G., (2008). Girls with guns: Gender-based sexual exploitation of female child soldiers. Journal of Sex Research, 45, 91-92.
30. Coalition to Stop the Use of Child Soldiers. (2008). Child soldiers: Global report 2008. London: Coalition to Stop the Use of Child Soldiers.
31. De Silva, H., Hobbs, C., &, Hanks, H., (2001). Conscription of children in armed conflict-a form of child abuse. A study of 19 former child soldiers. Child Abuse Review, 10, 125-134. (Pubitemid 33281891)
32. Denov, M., (2010). Coping with the trauma of war: Former child soldiers in post-conflict Sierra Leone. International Social Work, 53, 791-806.
33. Denov, M., &, Maclure, R., (2007). Turnings and epiphanies: Militarization, life histories, and the making and unmaking of two child soldiers in Sierra Leone. Journal of Youth Studies, 10, 243-261.
34. Derluyn, I., Broekaert, E., Schuyten, G., &, De Temmerman, E., (2004). Post-traumatic stress in former Ugandan child soldiers. Lancet, 363, 861-863. (Pubitemid 38368836)
35. Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., &, Neuner, F., (2011). Community-implemented trauma therapy for former child soldiers in northern Uganda. The Journal of the American Medical Association, 306, 503-512.
36. Forstmeier, S., Kuwert, P., Spitzer, C., Freyberger, H.J., &, Maercker, A., (2009). Posttraumatic growth, social acknowledgment as survivors, and sense of coherence in former German child soldiers of World War II. The American Journal of Geriatric Psychiatry, 17, 1030-1039.
37. Fox, M.-J., (2004). Girl soldiers: Human security and gendered insecurity. Security Dialogue, 35, 465-479. (Pubitemid 40042581)
38. Gingerich, T., &, Leaning, J., (2004). The use of rape as a weapon of war in the conflict in Darfur, Sudan: François-Xavier Bagnoud Center for health and human rights, Harvard School of Public Health.
39. Gregory, J., &, Embrey, D.G., (2009). Reducing the effects of profound catastrophic trauma for former child soldiers: Companion recovery model. Traumatology, 15, 52-62.
40. Heckathorn, D.D., (1997). Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems, 44, 174-199.
41. Heckathorn, D.D., (2002). Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems, 49, 11-34.
42. Honwana, A., (2006). Child soldiers in Africa. Baltimore: University of Pennsylvania Press.
43. Johnson, K., Asher, J., Rosborough, S., Raja, A., Panjabi, R., Beadling, C., &, Lawry, L., (2008). Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. The Journal of the American Medical Association, 300, 676-690.
44. de Jong, J.T., (Ed.). (2002). Trauma, war, and violence: public mental health in socio-cultural context. New York: Kluwer Academic/Plenum.
45. Kanagaratnam, P., Raundalen, M., &, Asbjornsen, A.E., (2005). Ideological commitment and posttraumatic stress in former Tamil child soldiers. Scandinavian Journal of Psychology, 46, 511-520. (Pubitemid 41712611)
46. Karki, R., Kohrt, B.A., &, Jordans, M.J., (2009). Child led indicators: Pilot testing a child participation tool for psychosocial support programmes for former child soldiers in Nepal. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 7, 92-109.
47. Klasen, F., Oettingen, G., Daniels, J., &, Adam, H., (2010). Multiple trauma and mental health in former Ugandan child soldiers. Journal of Traumatic Stress, 23, 573-581.
48. Klasen, F., Oettingen, G., Daniels, J., Post, M., Hoyer, C., &, Adam, H., (2010). Posttraumatic resilience in former Ugandan child soldiers. Child Dev, 81, 1096-1113.
49. Klasen, F., Schrage, J., Post, M., &, Adam, H., (2011). Guiltless guilty - trauma-related guilt and posttraumatic stress disorder in former Ugandan child soldiers. Praxis der Kinderpsychologie und Kinderpsychiatrie, 60, 125-142.
50. Kleinman, A., (1988). Rethinking psychiatry: From cultural category to personal experience. New York: Free Press.
51. Kohrt, B.A., (in press). The role of traditional rituals for reintegration and psychosocial wellbeing of child soldiers in Nepal. In, A.L. Hinton, &, D.E. Hinton, (Eds.), Legacies of mass violence. Durham, NC: Duke University Press.
