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Coping and mental health outcomes among Sierra Leonean war-affected youth: Results from a longitudinal study

Published online by Cambridge University Press:  21 November 2016

Manasi Sharma ,
Shoshanna L. Fine ,
Robert T. Brennan  and
Theresa S. Betancourt
Manasi Sharma*
Affiliation:
Harvard T. H. Chan School of Public Health
Shoshanna L. Fine
Affiliation:
Harvard T. H. Chan School of Public Health
Robert T. Brennan
Affiliation:
Harvard T. H. Chan School of Public Health
Theresa S. Betancourt
Affiliation:
Harvard T. H. Chan School of Public Health
*
Address correspondence and reprint requests to: Manasi Sharma, Department of Social and Behaviors Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115; E-mail: [email protected].
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Abstract

This study explored how coping with war-related traumatic events in Sierra Leone impacted mental health outcomes among 529 youth (aged 10–17 at baseline; 25% female) using longitudinal data from three time points (Time 1 in 2002, Time 2 in 2004, and Time 3 in 2008). We examined two types of coping items (approach and avoidance); used multiple regression models to test their relations with long-term mental health outcomes (internalizing behaviors, externalizing behaviors, adaptive/prosocial behaviors, and posttraumatic stress symptoms); and used mediation analyses to test whether coping explained the relation between previous war exposures (being raped, death of parent(s), or killing/injuring someone during the war) and those outcomes. We found that avoidance coping items were associated with lower internalizing and posttraumatic stress behaviors at Time 3, and provided some evidence of mediating the relation between death of parent(s) during the war and the two outcomes mentioned above. Approach coping was associated with higher Time 3 adaptive/prosocial behaviors, whereas avoidance coping was associated with lower Time 3 adaptive/prosocial behaviors. Avoidance coping may be a protective factor against mental illness, whereas approach coping may be a promotive factor for adaptive/prosocial behaviors in war-affected societies. This study has important implications for designing and implementing mental health interventions for youth in postconflict settings.

Type
Special Section Articles
Information
Development and Psychopathology , Volume 29 , Special Issue 1: Developmental and Social–Ecological Perspectives on Children, Political Violence, and Armed Conflict , February 2017 , pp. 11 - 23
Copyright
Copyright © Cambridge University Press 2016 

