Associations between trauma-related guilt, symptoms of posttraumatic stress disorder, and problematic alcohol use.

Trauma-related guilt, or a belief that one should have felt, thought, or acted differently during a traumatic event in which someone's life or physical integrity was threatened, has been consistently associated with mental health disorders such as posttraumatic stress disorder (PTSD). Theories of trauma-related guilt suggest that some avoidant coping behaviors, such as problematic alcohol use, are crucial pathways connecting trauma-related guilt to PTSD but have not been thoroughly investigated. The present study uses data from a longitudinal cohort of veterans to examine two models: the first assessed problematic alcohol use as a mechanism linking trauma-related guilt and PTSD. The second explored PTSD as a mechanism linking trauma-related guilt to problematic alcohol use. Results indicated that problematic alcohol use was a significant mechanism linking global guilt and guilt cognitions with PTSD. Further, results indicated that PTSD was a significant mechanism linking global guilt and distress with problematic alcohol use. Results of our study indicate that alcohol use is a key construct that has been overlooked in the trauma-related guilt literature, despite the high prevalence of co-occurring PTSD and alcohol use (and alcohol use disorder). Targeting trauma-related guilt during integrated treatments for PTSD and alcohol use disorder may be particularly important for veterans.

Barriers to treatment and care for depression among the youth in Uganda: The role of mental health literacy.

Background: Depression represents a significant mental health problem (MHP) in low- and middle-income countries (LMICs), especially among early adults. Nevertheless, most early adults with depression do not seek treatment. Failure to recognize depression and knowledge about mental health literacy (MHL) may contribute to poor help-seeking behavior. This study assessed MHL, access and barriers to mental health care for depression among early adults in Uganda. Methods: Data were collected from students in two of the largest universities in Uganda. Participants completed questionnaires on depression, MHL, sources of barriers and opportunities for MH service. Regression analyses and parametric tests were used to assess depression, access, barriers and opportunities to promote MH. Results: About 12 per cent (n = 56) of the respondents were at the level of moderately severe to severe depression. Mental health literacy (MHL) scores were generally low ranging from "Ability to recognize mental disorders" (mean = 19.32, SD 3.22, range 18-32), and "Knowledge of risk factors" (mean = 4.39, SD 1.17, range 2-8), and "Knowledge of available information" (mean = 9.59, SD 2.53, range 5-20). Respondents reported barriers such as "stigma/discrimination" (65.53%), "lack of knowledge of where to receive help" (65.15%), "lack of trust in health workers" (62.56%), and "distant health facilities" (19.70%) that impede access to treatment and care. MHL significantly predicted depression (based on a continuous scale) (ß = 0.63, 95% confidence interval [CI]: [0.56, 0.70]) with the regression model yielding a significant fit [R 2 = 0.40, F (2, 460) = 189.84, p < 0.001]. Conclusions: MHL is low among university students amidst several barriers such as stigma, fear, and lack of trust. To attenuate the negative effects of MHPs on wellbeing and lower the increased risk of psychopathology into adulthood, it is critical to prioritize MHL, address barriers to treatment and care, and develop the requisite infrastructure to tackle depression among early adults.

Echoes of the past: prevalence and correlates of PTSD among formerly abducted youths in northern Uganda: findings from the WAYS study.

Background: Post-traumatic stress disorder (PTSD) has considerable and persistent effects on survivors of war, particularly in postconflict areas. Yet, evidence on what keeps survivors on the path of PTSD remains scarce. Aims: The current study aimed to assess the prevalence and correlates of PTSD symptoms among the war-affected population in northern Uganda. Methods: Data from 476 war-affected youths (aged 20-27 years) who had participated in a longitudinal cohort study were analysed to describe the enduring associations of background and postwar environmental risk factors with PTSD symptoms. The Impact of Event Scale-Revised was used to evaluate symptoms of PTSD. Descriptive statistics were used to compute background and postwar environmental correlates. Binary logistic regression analyses were fitted to assess the magnitude of the effects of the correlates on PTSD symptoms. Results: Background and postwar environmental factors (eg, sexual abuse and injury in captivity) were significantly associated with PTSD symptoms. Postwar environmental factors associated with PTSD symptoms included postwar hardships, stigma/discrimination, chronic illness, community relations, family acceptance and general functioning, among others. The odds ratios (ORs) for post-war hardships were 2.41 (95% confidence interval (CI): 1.63 to 3.56) and 2.90 (95% CI: 2.03 to 4.14) for high and severe PTSD, respectively. For stigma/discrimination, compared with higher scores, the ORs were 3.38 (95% CI: 2.22 to 5.17) and 4.12 (95% CI: 2.69 to 6.30) for high and severe PTSD symptoms, respectively. Conclusions: Background and postwar environmental stressors exacerbate the severity of PTSD symptoms in survivors of war and should form the basis for interventions to alleviate the toxic effects of war on survivors.

