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Original Contribution
August 13, 2008

Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by Armed Groups in Nepal

Author Affiliations

Author Affiliations: Department of Anthropology (Mr Kohrt and Dr Worthman) and Rollins School of Public Health (Ms Speckman), Emory University, Atlanta, Georgia; Transcultural Psychosocial Organization Nepal (Messrs Kohrt, Jordans, Tol, and Maharjan) and Department of Psychology, Trichandra College (Mr Maharjan), Kathmandu, Nepal; and Vrije Universiteit University Medical Center (Messrs Jordans and Tol) and Department of Public Health and Research, Healthnet TPO (Messrs Jordans and Tol and Dr Komproe), Amsterdam, the Netherlands.

JAMA. 2008;300(6):691-702. doi:10.1001/jama.300.6.691

Context Former child soldiers are considered in need of special mental health interventions. However, there is a lack of studies investigating the mental health of child soldiers compared with civilian children in armed conflicts.

Objective To compare the mental health status of former child soldiers with that of children who have never been conscripts of armed groups.

Design, Setting, and Participants Cross-sectional cohort study conducted in March and April 2007 in Nepal comparing the mental health of 141 former child soldiers and 141 never-conscripted children matched on age, sex, education, and ethnicity.

Main Outcome Measures Depression symptoms were assessed via the Depression Self Rating Scale, anxiety symptoms via the Screen for Child Anxiety Related Emotional Disorders, symptoms of posttraumatic stress disorder (PTSD) via the Child PTSD Symptom Scale, general psychological difficulties via the Strength and Difficulties Questionnaire, daily functioning via the Function Impairment tool, and exposure to traumatic events via the PTSD Traumatic Event Checklist of the Kiddie Schedule of Affective Disorders and Schizophrenia.

Results Participants were a mean of 15.75 years old at the time of this study, and former child soldiers ranged in age from 5 to 16 years at the time of conscription. All participants experienced at least 1 type of trauma. The numbers of former child soldiers meeting symptom cutoff scores were 75 (53.2%) for depression, 65 (46.1%) for anxiety, 78 (55.3%) for PTSD, 55 (39.0%) for psychological difficulties, and 88 (62.4%) for function impairment. After adjusting for traumatic exposures and other covariates, former soldier status was significantly associated with depression (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.31-4.44) and PTSD among girls (OR, 6.80; 95% CI, 2.16-21.58), and PTSD among boys (OR, 3.81; 95% CI, 1.06-13.73) but was not associated with general psychological difficulties (OR, 2.08; 95% CI, 0.86-5.02), anxiety (OR, 1.63; 95% CI, 0.77-3.45), or function impairment (OR, 1.34; 95% CI, 0.84-2.14).

Conclusion In Nepal, former child soldiers display greater severity of mental health problems compared with children never conscripted by armed groups, and this difference remains for depression and PTSD (the latter especially among girls) even after controlling for trauma exposure.