Differential roles of childhood adversities and stressful war experiences in the development of mental health symptoms in post-war adolescents in northern Uganda.

James Okello,Maarten De Schryver,Ilse Derluyn,Seggane Musisi,Eric Broekaert

doi:10.1186/s12888-014-0260-5

Abstract

BackgroundPrevious studies have shown a relationship between stressful war experiences and mental health symptoms in children and adolescents. To date, no comprehensive studies on the role of childhood adversities have been conducted with war-exposed adolescents living in post-war, low-resource settings in Sub-Saharan Africa.MethodsA cross-sectional study of 551 school-going adolescents aged 13-21 years old was undertaken four years post-war in northern Uganda. Participants completed self-administered questionnaires assessing demographics, stressful war experiences, childhood adversities, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms.ResultsOur analyses revealed a main effect of gender on all mental health outcomes except avoidance symptoms, with girls reporting higher scores than boys. Stressful war experiences were associated with all mental health symptoms, after adjusting for potential confounders. Childhood adversity was independently associated with depression symptoms but not PTSD, anxiety, and PTSD cluster symptoms. However, in situations of high childhood adversity, our analyses showed that stressful war experiences were less associated with vulnerability to avoidance symptoms than in situations of low childhood adversity.ConclusionsBoth stressful war experiences and childhood adversities are risk factors for mental health symptoms among war-affected adolescents. Adolescents with histories of high childhood adversities may be less likely to develop avoidance symptoms in situations of high stressful war experiences. Further exploration of the differential roles of childhood adversities and stressful war experiences is needed.

Highlights

Previous studies have shown a relationship between stressful war experiences and mental health symptoms in children and adolescents
There is a paucity of data on whether childhood adversity adds independently to the risk associated with stressful war experiences, or if childhood adversity and stressful war experiences interact in predicting mental health
Differential roles of childhood adversity and stressful war experiences Hierarchical regression models revealed a main effect of gender on all mental health outcomes except avoidance symptoms, with girls reporting higher scores than boys (Table 4)

Summary

Introduction

Previous studies have shown a relationship between stressful war experiences and mental health symptoms in children and adolescents. Adolescents in Africa’s Great Lakes region continue to emerge from various armed conflicts that expose them to stressful war experiences and the risk of developing mental health symptoms e.g. PTSD, depression and anxiety [1,2,3]. There is limited data regarding the differential effects of childhood adversities and stressful war experiences on adolescents’ post-war mental health [6,12]. The impact of particular childhood adversities, such as intra-familial violence and chronic poverty, both considered risk factors for mental health in low-income countries, have not been adequately explored in Sub-Saharan Africa [1,10]. There is a paucity of data on whether childhood adversity adds independently to the risk associated with stressful war experiences, or if childhood adversity and stressful war experiences interact in predicting mental health

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