Prevalence, distribution and attributable risks of adverse childhood experiences in different family types: A survey of young adults in Botswana.

BACKGROUND: Although adverse childhood experiences (ACEs) are often associated with poor outcomes in adulthood, little is known about its distribution in various family types, especially in low- and middle-income countries. OBJECTIVE: We assessed the prevalence, distribution, and attributable risks of ACEs in different family types in early adults. METHODS: Using data from 483 young adults (18-25 years of age), we assessed the prevalence and distribution of ACEs and employed binary logistic regressions to quantify the attributable risk of ACEs in different family types: nuclear (reference), single-mother, separated/divorced, and extended family types. We compared respondents without reports of ACEs (reference) to those reporting different numbers of ACEs (1 or more, 2 or more, 3 or more, 4 or more and 5 or more) to assess attributable risks of ACEs in different family types. RESULTS: Out of the 483 participants, (female = 262 [53.3%]), 26.7% reported no ACEs, 21.1% reported 1 ACE, 13.3% reported 2 ACEs, and 38.9% reported 3 or more ACEs. Two hundred thirty-two (48%) and 153 (31.7%) students reported that they were from a nuclear and single-mother family types, respectively. Overall, there were higher densities of ACEs in single-mother and separated/divorced compared to nuclear family type. Compared to nuclear family type, the attributable risks of ACEs for single-mother family type ranged from 2.85 (95% Confidence Intervals (CI) 1.65) to 4.13 (95% CI: 1.92-8.91) and for separate/divorced family type ranging from 3.69 (95% CI: 1.72) to 6.32 (95% CI: 2.40-16.64). CONCLUSIONS: The odds of ACEs differ with family types and were markedly pronounced in single-mother and separated/divorced compared to nuclear family types. Interventions to mitigate the effects of ACEs should be targeted at family types with a high density of ACEs. Professionals should design programmes targeting single-mother, separated/divorced and extended family types to alleviate the negative effects of childhood adversity.

The relationship between adverse childhood experiences and depression: A cross-sectional survey with university students in Botswana.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with severe life-long negative outcomes, including depression. Particularly in low- and middle-income countries, few studies have been conducted to assess the impact of ACEs. AIM: To assess the influence of ACEs on depression among young adults. SETTING: Participants were students at a large university in Gaborone, Botswana. METHODS: Using a cross-sectional design, we investigated the associations between ACEs and depression in young adults in Botswana (n = 392, mean age = 22.2, ± 2.5, 53.4% female). Bivariate correlation analyses, t-tests and analyses of variance (ANOVA) were performed to assess associations and compare ACEs at different levels of depression. RESULTS: A total of 73% (n = 287) reported one or more ACEs, whilst 15% (59) reported five or more ACEs. About 64% (38) of those who reported five or more ACEs were female respondents. Prevalence of specific ACEs ranged from 9.5% (child neglect) to 36.3% (separation and divorce). One in three respondents reported parental separation or divorce, psychological abuse and family dysfunction, whilst 19% (11% moderate and 8% severe) reported significant depressive symptoms. Adverse childhood experiences significantly predicted depression (ß = 0.27, 95% confidence interval [CI]: 0.18, 0.37). Respondents at different levels of depression significantly differed on reporting ACEs (F (3, 389) = 11.43, p < 0.001). CONCLUSION: Adverse childhood experiences are highly prevalent and key determinants of depression in young adulthood. A multifaceted and cross-system intervention (e.g. schools, social work, psychological services, health services and law enforcement) is required to protect, prevent and treat survivors of childhood adversity.

Intervention targets for people living with HIV and depressive symptoms in Botswana.

