title: Past horrors, present struggles: the role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone.
abstract: Upon returning to their communities, children formerly associated with armed forces and armed groups--commonly referred to as child soldiers--often confront significant community stigma. Much research on the reintegration and rehabilitation of child soldiers has focused on exposure to past war-related violence and mental health outcomes, yet no empirical work has yet examined the role that post-conflict stigma plays in shaping long-term psychosocial adjustment. Two waves of data are used in this paper from the first prospective study of male and female former child soldiers in Sierra Leone. We examined the role of stigma (manifest in discrimination as well as lower levels of community and family acceptance) in the relationship between war-related experiences and psychosocial adjustment (depression, anxiety, hostility and adaptive behaviors). Former child soldiers differ from one another with regard to their post-war experiences, and these differences profoundly shape their psychosocial adjustment over time. Consistent with social stress theory, we observed that post-conflict factors such as stigma can play an important role in shaping psychosocial adjustment in former child soldiers. We found that discrimination was inversely associated with family and community acceptance. Additionally, higher levels of family acceptance were associated with decreased hostility, while improvements in community acceptance were associated with adaptive attitudes and behaviors. We found that post-conflict experiences of discrimination largely explained the relationship between past involvement in wounding/killing others and subsequent increases in hostility. Stigma similarly mediated the relationship between surviving rape and depression. However, surviving rape continued to demonstrate independent effects on increases in anxiety, hostility and adaptive/prosocial behaviors after adjusting for other variables. These findings point to the complexity of psychosocial adjustment and community reintegration in these youth and have a number of programmatic and policy implications.
authors.affiliation: Department of Global Health & Population, Harvard School of Public Health, Boston, MA 02115, USA. tstichic@hsph.harvard.edu
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Jessica
authors.initials: J
authors.lastname: Agnew-Blais
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gilman
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.forename: B Heidi
authors.initials: BH
authors.lastname: Ellis
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008889:Military Personnel / Q000523:psychology*; D011446:Prospective Studies; D000297:Psychology, Adolescent; D002666:Psychology, Child; D012044:Regression Analysis; D012111:Residence Characteristics; D012807:Sierra Leone / Q000453:epidemiology; D013240:Stereotyping; D013315:Stress, Psychological / Q000453:epidemiology; D014857:Warfare