OBJECTIVE To investigate the associations of war and postconflict factors with mental health among Sierra Leone's former child soldiers as adults. METHOD In 2002, we recruited former child soldiers from lists of soldiers (aged 10-17 years) served by Disarmament, Demobilization, Reintegration centers and from a random door-to-door sample in 5 districts of Sierra Leone. In 2004, self-reintegrated child soldiers were recruited in an additional district. At 2016/2017, 323 of the sample of 491 former child soldiers were reassessed. Subjects reported on war exposures and postconflict stigma, family support, community support, anxiety/depression, and posttraumatic stress symptoms. RESULTS Of the subjects, 72% were male, with a mean age of 28 years. In all, 26% reported killing or injuring others; 67% reported being victims of life-threatening violence; 45% of female subjects and 5% of male subjects reported being raped; and 32% reported death of a parent. In 2016/2017 (wave 4), 47% exceeded the threshold for anxiety/depression, and 28% exceeded the likely posttraumatic stress disorder threshold. Latent class growth analysis yielded 3 trajectory groups based on changes in stigma and family/community acceptance; "Improving Social Integration" (n = 77) fared nearly as well as the "Socially Protected" (n = 213). The "Socially Vulnerable" group (n = 33) had increased risk of anxiety/depression above the clinical threshold and possible PTSD, and were around 3 times more likely to attempt suicide. CONCLUSION Former child soldiers had elevated rates of mental health problems. Postconflict risk and protective factors related to outcomes long after the end of conflict. Targeted social inclusion and family interventions could benefit the long-term mental health of former child soldiers.

中文翻译：

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塞拉利昂儿童兵的耻辱和接受：成人心理健康和社会功能的前瞻性纵向研究。


目的 调查战争和冲突后因素与塞拉利昂前儿童兵成年后心理健康的关系。方法 2002 年，我们从解除武装、复员、重返社会中心服务的士兵名单（10 至 17 岁）中招募前儿童兵，并从塞拉利昂 5 个地区的挨家挨户随机抽样中招募。 2004年，另一个地区招募了自行重返社会的儿童兵。 2016/2017 年，491 名前儿童兵样本中的 323 人接受了重新评估。受试者报告了战争经历和冲突后耻辱、家庭支持、社区支持、焦虑/抑郁和创伤后应激症状。结果 受试者中，72% 为男性，平均年龄 28 岁。总共有 26% 的人报告杀害或伤害他人； 67% 的人表示自己是危及生命的暴力行为的受害者； 45% 的女性受试者和 5% 的男性受试者报告称自己曾被强奸； 32% 的人报告父母去世。 2016/2017 年（第 4 波），47% 的人超过了焦虑/抑郁的阈值，28% 的人超过了可能的创伤后应激障碍阈值。潜在阶级增长分析根据耻辱感和家庭/社区接受度的变化产生了 3 个轨迹组； “改善社会融合”（n = 77）的表现几乎与“社会保护”（n = 213）一样。 “社会弱势群体”(n = 33) 的焦虑/抑郁风险增加至高于临床阈值和可能的 PTSD，并且尝试自杀的可能性高出约 3 倍。结论 前儿童兵的心理健康问题发生率较高。冲突后风险和保护因素与冲突结束后很久的结果相关。有针对性的社会包容和家庭干预可能有利于前儿童兵的长期心理健康。