Background: The prevalence of HIV in Botswana is high. Many people living with HIV (PLWH) suffer from depressive symptoms and have inadequate coping skills. Most PLWH do not receive adequate psychological treatment. Empirically based interventions for PLWH with depressive symptoms in Botswana should be developed, with a focus on improving coping skills. The present study was a first step towards this goal, by trying to identify targets for intervention. The study aimed to provide prevalence rates of depression among PLWH in Botswana, to assess their mental health treatment needs and wishes as expressed by themselves, and to study the relationships between cognitive and behavioural coping strategies and depressive symptoms.Method: A cross-sectional study was conducted. The sample consisted of 291 participants (73% female) from 8 HIV treatment centres from Botswana. Participants completed standardized questionnaires on depressive symptoms (CES-D) and coping skills (CERQ, BERQ). They also answered questions regarding their mental health care needs and wishes.Results: In total 43.4% of participants reported clinically significant depressive symptoms. The majority of participants indicated that they needed help with the following topics: feelings of depression, physical tension, finding new goals and coping with HIV. In addition, they indicated preferring a self-help programme in booklet format. Multiple regression analyses showed that the following coping strategies had significant relationships with depressive symptoms: rumination, catastrophising, withdrawal, positive refocusing and refocus on planning (the latter two negatively).Conclusion: Almost half of the PLWH reported depressive symptoms that were clinically significant. The findings suggested that an intervention for PLWH with depressive symptoms in Botswana should preferably be a self-help programme presented in booklet format. With regard to content, the results confirmed that the intervention should focus on specific coping skills. In addition, elements like goal finding and strategies to reduce physical tension should be added.

Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study.

Cognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.

Cognitive emotion regulation strategies and mental health problems in war-affected youth in Northern Uganda: findings from the WAYS study.

BACKGROUND: Cognitive emotion regulation strategies (CERS) have been shown to moderate the influence of War Experiences (WE) on mental health problems. AIMS: This study assessed the influence of WE and use of specific CERS on mental health problems among war-affected youth in Northern Uganda. METHODS: Five hundred and thirty-nine participants in an ongoing war-affected youth study (WAYS) were assessed by locally developed measures. CERS were measured by Cognitive Emotion Regulation Questionnaire (CERQ). Multiple regressions were used to assess independent effects of gender, WE, and CERS on mental problems and their potential interaction. RESULTS: Gender, WE and all CERS except positive refocussing and reappraisal had significant independent main effects on symptoms of depression while only WE, self-blame and blaming others had significant main effects on conduct problems. The interaction terms of WE and coping strategies of rumination, catastrophizing, and self-blame significantly predicted symptoms of depression/anxiety while only the interaction between WE and blaming others predicted conduct problems. In contrast, putting into perspective and planning negatively predicted symptoms of depression/anxiety. CONCLUSIONS: Interventions to reduce mental health problems should target coping strategies, especially adaptive strategies to youth in many post-conflict settings in Africa.

Interpersonal Sensitivity as Mediator of the Relations Between War Experiences and Mental Illness in War-Affected Youth in Northern Uganda: Findings From the WAYS Study.

The pathways from war experiences to mental health problems are poorly understood. The current study aims to assess the role of interpersonal sensitivity in the relations between war experiences and mental health problems based on data from the War-Affected Youth Survey cohort study. The War-Affected Youth Survey is an ongoing research project of formerly abducted children in Northern Uganda assessing their war experiences and the risk and protective factors in the development of mental health problems. Mediation of the relations between war experiences and mental health problems by interpersonal sensitivity was analyzed using structural equation modeling. War experiences were related to posttraumatic stress disorder through interpersonal sensitivity accounting for 55% of the variance in their relations, to depression/anxiety through interpersonal sensitivity accounting for 89% of the variance in their relations (i.e., near complete mediation), and to psychotic symptoms through interpersonal sensitivity accounting for 53% of the variance in their relations. The direct relation between war experiences, on the one hand, and posttraumatic stress disorder and psychotic symptoms, on the other hand, attenuated but remained statistically significant. For depression/anxiety, the direct relationship ceased to be significant after including interpersonal sensitivity in the model. Interpersonal sensitivity is an important determinant of long-term mental health problems in war-affected youth. Interventions to improve mental health should target youth with high scores on interpersonal sensitivity. Cognitive-behavioral therapy to recognize and change cognitive schemas in youth prone to interpersonal sensitivity is recommended.

PTSD, mental illness, and care among survivors of sexual violence in Northern Uganda: Findings from the WAYS study.

