Sierra Leone's Former Child Soldiers: A Longitudinal Study of Risk, Protective Factors, and Mental Health

Abstract

Objective To investigate the longitudinal course of internalizing and externalizing problems and adaptive/prosocial behaviors among Sierra Leonean former child soldiers and whether post-conflict factors contribute to adverse or resilient mental health outcomes. Method Male and female former child soldiers (N=260, ages 10–17 at baseline) were recruited from the roster of an NGO-run Interim Care Center in Kono District and interviewed in 2002, 2004 and 2008. The retention rate was 69%. Linear growth models were used to investigate trends related to war and post-conflict experiences. Results The long-term mental health of former child soldiers was associated with war experiences and post-conflict risk factors, which were partly mitigated by post-conflict protective factors. Increases in externalizing behavior were associated with killing/injuring others during the war and post-conflict stigma while increased community acceptance was associated with decreases in externalizing problems (B=−1.09). High baseline levels of internalizing problems were associated with surviving rape while increases were associated with younger involvement in armed groups and social and economic hardships. Improvements in internalizing problems were associated with higher levels of community acceptance and increases in community acceptance (B=−0.86). Decreases in adaptive/prosocial behaviors were associated with killing/injuring others during the war and post-conflict stigma, but partially mitigated by social support, being in school and increased community acceptance (B=1.93). Conclusions Psychosocial interventions for former child soldiers may be more effective if they account for post-conflict factors in addition to war exposures. Youth with accumulated risk factors, lack of protective factors, and persistent distress should be identified; sustainable services to promote community acceptance, reduce stigma, and expand social supports and educational access are recommended.