Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
J Epidemiol Community Health
Abstract
War experiences (WE) and postwar
environments (PWE) are associated with mental
ill-health. The present study aims to investigate the
pathways from WE and PWE to mental ill-health and to
define opportunities for intervention through analysis of
the war-affected youths study (WAYS) cohort study.
Method WAYS is an ongoing study of a large cohort of
former child soldiers being conducted in Uganda. Mental
health problems, subjective WE and PWE contexts were
assessed by local adaptations of internationally
developed measures for use with former child soldiers at
least 6 years after the end of the war. Structural
equation modeling was used to test two mediation
hypotheses: (1) the ‘trauma model’ in which WE directly
influence long-term mental health and (2) the
‘psychosocial path’ in which WE influence long-term
mental health through PWE stressors.
Results WE were linked to depression/anxiety (β=0.15
(95% CI 0.01 to 0.30)) through PWE (accounting for
44% of the variance in the relationship between these
variables) and to conduct problems (β=0.23 (95% CI
0.03 to 0.43); (accounting for 89% of the variance, ie,
near complete mediation)). The direct relation between
WE and depression/anxiety attenuated but remained
statistically significant. For conduct problems, the direct
relationship was no longer significant after accounting
for PWE.
Conclusions PWE are a key determinant of continued
mental health problems in former child soldiers.
Interventions to reduce long-term mental problems
should address both PWE stressors (psychosocial model)
and specialised mental healthcare (trauma model) and
consider both models of intervention as complementary.
Description
Keywords
Postwar environment, Mental health, Child soldiers, Northern Uganda
Citation
Amone-P'Olak, K., Stochl, J., Ovuga, E., Abbott, R., Meiser-Stedman, R., Croudace, T. J., & Jones, P. B. (2014). Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study. J Epidemiol Community Health, 68(5), 425-430. doi:10.1136/jech-2013-203042