title: Post-traumatic stress symptoms among former child soldiers in Sierra Leone: follow-up study.
abstract: BACKGROUND
  Former child soldiers are at risk of developing post-traumatic stress disorder (PTSD); however, the trajectory of symptoms has yet to be examined.
  
  
  OBJECTIVE
  The risk and protective factors associated with PTSD symptom change among former child soldiers in Sierra Leone were investigated.
  
  
  METHODS
  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.
authors.affiliation: François-Xavier Bagnoud Center for Health and Human Rights, and Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Newnham
authors.forename: Ryan
authors.initials: R
authors.lastname: McBain
authors.forename: Robert T
authors.initials: RT
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D003130:Combat Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012807:Sierra Leone / Q000453:epidemiology; D013240:Stereotyping; D014754:Violence / Q000706:statistics & numerical data; D014857:Warfare