Abstract
This article reviews the available quantitative research on psychosocial adjustment and mental health among children (age <18 years) associated with armed forces and armed groups (CAAFAG)--commonly referred to as child soldiers. PRISMA standards for systematic reviews were used to search PubMed, PsycInfo, JSTOR, and Sociological Abstracts in February 2012 for all articles on former child soldiers and CAAFAG. Twenty-one quantitative studies from 10 countries were analyzed for author, year of publication, journal, objectives, design, selection population, setting, instruments, prevalence estimates, and associations with war experiences. Opinion pieces, editorials, and qualitative studies were deemed beyond the scope of this study. Quality of evidence was rated according to the systematic assessment of quality in observational research (SAQOR). According to SAQOR criteria, among the available published studies, eight studies were of high quality, four were of moderate quality, and the remaining nine were of low quality. Common limitations were lack of validated mental health measures, unclear methodology including undefined sampling approaches, and failure to report missing data. Only five studies included a comparison group of youth not involved with armed forces/armed groups, and only five studies assessed mental health at more than one point in time. Across studies, a number of risk and protective factors were associated with postconflict psychosocial adjustment and social reintegration in CAAFAG. Abduction, age of conscription, exposure to violence, gender, and community stigma were associated with increased internalizing and externalizing mental health problems. Family acceptance, social support, and educational/economic opportunities were associated with improved psychosocial adjustment. Research on the social reintegration and psychosocial adjustment of former child soldiers is nascent. A number of gaps in the available literature warrant future study. Recommendations to bolster the evidence base on psychosocial adjustment in former child soldiers and other war-affected youth include more studies comprising longitudinal study designs, and validated cross-cultural instruments for assessing mental health, as well as more integrated community-based approaches to study design and research monitoring.
Highlights
In the last decade, conflicts have killed 2 million children, disabled 6 million, and displaced an estimated 20 million people (UNICEF, 2007b)
The reality of children associated with armed forces and armed groups is that they are often both victims and perpetrators of violence
It is an evidence-based minimum set of standards for reporting in systematic reviews and meta-analyses.) the term ‘child soldiers’ appears frequently in the literature, humanitarian practitioners often employ the term ‘children associated with armed forces and armed groups’ (CAAFAG) given the diverse roles conscripted children may assume
Summary
Conflicts have killed 2 million children, disabled 6 million, and displaced an estimated 20 million people (UNICEF, 2007b). An estimated 300,000 children under 18 years of age are involved in armed forces or armed groups in more than 87 countries (Coalition to Stop the Use of Child Soldiers, 2008). Children involved with armed groups assume myriad roles as soldiers, porters, cooks, servants, human shields, mine sweepers, and guards (Coalition to Stop the Use of Child Soldiers, 2008). Many are forced to perpetrate violence, even participating in village raids and mass atrocities (Coalition to Stop the Use of Child Soldiers, 2008; Wessells & Jonah, 2006). Child soldiers often face years of violence exposure and physical and sexual abuse themselves, resulting in serious health and mental health risks as well as social stigma upon return (Betancourt, Agnew-Blais, Gilman, Williams, & Ellis, 2010; Coalition to Stop the Use of Child Soldiers, 2008; Gingerich & Leaning, 2004; Johnson et al, 2008; Kohrt, Tol, Pettigrew, & Karki, 2010; Ward & Marsh, 2006), and for girls, unwanted pregnancies
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