Examining the link between socio-economic position and mental health in early adolescents

Mental health (MH) is fundamental to good quality of life and contributes to success in society. Healthy and confident children are more likely to turn out into healthy and confident adults. Adverse family situations such as low socio-economic position (SEP) may have negative consequences for child and adolescent MH. However, little is known about the link between low family SEP and MH. This thesis examined four aspects of this link: 1) the domain-specific link, 2) the mediation link, 3) the interaction link, and 4) the link with MH service use. The link between low SEP and MH was found to be larger for the externalizing than internalizing problem domain and the SEP-MH relationship was partly mediated by environment-related life stressors, particularly for internalizing problems. Familial psychopathology and low SEP were independent and non-interacting risk factors for offspring MH problems. Finally, the true association between SEP and MH service use was obscured by severity of mental problems. Maternal education, independent of other indices of SEP and severity of MH problems, significantly predicted MH service use. In conclusion, the effect of low family SEP on MH may be domain-specific, partly mediated by environment-related life stressors and the synergy between low SEP and parental psychopathology appear not to confer additional risks for mental problems in offspring. Further, failure to correct for severity of mental problems obscures the true association between SEP and MH service use in early adolescents. Finally, although the effects of SEP on MH may be relatively small, the negative SEP-MH association may be cumulative as suggested by previous studies. Since early adolescence is still at the beginning of the life-course, small SEP differences in early life may give rise to increasing differences later in the life. Therefore, interventions to ameliorate the negative effect of low SEP in families may be an important investment.

Cohort profile: mental health following extreme trauma in a northern Ugandan cohort of War-Affected Youth Study (The WAYS Study).

War experiences are associated with the risk of long-term mental health problems. The War-affected Youths (WAYS) Study comprises a cohort of 539 youths (61% female) aged between 18 to 25 (at baseline) randomly sampled from the population of war-affected youths in northern Uganda. The study aims to chart the trajectory of long-term mental health consequences of war and the roles of individual, family, and community contextual risk and protective factors in influencing the course of mental health using Social Ecology Model, thus, addressing both the individual and its social ecology. Knowledge of postwar contexts may inform policy and guide interventions on postwar psychosocial adjustment and reintegration in conflict-prone Great Lakes region of Africa (Rwanda, Burundi, DR Congo, Uganda, Central African Republic, and South Sudan). Two waves of data collection have been conducted and more data collection is planned. At baseline, information on demographic characteristics, pre-war experiences, psychosocial outcomes, coping, stigma/discrimination, family and community acceptance and relationship, family functioning, and post-war experiences were obtained. At follow-up, information on general health, gender-based violence, PTSD, social skills, trauma memory quality, rumination, self-esteem, and psychosocial outcomes were collected. Approval to access the data can be obtained on application to the Principal Investigator upon submission of a research proposal with ethical approval from the applicant's institution. This research is funded by Wellcome Trust and Gulu University.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Sexual violence and general functioning among formerly abducted girls in Northern Uganda: the mediating roles of stigma and community relations--the WAYS study.

BACKGROUND: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. METHOD: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. RESULTS: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. CONCLUSION: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities

Coping with life in rebel captivity and the challenge of reintegrating formerly abducted boys in Northern Uganda

In this qualitative study of 134 formerly abducted adolescent boys at four rehabilitation centres in Northern Uganda, the boys described their lives in rebel captivity and coping strategies and suggested ways of reintegration. They witnessed, endured and participated in hideous atrocities while in rebel captivity. Vigilance, absolute obedience, and cooperation with their captors; prayer and hope; denial, blaming others, constant preparedness to flee; use of traditional medicine; and resilience and perseverance, were some of the coping strategies they employed while in captivity and during escape. Once out of captivity, they suggested a reintegration agenda sensitive to their economic wellbeing and social relations in the context of their culture and tradition. They proposed psychosocial activities, vocational and entrepreneurial skills training, provision of credit facilities, and an education system that recognizes their background and needs. However, all these should be viewed in the context of huge resource limitations and the continuing conflict

War experiences, general functioning and barriers to care among former child soldiers in Northern Uganda:the WAYS study

Exposure to war is associated with considerable risks for long-term mental health problems (MHP) and poor functioning. Yet little is known about functioning and mental health service (MHS) use among former child soldiers (FCS). We assessed whether different categories of war experiences predict functioning and perceived need for, sources of and barriers to MHS among FCS

War experiences and psychotic symptoms among former child soldiers in Northern Uganda: the mediating role of post-war hardships-the WAYS Study

Psychotic symptoms have been associated with post-traumatic stress disorder and war experiences. However, the relationships between types of war experiences, the onset and course of psychotic symptoms, and post-war hardships in child soldiers have not been investigated. This study assessed whether various types of war experiences contribute to psychotic symptoms differently and whether post-war hardships mediated the relationship between war experiences and later psychotic symptoms. In an ongoing longitudinal cohort study (the War-Affected Youths Survey), 539 (61% male) former child soldiers were assessed for psychotic symptoms, post-war hardships, and previous war experiences. Regression analyses were used to assess the contribution of different types of war experiences on psychotic symptoms and the mediating role of post-war hardships in the relations between previous war experiences and psychotic symptoms. The findings yielded ‘witnessing violence’, ‘deaths and bereavement’, ‘involvement in hostilities’, and ‘sexual abuse’ as types of war experiences that significantly and independently predict psychotic symptoms. Exposure to war experiences was related to psychotic symptoms through post-war hardships (β = .18, 95% confidence interval = [0.10, 0.25]) accounting for 50% of the variance in their relationship. The direct relation between previous war experiences and psychotic symptoms attenuated but remained significant (β = .18, 95% confidence interval = [0.12, 0.26]). Types of war experiences should be considered when evaluating risks for psychotic symptoms in the course of providing emergency humanitarian services in post-conflict settings. Interventions should consider post-war hardships as key determinants of psychotic symptoms among war-affected youths

Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda:the WAYS study

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 (β=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 (β=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