Social Ecology of Child Soldiers: Child, Family, and Community Determinants of Mental Health, Psychosocial Well-being, and Reintegration in Nepal

Abstract

This study employs social ecology to evaluate psychosocial wellbeing in a cross-sectional sample of 142 former child soldiers in Nepal. Outcome measures included the Depression Self Rating Scale (DSRS), Child Posttraumatic Stress Scale (CPSS), and locally developed measures of function impairment and reintegration. At the child level, traumatic exposures, especially torture, predicted poor outcomes, while education improved outcomes. At the family level, conflict-related death of a relative, physical abuse in the household, and loss of wealth during the conflict predicted poor outcomes. At the community level, living in high caste Hindu communities predicted fewer reintegration supports. Ultimately, social ecology is well-suited to identify intervention foci across ecological levels, based on community differences in vulnerability and protective factors.

Community factors influencing child and adolescent depression: A systematic review and meta-analysis

“…A representative sample that used multi-level modelling to control for a large number of individual and family variables did not identify a significant association between immigrant concentration and younger children's (5-11 years) internalising problems (Xue et al, 2005). Similarly, applying multivariate regression models to control for village clusters and accounting for a range of individual and family variables, no significant association was identified between high caste proportion and depressive symptoms in adolescent (11-17 years) soldiers of war (Kohrt et al, 2010).…”

“…Six observational studies (Al-Krenawi and Graham, 2012;Behnke et al, 2010;Kohrt et al, 2010;Simons et al, 2002;Wight et al, 2005;Xue et al, 2005) utilised both selfreport and community measures of minority ethnicity or discrimination. Using the Stouffer method, the combined effect on child depressive symptoms was significant (N = 22,872, p = 0.028, ES = 0.041).…”

“…Observational studies that examined sub-sets of the population (k = 9) included the following: children from politically violent areas in the Gaza Strip and West Bank (Al-Krenawi and Graham, 2012), children of Latin American background (Behnke et al, 2010), children of mothers exposed to partner violence (Kennedy et al, 2010), child soldiers of war (Kohrt et al, 2010); children of African American background (Lambert et al, 2010;Simons et al, 2002), children of African American background who are at risk of or have been abused (Lindsey et al, 2008), children from Hispanic and African American backgrounds (Rosario et al, 2008) (Ialongo et al, 1999); BPI: Behaviour Problems Index (Zill, 1985); BSI: Brief Symptom Inventory (Derogatis and Melisaratos, 1983); C: Children's reports; CAPA: Child and Adolescent Psychiatric Assessment ; CBCL: Child Behaviour Checklist (Achenbach, 1991); CDI: Child Depression Inventory (Kovacs, 1984); CES-D: Center for Epidemiologic Studies Depression Scale (Radloff, 1977); CI: Confidence Interval; DAWBA: Development and Well-being Assessment (Goodman and Ford, 2000); DSRS: Depression Self Rating Scale (Birleson et al, 1987); DISC: Diagnostic Interview Schedule for Children (Shaffer et al, 1993) and children from low-socio-economic backgrounds (Witherspoon et al, 2009). Details of participants in studies examining community interventions are provided in Table 4.…”

“…A total of nine observational studies (AlKrenawi and Graham, 2012;Caughy et al, 2008;Kennedy et al, 2010;Kohrt et al, 2010;Lambert et al, 2010;Meltzer et al, 2007;Rosario et al, 2008;Witherspoon et al, 2009;Zinzow et al, 2009) included individual reports of community safety. Using the Stouffer method, the combined effect on child depressive symptoms was significant (N = 7951, p = 0.027, ES = 0.069).…”

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

“…Protective factors in one setting may be risk factors in other settings. For example, political affiliation appeared protective among Nepali former child soldiers (Kohrt et al, 2010), but the reverse was observed in Bosnian adolescents (Jones, 2002). Such complexity warns against pre-packaged resilience promotion approaches in conflict-affected populations, but rather suggests the need for careful assessment of risk -and protective factors in new settings to inform development of mental health prevention and promotion interventions that are tailored to context (Tol et al, 2013).…”