52. Kohrt, B.A., Hruschka, D.J., Worthman, C.M., Kunz, R.D., Baldwin, J.L., Upadhaya, N.,. &, Nepal, M.K., (2012). Political violence and mental health in Nepal: Prospective study. British Journal of Psychiatry, doi: 10.1192/bjp.bp.111.096222 [Epub ahead of print].
53. Kohrt, B.A., Jordans, M.J., &, Morley, C.A., (2010). Four principles of mental health research and psychosocial intervention for child soldiers: Lessions learned from Nepal. International Psychiatry, 7, 58-60.
54. Kohrt, B.A., Jordans, M., Tol, W.A., Luitel, N., Maharjan, S., &, Upadhaya, N., (2011). Validation of cross-cultural child mental health and psychosocial research instruments: Adapting the depression self-rating scale and child PTSD symptom scale in Nepal. BMC Psychiatry, 11, 127.
55. Kohrt, B.A., Jordans, M.J., Tol, W.A., Perera, E., Karki, R., Koirala, S., &, Upadhaya, N., (2010). Social ecology of child soldiers: Child, family, and community determinants of mental health, psychosocial well-being, and reintegration in Nepal. Transcult Psychiatry, 47, 727-753.
56. Kohrt, B.A., Jordans, M.J., Tol, W.A., Speckman, R.A., Maharjan, S.M., Worthman, C.M., &, Komproe, I.H., (2008). Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. The Journal of the American Medical Association, 300, 691-702.
57. Kohrt, B.A., &, Maharjan, S.M., (2009). When a child is no longer a child: Nepali ethnopsychology of child development and violence. Studies in Nepali History and Society, 14, 107-142.
58. Kohrt, B.A., Perera, E., Jordans, M.J., Koirala, S., Karki, R., Shrestha, B.,. &, Upadhaya, N., (2010). Psychosocial support model for children associated with armed forces and armed groups in Nepal. Kathmandu, Nepal: Transcultural Psychosocial Organization-Nepal/UNICEF.
59. Kohrt, B.A., Tol, W.A., Pettigrew, J., &, Karki, R., (2010). Children and revolution: The mental health and psychosocial wellbeing of child soldiers in Nepal's maoist army. In, M. Singer, &, G.D. Hodge, (Eds.), The war machine and global health (pp. 89-116). Lanham, MD: Altamira Press: Rowan & Littlefield
60. Kuruppuarachchi, K., &, Wijeratne, L.T., (2004). Post-traumatic stress in former Ugandan child soldiers. Lancet, 363, 1648.
61. Layne, C.M., Olsen, J.A., Baker, A., Legerski, J.P., Isakson, B., &, Pašalic̈, A., (2010). Unpacking trauma exposure risk factors and differential pathways of influence: Predicting post-war mental distress in Bosnian adolescents. Child Development, 81, 1053-1076.
62. Machel, G., (2001). The impact of war on children. London: Hurst & Company.
63. MacMullin, C., &, Loughry, M., (2004). Investigating psychosocial adjustment of former child soldiers in Sierra Leone and Uganda. Journal of Refugee Studies, 17, 460-472. (Pubitemid 40019941)
64. Magambo, C., &, Lett, R., (2004). Post-traumatic stress in former Ugandan child soldiers. Lancet, 363, 1647-1648.
65. Mazurana, D., &, McKay, S., (2001). Child soldiers: What about the girls? Bulletin of the Atomic Scientists, 57, 30-35.
66. McKay, S., &, Wessells, M.G., (2004). Post-traumatic stress in former Ugandan child soldiers: Comment. Lancet, 363, 1646-1646.
67. McMullen, J., O'Callaghan, P., Shannon, C., Black, A., &, Eakin, J., (under review). Group intervention with former child soldiers in the Democratic Republic of Congo: A randomised controlled trial.
68. Miller, K.E., &, Rasmussen, A., (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science and Medicine, 70, 7-16.
69. Moher, D., Liberati, A., Tetzlaff, J., &, Altman, D.G., (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6, e1000097.
70. Morley, C.A., &, Kohrt, B.A., (in press). Impact of peer support on PTSD, hope, and functional impairment: A mixed-methods study of child soldiers in Nepal. Journal of Child and Adolescent Trauma.
71. Neuner, F., Catani, C., Ruf, M., Schauer, E., Schauer, M., &, Elbert, T., (2008). Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): From neurocognitive theory to field intervention. Child and Adolescent Psychiatric Clinics of North America, 17, 641-664. (Pubitemid 351815008)
72. Okello, J., Onen, T., &, Musisi, S., (2007). Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda: A comparative study. African Journal of Psychiatry, 20, 225-231.
