Background

Former child soldiers are at risk of developing post-traumatic stress disorder (PTSD); however, the trajectory of symptoms has yet to be examined.

Aims

The risk and protective factors associated with PTSD symptom change among former child soldiers in Sierra Leone were investigated.

Method

Data from 243 former child soldiers (mean age 16.6 years, 30% female) were analysed.

Results

Self-reported rates of possible PTSD using standard cut-off points declined from 32% to 16% 4 years later (P<0.05). Symptoms of PTSD at baseline were significantly associated with war experiences (P<0.01) and post-conflict family abuse (P<0.001). Reliable improvement in symptoms was reported by 30%. In growth models examining symptom change, worsening of symptoms was associated with death of a parent (P<0.05) and post-conflict stigma (P<0.001). Protective effects were observed for increases in family acceptance (P<0.001).

Conclusions

The findings indicated improvement in PTSD symptoms among former child soldiers despite limited access to care. Family and community support played a vital part in promoting psychological adjustment.

The nature of modern warfare is changing and civilians have increasingly become caught in the violence. As a result, modern wars have witnessed a sizeable number of children involved with armed forces and armed groups (referred to here as ‘child soldiers’). These young people assume a variety of roles, including acting as spies, porters and front-line soldiers, and are often involved in the perpetration of violence towards others as well as being subjected to repeated physical, sexual and emotional violence. Former child soldiers are at risk of developing symptoms of post-traumatic stress disorder (PTSD).1,2 However, despite the high rates of PTSD documented in this population,2,3 there have been few assessments of the longitudinal course of symptoms in both male and female child soldiers.4 Within a cohort of 39 boys formerly child soldiers in Mozambique, reports of post-traumatic distress reduced over time, coupled with an increase in avoidance behaviours.5 Similarly, intervention studies have demonstrated responsiveness to psychological treatments among former child soldiers exhibiting post-traumatic stress and depression symptoms.6–8 A complex interplay of risk and protective factors is likely to influence the psychological adjustment of former child soldiers. Most experience chronic exposure to violence and repeated victimisation, yet differ with regard to the frequency, duration and severity of their war-related violence exposures.1

The post-conflict environment is also important in determining the course of psychopathological disorder. War-affected children, and former child soldiers in particular, are vulnerable to economic insecurity and interpersonal hardship.9 Prior research indicates that former child soldiers often face stigma in the community,10 domestic violence,11 and numerous daily stressors or hardships,1,9 on release or escape. However, former child soldiers may differ with regard to the post-conflict opportunities they encounter, particularly in terms of access to school, family and community supports, and economic circumstances.12 Despite great interest in the risks of PTSD among former child soldiers, no empirical work has explicitly investigated how individual, family and community risk and protective processes influence post-traumatic stress symptoms over time.4 We predicted that post-traumatic stress symptoms in this sample would persist over time, and would be associated with severe war violence and post-conflict hardships, whereas protective factors such as family support and community acceptance would be associated with a decrease in symptoms.