Even before Ebola arrived, Sierra Leone was a troubled country, fighting an 11-year civil war that killed an estimated 50,000 people. That war was infamous for the use of child soldiers and sexual abuse of women and girls. The civil war ended in 2002, and a new study published this month in Pediatrics by Betancourt et al. (doi: 10.1542/peds.2014-1521) tracks the outcomes of 529 war-affected youth who were ages 10 to 17 years when the war ended. About a fourth of the participants were girls. The investigators’ goals were to track outcomes in these individuals and also identify areas where targeted interventions might do the most good.
The study’s authors at Harvard University focused on internalizing and externalizing behaviors and the outcomes of participants as of 2008. Internalizing behavior focus negative and inward; depression and anxiety are examples. Externalizing behaviors focus on the outside world; hostility and aggression are examples.The researchers interviewed participants in 2002, just as the civil war was ending, and in 2004 and 2008. They did modeling to determine whether internal or external behaviors might be associated with better outcomes in 2008. They found a significant association between internalization behaviors in 2004 and outcomes in 2008, such as post-traumatic stress and social attitudes and behavior.
The authors suggested that working with war-affected youth by implementing programs to reduce anxiety and depression in survivors is an opportunity to improve their future lives and help them deal with the challenging environment in Sierra Leone. They suggested that low-cost, group therapy that deals with trauma experienced in war might be a way forward.
The study was done in a resource poor country, but the message about how internalization behaviors like depression and anxiety can shape future behavior is important. In the United States, we see the impact of war on returning veterans from the Middle East with high rates of suicide.
Maybe the Civil War Union General William T. Sherman said it best. His 1880 speech in Ohio included the phrase “War is hell.” 2 And for survivors, the aftermath can be hell too. Work like that done by these Harvard researchers is important in helping war-torn survivors live better lives.
1. World Health Organization. Ebola Situation Report - 8 July 2015. http://apps.who.int/ebola/current-situation/ebola-situation-report-8-july-2015
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