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Emory study of former child soldiers yields new data to guide mental health interventions

August 14, 2008

Former child soldiers in Nepal are more than twice as likely to suffer from symptoms of depression and post-traumatic stress disorder (PTSD) as Nepali children who experienced war trauma as civilians, according to a study led by Brandon Kohrt, an Emory University graduate student. It is the first published study of the mental health of child soldiers that includes comparative data with children who were not coerced into military service.

The Journal of the American Medical Association (JAMA) published the study results Aug. 13 [http://jama.ama-assn.org/cgi/content/short/300/6/691] in its annual theme issue on violence and human rights.

"Our findings suggest that many former child soldiers may need more than interventions to reduce the mental health problems associated with surviving bombings and torture. Often they have to endure being stigmatized when they return to their home villages," says Kohrt, a final-year student in Emory's School of Medicine and a PhD candidate in Emory's Department of Anthropology.

Kohrt speaks Nepali and has studied mental health issues in both Hindu and ethnic minorities of Nepal for nearly a decade. He co-wrote "Returned: Child Soldiers of Nepal's Maoist Army," which recently won the "Best Student Film" award from the Society for Visual Anthropology. The documentary, about the impact of the long-running battle between the Nepal government and Communist insurgents, was produced by Atlanta filmmaker Robert Koenig and will air Aug. 22 at the Atlanta Underground Film Festival.

Kohrt conducted the comparative study of former child soldiers of the Maoist army for the Transcultural Psychosocial Organization (TPO) Nepal, a Nepali non-governmental organization that works with conflict-affected children. The study's co-authors include: Carol Worthman, Samuel Candler Dobbs Professor of Anthropology at Emory; Rebecca Speckman, a graduate student in Emory's Rollins School of Public Health; and colleagues from Nepal and Amsterdam.

The researchers identified 141 former child soldiers, both male and female, who had been coerced to join the Maoist forces. At the time of conscription, the children ranged in age from 5 to 16 years. The matched-pair cross-sectional study included another 141 Nepali children who experienced the war but were not conscripted into a military group. All of the study participants had experienced at least one trauma associated with the war, such as enduring beatings, bombings and torture.

Lengthy interviews were conducted with each child, and standard instruments were used to assess symptoms of psychological difficulties. The results found that both groups of children exhibited similar levels of general psychological difficulties and anxiety, when controlling for the number of traumas they each experienced.

Even after adjusting for traumatic exposures, however, 53 percent of the former child soldiers met symptom cutoff scores for depression, compared to 24 percent of the other children. And 55 percent of the former child soldiers had levels of PTSD that warranted mental health interventions, compared to 20 percent of the other children. The risk of PTSD was especially high for girls who had been conscripted.

"These findings suggest that there is something else - in addition to war trauma - that is causing problems for the former child soldiers," Kohrt says. "One hypothesis is that the reintegration process puts added stress on them."

Some of the child soldiers reported being ostracized upon returning to their home villages because they were seen as "polluted." Girls from Hindu households were especially affected, perhaps due to cultural taboos about girls sharing close quarters with males outside of the family.

Kohrt plans to conduct further research with TPO Nepal to help develop targeted mental health programs for children who experienced the war. After receiving his medical degree, he hopes to do a psychiatric residency for global mental health.

"I want a career that allows me to do evidence-based research and provide mental health care to those in the most desperate need," Kohrt says.

Emory University