For the study, conducted in March and April 2007 in Nepal, Brandon A. Kohrt, M.A., of Emory University, Atlanta, and colleagues compared the mental health of 141 former child soldiers and 141 never conscripted children matched on age, sex, education, and ethnicity.
Participants were an average of 15.75 years old at the time of the 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 study showed that the numbers of child soldiers meeting symptom cutoff scores on various measures and scales were 75 for depression, 65 for anxiety, 78 for PTSD, 55 for general psychological difficulties, and 88 for function impairment.
After adjusting for traumatic exposures and other variables, soldier status was significantly associated with depression and PTSD among girls, and PTSD among boys, but was not associated with general psychological difficulties, anxiety, or function impairment.
"The difference in mental health outcomes between child soldiers and never-conscripted children can be explained in part by greater exposure to traumatic events among child soldiers, especially for general psychological difficulties and function impairment," the authors said.
"The study has several clinical and programmatic implications. First, the greater burden of mental health problems among former child soldiers supports the need for focused programming, which should include, but not consist solely of, interventions to reduce depression symptoms and the psychological sequelae of trauma, especially bombings and torture, as well as incorporate belongingness and income generation.
"Second, girl soldiers may require focused attention, possibly for factors not addressed in this study, such as problems of sexual violence and reintegration difficulties. Third, the variation in type and severity of mental health problems highlights the importance of screening, including locally developed measures of function impairment, as a base for intervention."
"Without screening there is a risk of pathologizing child soldiers as a group rather than providing support to those individuals most impaired. Finally, the presence of mental health problems among never-conscripted children illustrates the need for comprehensive post conflict community-based psychosocial care not restricted only to child soldiers," the authors added.
The study is published in the August 13 issue of JAMA.