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Problems internalizing predicted mental health issues among war-affected youth

Problems internalizing emotions, often associated with depression and anxiety, were a significant predictor of future mental health issues among war-affected youth in Sierra Leone, suggesting that potential interventions should address internalizing problems.

“War has wide-reaching, often catastrophic consequences for children and adolescents. In day-to-day settings (schools, neighborhoods, communities), the family and broader social relationships that normally support healthy child development are disrupted. The direct and indirect consequences of war have been shown to persist long after the cessation of armed conflict, particularly in the domains of social and psychological well-being,” study researcher Theresa S. Betancourt, ScD, MA, of Harvard T. H. Chan School of Public Health, and colleagues wrote.

Theresa S. Betancourt

Using observational data from three waves of a longitudinal study on mental health among 529 war-affected youth in Sierra Leone, researchers assessed how internalizing and externalizing problems and prosocial attitudes and behaviors changed over time in an effort to identify potential mental health intervention targets for the cohort. The study cohort, aged 10 to 17 years at baseline, were interviewed in 2002, 2004 and 2008. The second interview period occurred 2 years after the cessation of the civil war.

During the conflict, 15.8% of study participants reported experiencing rape or sexual assault, 31.4% reported killing or injuring others and 31.2% reported losing a parent or caregiver.

Internalizing problems at the second time point were associated with internalizing (Β = 0.27; 95% CI, 0.11-0.42), prosocial attitudes (Β = –0.02; 95% CI, –0.33 to –0.07) and posttraumatic stress symptoms (Β = 0.22; 95% CI, 0.02-0.43) at the third time point.

Prosocial attitudes at the second time point had a significant effect on prosocial attitudes at the third time point (Β = 0.18; 95% CI, 0.07-0.29).

“In this longitudinal sample of Sierra Leonean war-affected youth, we find that reductions in internalizing at one time point may have far-ranging benefits for other mental health outcomes at a later point in time, even when we controlled for any number of possible confounding variables,” Betancourt and colleagues wrote. “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.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.