title: Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study.
abstract: BACKGROUND
  War experiences (WE) and postwar environments (PWE) are associated with mental ill-health. The present study aims to investigate the pathways from WE and PWE to mental ill-health and to define opportunities for intervention through analysis of the war-affected youths study (WAYS) cohort study.
  
  
  METHODS
  WAYS is an ongoing study of a large cohort of former child soldiers being conducted in Uganda. Mental health problems, subjective WE and PWE contexts were assessed by local adaptations of internationally developed measures for use with former child soldiers at least 6 years after the end of the war. Structural equation modeling was used to test two mediation hypotheses: (1) the 'trauma model' in which WE directly influence long-term mental health and (2) the 'psychosocial path' in which WE influence long-term mental health through PWE stressors.
  
  
  RESULTS
  WE were linked to depression/anxiety (β=0.15 (95% CI 0.01 to 0.30)) through PWE (accounting for 44% of the variance in the relationship between these variables) and to conduct problems (β=0.23 (95% CI 0.03 to 0.43); (accounting for 89% of the variance, ie, near complete mediation)). The direct relation between WE and depression/anxiety attenuated but remained statistically significant. For conduct problems, the direct relationship was no longer significant after accounting for PWE.
  
  
  CONCLUSIONS
  PWE are a key determinant of continued mental health problems in former child soldiers. Interventions to reduce long-term mental problems should address both PWE stressors (psychosocial model) and specialised mental healthcare (trauma model) and consider both models of intervention as complementary.
authors.affiliation: Department of Psychology, Gulu University, , Gulu, Uganda.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Amone-P'Olak
authors.forename: Jan
authors.initials: J
authors.lastname: Stochl
authors.forename: Emilio
authors.initials: E
authors.lastname: Ovuga
authors.forename: Rosemary
authors.initials: R
authors.lastname: Abbott
authors.forename: Richard
authors.initials: R
authors.lastname: Meiser-Stedman
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Croudace
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D019955:Conduct Disorder / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data; D012931:Social Environment; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D014754:Violence / Q000523:psychology*; D014857:Warfare
keywords: Mental Health; Public Health; Social Epidemiology