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

Abstract

Aims and scope This article reviews the available quantitative research on psychosocial adjustment and mental health among children (age <18 years) associated with armed forces and armed groups (CAAFAG) – commonly referred to as child soldiers. Methods PRISMA standards for systematic reviews were used to search PubMed, PsycInfo, JSTOR, and Sociological Abstracts in February 2012 for all articles on former child soldiers and CAAFAG. Twenty-one quantitative studies from 10 countries were analyzed for author, year of publication, journal, objectives, design, selection population, setting, instruments, prevalence estimates, and associations with war experiences. Opinion pieces, editorials, and qualitative studies were deemed beyond the scope of this study. Quality of evidence was rated according to the Systematic Assessment of Quality in Observational Research (SAQOR). Findings According to SAQOR criteria, among the available published studies, eight studies were of high quality, four were of moderate quality, and the remaining nine were of low quality. Common limitations were lack of validated mental health measures, unclear methodology including undefined sampling approaches, and failure to report missing data. Only five studies included a comparison group of youth not involved with armed forces/armed groups, and only five studies assessed mental health at more than one point in time. Across studies, a number of risk and protective factors were associated with postconflict psychosocial adjustment and social reintegration in CAAFAG. Abduction, age of conscription, exposure to violence, gender, and community stigma were associated with increased internalizing and externalizing mental health problems. Family acceptance, social support, and educational/economic opportunities were associated with improved psychosocial adjustment. Conclusions Research on the social reintegration and psychosocial adjustment of former child soldiers is nascent. A number of gaps in the available literature warrant future study. Recommendations to bolster the evidence base on psychosocial adjustment in former child soldiers and other war-affected youth include more studies comprising longitudinal study designs, and validated cross-cultural instruments for assessing mental health, as well as more integrated community-based approaches to study design and research monitoring.

Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers

“…For example, non-WEIRD populations are more likely to be exposed to war and political violence (18,19). Children in non-WEIRD populations are also more likely to be exposed to war as both civilians and combatants (20). WEIRD cultures may also atypically influence the nature and sources of psychological resilience to early life adversity.…”

Broadening the scope of epidemiology in conflict-affected settings: opportunities for mental health prevention and promotion

“…The review also identified only two studies focused on the early childhood period, even though this area understandably is regarded as the most costeffective period for preventive efforts (Heckman, 2006;Shonkoff & Garner, 2012). Authors of similar reviews have all emphasized that an important future research direction among conflict-affected children and adolescents concerns contextually sensitive longitudinal epidemiological research focused on identifying modifiable risk and protective factors at multiple levels of the social ecology (e.g., individual-, family-, school-, community-levels) (Reed et al, 2012;Betancourt et al, 2013). Such a multi-level model research could, for instance, focus on family-level variables by sampling family units rather than individuals within households (Farhood et al, 1993), which is the current norm.…”

Applying the ADAPT Psychosocial Model to War-Affected Children and Adolescents

“…Indirect exposure to violence, through television or radio broadcasts, is another source of trauma (e.g., see Hadi & Llabre, 1998;Macksoud & Aber, 1996;Thabet, Ibraheem, Shivram, Winter, & Vostanis, 2009). Children and adolescents are also involved in the hostilities (e.g., see Amone-P'Olak, 2005;Bayer, Klasen, & Adam, 2007;Betancourt, Borisova, et al, 2013;Derluyn et al, 2004;Macksoud & Aber, 1996;Robinson, 2013;Sack, Him, & Dickason, 1999), either training with armed forces, patrolling, or being forced to commit acts of violence or subterfuge. In some conflicts, girls are abducted by rebel forces and forced into marriage or other types of sexual abuse as reported among girls abducted in Northern Uganda (Amone-P'Olak, 2005).…”