Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study
Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study
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DOI：
10.1136/jech-2013-203042
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发表时间：
2014-05-01
影响因子：
6.3
通讯作者：
Jones, Peter B.
中科院分区：
文献类型：
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作者：
Amone-P'Olak, Kennedy;Stochl, Jan;Jones, Peter B.
背景战争经历（WE）和战后环境（PWE）与精神疾病有关。本研究的目的是调查的途径，从我们和PWE精神疾病，并通过分析的受战争影响的青年研究（WAYS）队列study.Method WAYS是一个正在进行的研究，一个大的队列的前儿童兵正在乌干达进行干预的机会。心理健康问题，主观WE和PWE的背景下进行了评估，当地适应国际开发的措施，用于前儿童兵至少6年后的战争结束。结构方程模型用于检验两个中介假设：（1）我们直接影响长期心理健康的“创伤模型”和（2）我们通过PWE压力源影响长期心理健康的“心理社会路径”。（β = 0.15（95% CI 0.01 - 0.30））通过PWE（占这些变量之间关系方差的44%）和进行问题（β = 0.23（95% CI 0.03 - 0.43）;（占方差的89%，即接近完全中介））。WE和抑郁/焦虑之间的直接关系减弱，但仍然具有统计学意义。对于行为问题，直接关系不再显着后占PWE.Conclusions PWE是前儿童兵持续的心理健康问题的一个关键决定因素。减少长期心理问题的干预措施应同时解决PWE压力源（心理社会模型）和专门的心理保健（创伤模型），并将这两种干预模式视为互补。
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 (beta= 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 (beta= 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.