BACKGROUND: Previous studies have mainly considered war-affected youth as a homogenous group yet several subpopulations of war-affected youth, such as survivors of sexual violence, exist with unique mental health problems and treatment needs. This study aimed to assess posttraumatic stress disorder (PTSD), perceptions and meaning of mental illness, and access and barriers to mental health care among survivors of sexual violence. METHOD: Data were collected from survivors of sexual violence during war (N = 181) who are participants in the longitudinal War-Affected Youth Survey (WAYS) study in Northern Uganda. Chi-square tests of independence and binary logistic regression were used to compute participants' characteristics and assess relations between exposure to sexual violence and PTSD. RESULTS: Sixty-six (n = 119, 66%) reported sexual abuse: 35% (n = 63) of whom returned from captivity with at least 1 child, and 43% (n = 78) met the criteria for PTSD (Impact of Events Scale-Revised score [IES-R] ≥33). Those who reported sexual abuse scored significantly higher on PTSD (OR = 3.23; 95% CI [2.09, 6.93]), perceived more stigma, reported more barriers to seeking care, and viewed mental illness as futile and fatal compared with their peers without a history of sexual abuse. CONCLUSIONS: Survivors of sexual violence are at risk of PTSD and report major obstacles to treatment and care. More resources should be allocated for interventions to improve access to care for survivors of sexual violence. Psychoeducation to create awareness, demystify myths and public stigma about mental illness, and trauma-focused cognitive-behavioral therapies to reduce PTSD among survivors are recommended. (PsycINFO Database Record

The influence of types of war experiences on conduct problems in war-affected youth in Northern Ugandan: Findings from the WAYS study.

Exposure to war is associated with poor psychosocial outcomes. Yet the effects of different types of war events on various psychosocial outcomes such as conduct problems remain unknown. This study aims to assess whether various war events differ in predicting conduct problems. Using data from an on-going longitudinal research project, the WAYS study, the current article examined the relationship between specific war events and conduct problems in war-affected youth in Northern Uganda (N=539, baseline age=22.39; SD=2.03, range 18-25). Regression analyses were conducted to relate each type of war experience to conduct problems. War categories of "witnessing violence", "deaths", "threat to loved ones" and "sexual abuse" were associated with reporting conduct problems. Multivariable models yielded independent effects of ''witnessing violence'' (ß=0.09, 95% CI: 0.01, 0.18) and ''Sexual abuse'' (ß=0.09, 95% CI: 0.02, 0.19) on conduct problems while "duration in captivity" independently and negatively predicted conduct problems (ß=-0.14, 95% CI: -0.23, -0.06). Types of war events vary in predicting conduct problems and should be considered when designing interventions to alleviate negative consequences of exposure to war. Moreover, longer duration in captivity appear to protect war-affected youth from conduct problems.

Validity of the Finnish Diabetes Risk Score for Detecting Undiagnosed Type 2 Diabetes among General Medical Outpatients in Botswana.

This was a cross-sectional study designed to assess the validity of the Finnish Diabetes Risk Score for detecting undiagnosed type 2 diabetes among general medical outpatients in Botswana. Participants aged ≥20 years without previously diagnosed diabetes were screened by (1) an 8-item Finnish diabetes risk assessment questionnaire and (2) Haemoglobin A1c test. Data from 291 participants were analyzed (74.2% were females). The mean age of the participants was 50.1 (SD = ±11) years, and the prevalence of undiagnosed diabetes was 42 (14.4%) with no significant differences between the gender (20% versus 12.5%, P = 0.26). The area under curve for detecting undiagnosed diabetes was 0.63 (95% CI 0.55-0.72) for the total population, 0.65 (95% CI: 0.56-0.75) for women, and 0.67 (95% CI: 0.52-0.83) for men. The optimal cut-off point for detecting undiagnosed diabetes was 17 (sensitivity = 48% and specificity = 73%) for the total population, 17 (sensitivity = 56% and specificity = 66%) for females, and 13 (sensitivity = 53% and specificity = 77%) for males. The positive predictive value and negative predictive value were 20% and 89.5%, respectively. The findings indicate that the Finnish questionnaire was only modestly effective in predicting undiagnosed diabetes among outpatients in Botswana.

Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana.

BACKGROUND: Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients' attendances in Botswana. METHODS: A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants' sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria. RESULTS: In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference. CONCLUSION: Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.

Sexual violence and general functioning among formerly abducted girls in Northern Uganda: the mediating roles of stigma and community relations--the WAYS study.

BACKGROUND: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. METHOD: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. RESULTS: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. CONCLUSION: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities.

The effects of sexual violence on psychosocial outcomes in formerly abducted girls in Northern Uganda: the WAYS study.

