Identifying the war-afflicted teenagers most in need of mental health care

A new study finds widespread post-traumatic stress disorder, depression, and suicidal ideation among teenagers in warn-torn Northern Uganda, not only among former child soldiers. Psychological support should be offered to all young people in the region through the education system.

In Northern Uganda, an estimated nine out of ten teenagers have been displaced at least once in their life. Around one in three have been abducted by the notorious rebel group Lord's Resistance Army to serve as child soldiers. Approximately half of former child soldiers have been forced to commit violence, for example abducting other children or injuring people.

In a new controlled study, an international team of researchers surveyed mental health problems among teenagers in education programs in Northern Uganda. They found evidence of Post-Traumatic Stress Disorder (PTSD) in 32% of former abductees and 12% of other teenagers. Depression and suicidal ideation were less frequent, but still elevated and widespread.

The study was done by psychologists and psychiatrists from Germany and Uganda, in partnership with the mental health organization Vivo International. Further support came from the Windle Trust and the Norwegian Refugee Council.

"The rates of PTSD and depression were highest among former child soldiers. But we also found very high rates in other war-affected youth," says lead author Nina Winkler from the University of Konstanz, Germany.

The results are drawn from clinical interviews with a controlled, representative sample of 843 teenagers from 12 secondary schools and 6 vocational training centers in the Gulu and Amuru regions of Uganda. Interviews were conducted by local trauma counselors in the language Lou, under close supervision by expert psychologists.

The researchers looked for symptoms of PTSD, depression, and suicidal ideation. They also asked interviewees about their exposure to different types of traumatic events, such as being abducted or displaced, assault with weapons, sexual violence, life-threatening injury, or witnessing violent death.

Rates of trauma exposure, PTSD, depression, and suicidal ideation were higher in former abductees than in non-abductees, and highest in former child soldiers who had been forced to commit violence. However, PTSD was widespread among teenagers exposed to many types of traumatic events, regardless of whether they had also been abducted.

These results suggest a stepwise "building block" mechanism for the development of PTSD, where the risk increases with each traumatic experience.

"All learners, abducted or not, with high trauma exposure appear at risk of developing symptoms of PTSD and depression. Our results suggest that there is no valid reason to focus mental healthcare exclusively on former child soldiers."

The researchers are concerned that the widespread mental health problems among teenagers might make it easier for gangs and armed groups to find recruits, prolonging unrest and violence in the region.

They suggest that the local education system could help to deliver mental healthcare and psychosocial support to all war-affected young people, including former child soldiers.

The study is published in the open-access journal Frontiers in Psychiatry.

Findings include:

• 84% of girls and 89% of boys had been displaced at least once
• 30% of girls and 50% of boys had been abducted at least once
• Abductions lasted on average 12 months, with a maximum of 11 years
• Among former abductees, 34% of girls and 31% of boys were diagnosed with PTSD
• Among non-abductees, 16% of girls and 8% of boys were diagnosed with PTSD
• Among former abductees with PTSD, 30% of girls and 17% of boys were diagnosed with depression
• Among former abductees with PTSD, 57% of girls and 34% of boys reported having current suicidal ideations
• The highest rate of PTSD, 87%, was found in former abductees who had committed violence and experienced 25 or more types of traumatic events