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Context matters: community characteristics and mental health among war-affected youth in Sierra Leone.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Betancourt, Theresa S. McBain, Ryan Newnham, Elizabeth A. Brennan, Robert T.
Spatial Coverage	Sierra Leone
Description	Country affiliation: United States Author Affiliation: Betancourt TS ( Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA)
Abstract	BACKGROUND: Worldwide, over one billion children and adolescents live in war-affected settings. At present, only limited research has investigated linkages between disrupted social ecology and adverse mental health outcomes among war-affected youth. In this study, we examine three community-level characteristics - social disorder and collective efficacy within the community, as reported by caregivers, and perceived stigma as reported by youth - in relation to externalizing behaviors and internalizing symptoms among male and female former child soldiers in postconflict Sierra Leone. METHODS: A total of 243 former child soldiers (30% female, mean age at baseline: 16.6 years) and their primary caregivers participated in interviews in 2004 and 2008, as part of a larger prospective cohort study of war-affected youth in Sierra Leone. Two-point growth models were estimated to examine the relationship between community-level characteristics and externalizing and internalizing outcomes across the time points. RESULTS: Both social disorder within the community, reported by caregivers, and perceived stigma, reported by youth, positively covaried with youths' externalizing and internalizing scores - indicating that higher levels of each at baseline and follow-up were associated with higher levels of mental health problems at both time points (p < .05). The relationship between collective efficacy and mental health outcomes was nonsignificant (p > .05). CONCLUSIONS: This study offers a rare glimpse into the role that the postconflict social context plays in shaping the mental health among former child soldiers. Results indicate that both social disorder and perceived stigma within the community demonstrate an important relationship to externalizing and internalizing problems among adolescent ex-combatants. Moreover, these relationships persisted over a 4-year period of follow-up. These results underscore the importance of the postconflict social environment and the need to develop postconflict interventions that address community-level processes in addition to the needs of families and individuals.
File Format	HTM / HTML
ISSN	00219630
e-ISSN	14697610
DOI	10.1111/jcpp.12131
Journal	Journal of Child Psychology and Psychiatry
Issue Number	3
Volume Number	55
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2014-03-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Psychology Mental Disorders Psychology Social Environment Social Stigma Adolescent Combat Disorders Complications Etiology Military Personnel Residence Characteristics Sierra Leone Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't Research Support, U.s. Gov't, Non-p.h.s.
Content Type	Text
Resource Type	Article
Subject	Developmental and Educational Psychology Psychiatry and Mental Health Pediatrics, Perinatology and Child Health

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