73. Ovuga, E., Oyok, T.O., &, Moro, E.B., (2008). Post traumatic stress disorder among former child soldiers attending a rehabilitative service and primary school education in northern Uganda. African Health Sciences, 8, 136-141.
74. Pfeiffer, A., &, Elbert, T., (2011). PTSD, depression and anxiety among former abductees in Northern Uganda. Conflict and Health, 5, 14.
75. Ross, L.E., Grigoriadis, S., Mamisashvili, L., Koren, G., Steiner, M., Dennis, C.L.,. &, Mousmanis, P., (2011). Quality assessment of observational studies in psychiatry: An example from perinatal psychiatric research. International Journal of Methods in Psychiatric Research, 20, 224-234.
76. Sanderson, S., Tatt, I.D., &, Higgins, J.P., (2007). Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: A systematic review and annotated bibliography. International Journal of Epidemiology, 36, 666-676. (Pubitemid 47244573)
77. Santacruz, M.L., &, Arana, R.E., (2002). Experiences and psychosocial impact of the El Salvador civil war on child soldiers. Biomedica, 22 (Suppl. 2), 283-397.
78. Shakya, A., (2010). Experiences of children in armed conflict in Nepal. Children and Youth Services Review, 33, 557-563.
79. Stark, L., (2006). Cleansing the wounds of war: An examination of traditional healing, psychosocial health and reintegration in Sierra Leone. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 4, 206-218.
80. Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R.A., &, van Ommeren, M., (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. The Journal of the American Medical Association, 302, 537-549.
81. Stroup, D.F., Berlin, J.A., Morton, S.C., Olkin, I., Williamson, G.D., Rennie, D.,. &, Thacker, S.B., (2000). Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. The Journal of the American Medical Association, 283, 2008-2012. (Pubitemid 30214957)
82. Tol, W.A., Barbui, C., Galapatti, A., Silove, D., Betancourt, T.S., Souza, R.,. &, van Ommeren, M., (2011). Mental health and psychosocial support in humanitarian settings: Linking practice and research. Lancet, 378, 1581-1591.
83. UNICEF. (2007a). The Paris principles: Principles and guidelines on children associated with armed forces or armed conflict. Paris: UNICEF.
84. UNICEF. (2007b). State of the world's children 2007. New York: UNICEF.
85. Van Ommeren, M., Sharma, B., Thapa, S., Makaju, R., Prasain, D., Bhattarai, R., &, De Jong, J., (1999). Preparing instruments for transcultural research: Use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcultural Psychiatry, 36, 285.
86. Vandenbroucke, J.P., von Elm, E., Altman, D.G., Gøtzsche, P.C., Mulrow, C.D., Pocock, S.J.,. & for the S. I. (2007). Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. PLoS Medicine, 4, e297.
87. Ward, J., &, Marsh, M., (2006). Sexual violence against women and girls in war and its aftermath: Realities, responses, and required resources. Brussels, Belgium: UNFPA.
88. Wessells, M., (1998). Children, armed conflict, and peace. Journal of Peace Research, 35, 635-646.
89. Wessells, M., Fitzduff, M., &, Stout, C., (2006). Child soldiering: Entry, reintegration, and breaking cycles of violence. In, M. Fitzduff, &, C. Stout, (Ed.), The psychology of resolving global conflicts: From war to peace (vol. 3). (pp. 243-266). Westport, CT: Praeger Security International.
90. Wessells, M., &, Jonah, D., (2006). Recruitment and reintegration of former youth soldiers in Sierra Leone: Challenges of reconciliation & post-accord peace building. In, S. McEvoy-Levy, (Ed.), Troublemakers or peacemakers? Youth and post-accord peace building (pp. 27-47). Notre Dame, IN: University of Notre Dame Press.
91. West, H.G., (2004). Girls with guns: Narrating the experience of war of FRELIMO's 'female detachment'. In, J. Boyden, &, J. De Berry, (Eds.), Children and youth on the front line: Ethnography, armed conflict and displacement (pp. 105-129). New York: Berghahn Books.
92. Williamson, J., (2005). Reintegration of child soldiers in Sierra Leone: January 31-February 9, 2005 displaced children and orphans fund. Washington, D.C: US Agency for International Development.