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 The study, of former child soldiers and other young people affected
by Sierra Leone's civil war, found that those with higher levels of
anxiety and depression two years after the end of the conflict had
the highest levels of these “internalizing symptoms” four years
later. They also had worse post-traumatic stress symptoms and
exhibited more anti-social behavior.
The findings suggest that treating anxiety and depression in
war-affected youth could have multi-faceted effects on their future
mental health, attitudes, and behavior, the researchers write in
Pediatrics.
“We were surprised to see the large role that targeting symptoms of
hopelessness and depression played across many years of observing
war-affected youth,” Theresa Betancourt of Harvard T.H. Chan School
of Public Health in Boston, the first author of the new study, told
Reuters Health via email.
“As a result,” she said, “we have amplified the elements of the
intervention models we are developing and testing to address
self-efficacy and elements of grief and loss given all the loss and
life change that war-affected youth have experienced.”
Armed conflict has devastating, long-lasting effects on young
people's social and physiological well-being, and there has been
little research on how to best to help children and adolescents
affected by war, Betancourt and her colleagues write.
“Mental health interventions are increasingly being made available
to war-affected youth, but very few of them are evidence-based,”
Betancourt said in an interview.
To investigate how these interventions could have the most benefit,
the researchers looked at 529 war-affected youth who ranged in age
from 10 to 17 when they enrolled in the study, in 2002. One-quarter
of the study participants were female. Sixteen percent of the study
participants said they had been raped or sexually assaulted during
the conflict, while about one-third had killed or injured another
person, and about one third had lost a parent or caregiver.
The investigators interviewed the study participants when they
joined the study, and again in 2004 and 2008.
To identify where interventions should focus, the researchers took
note of potentially modifiable factors that were present in the
youngsters in 2004 - including externalizing behaviors such as
hostility and aggression, internalizing behaviors like depression
and anxiety, community acceptance, social behaviors, school
participation, and social support.
Then they looked at how these factors affected the children’s mental
health outcomes in 2008, after taking into account their baseline
mental health, exposure to trauma, and other factors.
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Levels of internalizing behaviors in 2004 predicted internalizing
symptoms, social behaviors and attitudes, and post-traumatic stress
symptoms in 2008, the researchers found. None of the other potential
intervention targets were significantly associated with the 2008
outcomes.
“Our findings emphasize the need for low-cost, group-based,
trauma-informed mental health interventions grounded in
evidence-based techniques, which can be implemented in low- and
middle-income countries by mental health workers with strong
training and supervision, reserving the scarcest resources for youth
with the greatest need,” the researchers say.
Last year, Betancourt and her colleagues reported on a randomized
trial of a cognitive-behavioral group therapy-based program, “the
Youth Readiness Intervention,” in war-affected 15- to 24-year-olds.
The intervention was linked to better emotion regulation, social
attitudes and behaviors, and social support as well as improved
day-to-day functioning, Betancourt said. The improvements spilled
over into school functioning, she said, with participants more
likely to stay in school, with better attendance and classroom
behavior.
“When offering health and other services for war-affected youth, we
cannot leave mental health out of the equation,” Betancourt
concluded. “Integrated mental health interventions that attend to
key symptoms and impairments in war-affected youth, such as
internalizing or depression-like problems, may have spillover
effects on other domains of life functioning and are an important
part of the big picture of caring for children affected by war.”
SOURCE: http://bit.ly/1KLKhwd Pediatrics, online July 6, 2015.
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