title: Sierra Leone's child soldiers: war exposures and mental health problems by gender.
abstract: OBJECTIVE
  To examine associations between war experiences, mental health, and gender in a sample of male and female Sierra Leonean former child soldiers.
  
  
  METHODS
  A total of 273 former child soldiers (29% females) were assessed for depression and anxiety by using the Hopkins Symptoms Checklist, and for hostility, confidence, and prosocial attitudes by using an instrument developed for use with Sierra Leonean child soldiers.
  
  
  RESULTS
  The former child soldiers had witnessed and perpetrated violence at largely comparable rates, although females experienced higher rates of rape (p < .0001). More females scored within clinical ranges for depression (p = .008) and anxiety (p < .0001). In multiple regression analyses, female gender was a significant predictor of lower levels of confidence but not of mental health problems. Children who perpetrated injury or killing reported greater levels of depression (p < .0001), anxiety (p < .0001), and hostility (p < .0001). Surviving rape was associated with increased anxiety (p < .05) and hostility (p < .05), in males. Surviving rape was also related to higher confidence levels (p < .05) and prosocial attitudes (p < .05). Male former child soldiers who lost caregivers were also more vulnerable to depression (p < .05) and anxiety (p < .05), strong and significant effects noted among male child soldiers.
  
  
  CONCLUSIONS
  In our sample, female and male child soldiers experienced comparable levels of most war exposures. Female soldiers reported higher rates of rape and lower levels of adaptive outcomes. Toxic forms of violence (killing or injuring; rape) were associated with particularly poor outcomes. Although all boys and girls who experience rape and loss of caregivers are generally at risk for mental health problems, boys in our sample demonstrated increased vulnerability; these findings indicate a need for more inclusive mental health services.
authors.affiliation: Department of Global Health and Population, François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, Massachusetts 02115, USA. theresa_betancourt@harvard.edu
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Ivelina I
authors.initials: II
authors.lastname: Borisova
authors.forename: Marie
authors.initials: M
authors.lastname: de la Soudière
authors.forename: John
authors.initials: J
authors.lastname: Williamson
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008889:Military Personnel / Q000523:psychology*; D012737:Sex Factors; D012807:Sierra Leone / Q000453:epidemiology; D014857:Warfare; D055815:Young Adult