BACKGROUND: The objective of this study is to investigate the effects of sexual violence on the odds of different psychosocial outcomes (depression, psychotic symptoms, somatic complaints, conduct problems, daily functioning, community relations, and stigma) among formerly abducted girls in Uganda. METHODS: Data from an on-going War-Affected Youth Study (WAYS) in Uganda was used to compute the prevalence of psychosocial problems (scores ≥ 75th percentile) among three categories of formerly abducted girls (1) no history of sexual violence without children, 2) a history of sexual violence without children, and 3) a history of sexual violence with children as a consequence) among 210 women (age 22.06, SD = 2.06, range 18-25). Multiple logistic regression analyses were used to examine differences in psychosocial outcomes by the different categories of formerly abducted girls. RESULTS: Compared to participants with no history of sexual violence and without any children, the odds of adverse psychosocial outcomes were increasingly higher for all psychosocial dimensions for those who reported sexual violence with or without children. Those with a history of sexual violence and with children as a consequence had more than five times the odds of reporting depressive symptoms (OR, 5.37; 95% CI (1.45-19.90), somatic complaints (OR, 6.59; 95% CI (1.80 - 24.11), and stigma (OR, 13.85; 95% CI (3.73 - 51.42) compared to those who did not report sexual violence. CONCLUSION: This study highlighted the risks of psychosocial problems among different categories of formerly abducted girls regarding sexual violence. Vulnerability to psychosocial problems among formerly abducted girls is further compounded by sexual violence, child care, stigma, and poverty.

Mediators of the relation between war experiences and suicidal ideation among former child soldiers in Northern Uganda: the WAYS study.

BACKGROUND: Globally, suicide is a public health burden especially in the aftermath of war. Understanding the processes that define the path from previous war experiences (WE) to current suicidal ideation (SI) is crucial for defining opportunities for interventions. We assessed the extent to which different types of previous WE predict current SI and whether post-war hardships and depression mediate the relations between WE and SI among former child soldiers (FCS) in Northern Uganda. METHODS: We performed cross-sectional analyses with a sample of 539 FCS (61% male) participating in an on-going longitudinal study. The influence of various types of previous WE on current SI and mediation by post-war hardships and depression were assessed by regression analyses. RESULTS: The following types of war experiences: "witnessing violence", "direct personal harm", "deaths", "Involvement in hostilities", "sexual abuse" and "general war experiences" significantly predicted current SI in a univariable analyses whereas "direct personal harm", "involvement in hostilities", and "sexual abuse" independently predicted current SI in a multivariable analyses. General WE were linked to SI (ß = 0.18 (95% CI 0.10 to 0.25)) through post-war hardships (accounting for 69% of the variance in their relationship) and through depression/anxiety (ß = 0.17 (95% CI 0.12 to 0.22)) accounting for 65% of the variance in their relationship. The direct relationship between previous WE and current SI reduced but remained marginally significant (ß = .08, CI: (.01, .17) for depression/anxiety but not for post-war hardships (ß = .09, CI: (-.03, .20). CONCLUSION: Types of WE should be examined when assessing risks for SI. Interventions to reduce SI should aim to alleviate post-war hardships and treat depression/anxiety.

The influence of different types of war experiences on depression and anxiety in a Ugandan cohort of war-affected youth: the WAYS study.

BACKGROUND: War experiences (WE) are frequently associated with mental health problems. Whether different types of WE vary in predicting which problem, or how severe, in former child soldiers (FCS) remains unknown. METHODS: Using data from the first wave of an on-going longitudinal cohort study (the WAYS study), we investigated relations between types of WE and symptoms of depression/anxiety among FCS in Northern Uganda (N = 539, baseline age = 22.39; SD = 2.03, range 18-25). Using robust Maximum Likelihood estimation in SEM, regression analyses were performed to relate binary indicators of types of WE to a single latent factor capturing symptoms of depression/anxiety. RESULTS: SEM results showed that "direct personal harm", "witnessing violence", "deaths", "threat to loved ones", "involvement in hostilities", and "sexual abuse" indicators were related to reported symptoms of depression/anxiety irrespective of gender and age. Multivariable models revealed independent associations of "witnessing violence" (ß = 0.29, SE = 0.09, p < 0.001) and "deaths" (ß = 0.14, SE = 0.05, p < 0.001) with symptoms of depression/anxiety in both sexes. "Sexual abuse" (ß = 0.32, SE = 0.16, p < 0.001) independently predicted symptoms of depression/anxiety for female but not male youths whilst "threat to loved ones" (ß = 0.13, SE = 0.07, p < 0.05) independently predicted symptoms of depression/anxiety in male but not female youths. CONCLUSIONS: Dimensions of WE predicted symptoms of depression/anxiety differently, but it is hard to establish their causal status. Our findings suggest that it might be fruitful to consider such exposure variations of WE when designing interventions to mitigate the symptoms of depression/anxiety on male and female FCS.

Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study.

BACKGROUND: War experiences (WE) and postwar environments (PWE) are associated with mental ill-health. The present study aims to investigate the pathways from WE and PWE to mental ill-health and to define opportunities for intervention through analysis of the war-affected youths study (WAYS) cohort study. METHOD: WAYS is an ongoing study of a large cohort of former child soldiers being conducted in Uganda. Mental health problems, subjective WE and PWE contexts were assessed by local adaptations of internationally developed measures for use with former child soldiers at least 6 years after the end of the war. Structural equation modeling was used to test two mediation hypotheses: (1) the 'trauma model' in which WE directly influence long-term mental health and (2) the 'psychosocial path' in which WE influence long-term mental health through PWE stressors. RESULTS: WE were linked to depression/anxiety (ß=0.15 (95% CI 0.01 to 0.30)) through PWE (accounting for 44% of the variance in the relationship between these variables) and to conduct problems (ß=0.23 (95% CI 0.03 to 0.43); (accounting for 89% of the variance, ie, near complete mediation)). The direct relation between WE and depression/anxiety attenuated but remained statistically significant. For conduct problems, the direct relationship was no longer significant after accounting for PWE. CONCLUSIONS: PWE are a key determinant of continued mental health problems in former child soldiers. Interventions to reduce long-term mental problems should address both PWE stressors (psychosocial model) and specialised mental healthcare (trauma model) and consider both models of intervention as complementary.

War experiences, general functioning and barriers to care among former child soldiers in Northern Uganda: the WAYS study.

BACKGROUND: Exposure to war is associated with considerable risks for long-term mental health problems (MHP) and poor functioning. Yet little is known about functioning and mental health service (MHS) use among former child soldiers (FCS). We assessed whether different categories of war experiences predict functioning and perceived need for, sources of and barriers to MHS among FCS. METHODS: Data were drawn from an on-going War-affected Youths (WAYS) cohort study of FCS in Uganda. Participants completed questionnaires about war experiences, functioning and perceived need for, sources of and barriers to MHS. Regression analyses and parametric tests were used to assess between-group differences. RESULTS: Deaths, material losses, threat to loved ones and sexual abuse significantly predicted poor functioning. FCS who received MHS function better than those who did not. Females reported more emotional and behavioural problems and needed MHS more than males. FCS who function poorly indicated more barriers to MHS than those who function well. Stigma, fear of family break-up and lack of health workers were identified as barriers to MHS. CONCLUSIONS: Various war experiences affect functioning differently. A significant need for MHS exists amidst barriers to MHS. Nevertheless, FCS are interested in receiving MHS and believe it would benefit them.

Cohort profile: mental health following extreme trauma in a northern Ugandan cohort of War-Affected Youth Study (The WAYS Study).

War experiences are associated with the risk of long-term mental health problems. The War-affected Youths (WAYS) Study comprises a cohort of 539 youths (61% female) aged between 18 to 25 (at baseline) randomly sampled from the population of war-affected youths in northern Uganda. The study aims to chart the trajectory of long-term mental health consequences of war and the roles of individual, family, and community contextual risk and protective factors in influencing the course of mental health using Social Ecology Model, thus, addressing both the individual and its social ecology. Knowledge of postwar contexts may inform policy and guide interventions on postwar psychosocial adjustment and reintegration in conflict-prone Great Lakes region of Africa (Rwanda, Burundi, DR Congo, Uganda, Central African Republic, and South Sudan). Two waves of data collection have been conducted and more data collection is planned. At baseline, information on demographic characteristics, pre-war experiences, psychosocial outcomes, coping, stigma/discrimination, family and community acceptance and relationship, family functioning, and post-war experiences were obtained. At follow-up, information on general health, gender-based violence, PTSD, social skills, trauma memory quality, rumination, self-esteem, and psychosocial outcomes were collected. Approval to access the data can be obtained on application to the Principal Investigator upon submission of a research proposal with ethical approval from the applicant's institution. This research is funded by Wellcome Trust and Gulu University.