Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by Armed Groups in Nepal

• Type of Material: Article
• Authors: Brandon A. Kohrt, Emory University; Mark J.D. Jordans, Transcultural Psychosocial Organization (TPO) Nepal; Wietse A. Tol, Transcultural Psychosocial Organization (TPO) Nepal; Rebecca A. Speckman, Emory University; Sujen M. Maharjan, Transcultural Psychosocial Organization (TPO) Nepal; Carol Worthman, Emory University; Ivan H. Komproe, Vrije Universiteit Amsterdam
• Language: English
• Date: 2008-08-13
• Publisher: American Medical Association (AMA): JAMA
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2008, American Medical Association
• Final Published Version (URL): http://dx.doi.org/10.1001/jama.300.6.691
• Title of Journal or Parent Work: Journal of the American Medical Association
• ISSN: 0098-7484
• Volume: 300
• Issue: 6
• Start Page: 691
• End Page: 691
• Grant/Funding Information: The first author was supported by an NIMH National Research Service Award F31 MH075584. NIMH NRSA approved the design of the study.; This study was funded by UNICEF Nepal. UNICEF Nepal approved the study design and supervised the conduct of the study.
• Research Categories: Health Sciences, Mental Health; Anthropology, Medical and Forensic

Abstract

Context: Despite child soldiers being considered in need of special mental health interventions, there is a lack of studies investigating the mental health of child soldiers compared with civilian children in armed conflicts. Objective: To compare the mental health status of former child soldiers with children who have never been conscripts of armed groups. Design, Setting, and Participants: A matched-pair cohort study conducted from March through April 2007 in Nepal compared the mental health of 141 former child soldiers to 141 never conscripted children matched on age, sex, education, and ethnicity. Outcome Measures: Depression symptoms were assessed via the Depression Self Rating Scale (DSRS), anxiety symptoms via the Screen for Child Anxiety Related Emotional Disorders (SCARED-5), symptoms of posttraumatic stress disorder (PTSD) via the Child PTSD Symptom Scale (CPSS), general psychological difficulties via the Strength and Difficulties Questionnaire (SDQ), daily functioning via the Function Impairment (FI) tool, and exposure to traumatic events via Kiddie-Schedule of Affective Disorders and Schizophrenia (KIDDIE-SADS) PTSD Traumatic Event Checklist. Results: Participants were a mean of 15.75 years at the time of this study and child soldiers ranged in age from 5 to 16 years at the time of conscription. All participants experienced at least 1 type of trauma. Number (%) of child soldiers meeting cutoff scores were 75 (53.2%) for depression, 65 (46.1%) for anxiety, 78 (55.3%) for PTSD, 55 (39.0%) for psychological difficulties, and 88 (62.4%) for function impairment. Child soldiers had greater odds of meeting cutoff for depression (OR=3.56, 95% CI 2.33—5.43), PTSD (for which we employed stratified analyses because of sex interaction: boys’ OR=3.85, 95% CI 1.77—8.39; girls’ OR=6.33, 95% CI 2.64—15.17), psychological difficulties (OR=2.91, 95% CI=1.53—5.51), and function impairment (OR=2.04, 95% CI 1.41—2.96), but no difference for anxiety (OR=1.46, 95% CI 0.72—2.68). After adjusting for traumatic exposures, soldier status was no longer associated with psychological difficulties or function impairment but remained significantly associated with depression (OR=2.69, 95% CI 1.48—4.89) and PTSD among girls (OR=5.98, 95% CI 1.86—19.27), but not PTSD among boys (OR=2.38, 95% CI 0.87—6.50). Conclusions: In Nepal, former child soldiers display greater severity of mental health problems compared with children never conscripted by armed groups, and this difference remains for depression and PTSD (the latter especially among girls) even after controlling for trauma exposure.