title: Youth mental health after civil war: the importance of daily stressors.
abstract: BACKGROUND
  Recent evidence suggests that post-conflict stressors in addition to war trauma play an important role in the development of psychopathology.
  
  
  OBJECTIVE
  To investigate whether daily stressors mediate the association between war exposure and symptoms of post-traumatic stress and depression among war-affected youth.
  
  
  METHODS
  Standardised assessments were conducted with 363 Sierra Leonean youth (26.7% female, mean age 20.9, s.d. = 3.38) 6 years post-war.
  
  
  RESULTS
  The extent of war exposures was significantly associated with post-traumatic stress symptoms (P<0.05) and a significant proportion was explained by indirect pathways through daily stressors (0.089, 95% CI 0.04-0.138, P<0.001). In contrast, there was little evidence for an association from war exposure to depression scores (P = 0.127); rather any association was explained via indirect pathways through daily stressors (0.103, 95% CI 0.048-0.158, P<0.001).
  
  
  CONCLUSIONS
  Among war-affected youth, the association between war exposure and psychological distress was largely mediated by daily stressors, which have potential for modification with evidence-based intervention.
authors.affiliation: Elizabeth A. Newnham, MPsych(Clin), PhD, François Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, USA and School of Psychology, The University of Western Australia, Perth, Australia; Rebecca M. Pearson, PhD, School of Social and Community Medicine, Bristol University, Bristol, UK; Alan Stein, MB, BCh, MA, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Theresa S. Betancourt, MA, ScD, François Xavier Bagnoud Center for Health and Human Rights and Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Newnham
authors.affiliation: Elizabeth A. Newnham, MPsych(Clin), PhD, François Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, USA and School of Psychology, The University of Western Australia, Perth, Australia; Rebecca M. Pearson, PhD, School of Social and Community Medicine, Bristol University, Bristol, UK; Alan Stein, MB, BCh, MA, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Theresa S. Betancourt, MA, ScD, François Xavier Bagnoud Center for Health and Human Rights and Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Pearson
authors.affiliation: Elizabeth A. Newnham, MPsych(Clin), PhD, François Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, USA and School of Psychology, The University of Western Australia, Perth, Australia; Rebecca M. Pearson, PhD, School of Social and Community Medicine, Bristol University, Bristol, UK; Alan Stein, MB, BCh, MA, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Theresa S. Betancourt, MA, ScD, François Xavier Bagnoud Center for Health and Human Rights and Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Stein
authors.affiliation: Elizabeth A. Newnham, MPsych(Clin), PhD, François Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, USA and School of Psychology, The University of Western Australia, Perth, Australia; Rebecca M. Pearson, PhD, School of Social and Community Medicine, Bristol University, Bristol, UK; Alan Stein, MB, BCh, MA, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Theresa S. Betancourt, MA, ScD, François Xavier Bagnoud Center for Health and Human Rights and Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
mesh_terms: D000293:Adolescent; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D014857:Warfare; D055815:Young Adult