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References

Achenbach, T. M., & Rescorla, L. (2007). Multicultural understanding of child and adolescent psychopathology: Implications for mental health assessment. New York: Guilford Press.Google Scholar
Ager, A. (2013). Resilience and child well-being: Public policy implications. Journal of Child Psychology and Psychiatry, 54, 488–500.CrossRefGoogle ScholarPubMed
American Psychological Association. (2014). The road to resilience. Retrieved from http://www.apa.org/helpcenter/road-resilience.aspx Google Scholar
Annan, J., Blattman, C., & Horton, R. (2006). The state of youth and youth protection in Northern Uganda. Kampala, Uganda: United Nations Children's Fund.Google Scholar
Band, E. B., & Weisz, J. R. (1988). How to feel better when it feels bad: Children's perspectives on coping with everyday stress. Developmental Psychology, 24, 247.CrossRefGoogle Scholar
Barber, B. K. (2013). Annual Research Review: The experience of youth with political conflict—Challenging notions of resilience and encouraging research refinement. Journal of Child Psychology and Psychiatry, 54, 461–473.CrossRefGoogle ScholarPubMed
Bayer, C. P., Klasen, F., & Adam, H. (2007). Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers. Journal of the American Medical Association, 298, 555–559.CrossRefGoogle ScholarPubMed
Betancourt, T. S., Agnew-Blais, J., Gilman, S. E., Williams, D. R., & Ellis, B. H. (2010). Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Social Science & Medicine, 70, 17–26.CrossRefGoogle ScholarPubMed
Betancourt, T. S., Borisova, I., Rubin-Smith, J. E., Gingerich, T., Williams, T., & Agnew-Blais, J. (2008). Psychosocial adjustment and social reintegration of children associated with armed forces and armed groups: The state of the field and future directions. Austin, TX: Psychology Beyond Borders.Google Scholar
Betancourt, T. S., Brennan, R. T., Rubin-Smith, J., Fitzmaurice, G. M., & Gilman, S. E. (2010). Sierra Leone's former child soldiers: A longitudinal study of risk, protective factors, and mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 606–615.Google ScholarPubMed
Betancourt, T. S., & Khan, K. T. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20, 317–328.CrossRefGoogle ScholarPubMed
Betancourt, T. S., McBain, R., Newnham, E. A., & Brennan, R. T. (2013). Trajectories of internalizing problems in war-affected Sierra Leonean youth: Examining conflict and postconflict factors. Child Development, 84, 455–470.CrossRefGoogle ScholarPubMed
Betancourt, T. S., & Williams, T. (2008). Building an evidence base on mental health interventions for children affected by armed conflict. Intervention (Amstelveen), 6, 39.CrossRefGoogle ScholarPubMed
Billings, A. G., & Moos, R. H. (1981). The role of coping responses and social resources in attenuating the stress of life events. Journal of Behavioral Medicine, 4, 139–157 CrossRefGoogle ScholarPubMed
Boxer, P., Morris, A. S., Terranova, A. M., Kithakye, M., Savoy, S. C., & McFaul, A. (2008). Coping with exposure to violence: Relations to aggression and emotional symptoms in three urban samples. Journal of Child and Family Studies, 17, 881–893.CrossRefGoogle Scholar
Boxer, P., & Sloan-Power, E. (2013). Coping with violence: A comprehensive framework and implications for understanding resilience. Trauma, Violence, & Abuse, 14, 209–221 CrossRefGoogle ScholarPubMed
Boxer, P., Sloan-Power, E., Mercado, I., & Schappell, A. (2012). Coping with stress, coping with violence: Links to mental health outcomes among at-risk youth. Journal of Psychopathology and Behavioral Assessment, 34, 405–414.CrossRefGoogle ScholarPubMed
Bronfenbrenner, U. (1979). Contexts of child rearing: Problems and prospects. American Psychologist, 34, 844.CrossRefGoogle Scholar
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development perspectives. Developmental Psychology, 22, 723–742.CrossRefGoogle Scholar
Canino, G., & Alegría, M. (2008). Psychiatric diagnosis—Is it universal or relative to culture? Journal of Child Psychology and Psychiatry, 49, 237–250.CrossRefGoogle ScholarPubMed
Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4, 92–100.CrossRefGoogle ScholarPubMed
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.CrossRefGoogle ScholarPubMed
Causey, D. L., & Dubow, E. F. (1992). Development of a self-report coping measure for elementary school children. Journal of Clinical Child Psychology, 21, 47–59.CrossRefGoogle Scholar
Cicchetti, D. (2006). Development and psychopathology. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology: Vol. 1. Theory and methods (pp. 1–23). Hoboken, NJ: Wiley.Google Scholar
Cicchetti, D., & Cohen, D. J. (1995). Perspectives on developmental psychopathology. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology: Vol. 1. Theory and methods (pp. 3–22). New York: Wiley.Google Scholar
Cicchetti, D., & Lynch, M. (1993). Toward an ecological/transactional model of community violence and child maltreatment: Consequences for children's development. Psychiatry, 56, 96–118.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Toth, S. L. (2006). Building bridges and crossing them: Translational research in developmental psychopathology. Development and Psychopathology, 18, 619–622. doi:10.1017/S0954579406060317 CrossRefGoogle ScholarPubMed
Compas, B. E., Banez, G. A., Malcarne, V., & Worsham, N. (1991). Perceived control and coping with stress: A developmental perspective. Journal of Social Issues, 47, 23–34.CrossRefGoogle Scholar
Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Progress, problems, and potential in theory and research. Psychological Bulletin, 127, 87–127.CrossRefGoogle ScholarPubMed
Conway, V. J., & Terry, D. J. (1992). Appraised controllability as a moderator of the effectiveness of different coping strategies: A test of the goodness of fit hypothesis. Australian Journal of Psychology, 44, 1–7.CrossRefGoogle Scholar
Cummings, E. M., & Cummings, J. L. (1988). A process-oriented approach to children's coping with adults' angry behavior. Developmental Review, 8, 296–321.CrossRefGoogle Scholar
Cummings, E. M., Goeke-Morey, M. C., Merrilees, C. E., Taylor, L. K., & Shirlow, P. (2014). A social-ecological, process-oriented perspective on political violence and child development. Child Development Perspectives, 8, 82–89.CrossRefGoogle ScholarPubMed
Cummings, E. M., Goeke-Morey, M. C., Schermerhorn, A. C., Merrilees, C. E., & Cairns, E. (2009). Children and political violence from a social ecological perspective: Implications from research on children and families in Northern Ireland. Clinical Child and Family Psychology Review, 12, 16–38.CrossRefGoogle ScholarPubMed
Cummings, E. M., & Valentino, K. V. (2015). Development psychopathology. In Overton, W. F. & Molenaar, P. C. M. (Eds.), Handbook of child psychology and developmental science: Vol. 1. Theory and method (7th ed., pp. 566–606). Hoboken, NJ: Wiley.Google Scholar
Dempsey, M. (2002). Negative coping as mediator in the relation between violence and outcomes: Inner-city African American youth. American Journal of Orthopsychiatry, 72, 102–109.CrossRefGoogle ScholarPubMed
Denov, M. (2010). Coping with the trauma of war: Former child soldiers in post-conflict Sierra Leone. International Social Work, 53, 791–806.CrossRefGoogle Scholar
Derluyn, I., Mels, C., & Broekaert, E. (2009). Mental health problems in separated refugee adolescents. Journal of Adolescent Health, 44, 291–297.CrossRefGoogle ScholarPubMed
Dubow, E. F., Huesmann, L. R., & Boxer, P. (2009). A social-cognitive-ecological framework for understanding the impact of exposure to persistent ethnic-political violence on children's psychosocial adjustment. Clinical Child and Family Psychology Review, 12, 113–126.CrossRefGoogle ScholarPubMed
Dubow, E. F., Huesmann, L. R., Boxer, P., Landau, S., Dvir, S., Shikaki, K., & Ginges, J. (2012). Exposure to political conflict and violence and post-traumatic stress in Middle East youth: Protective factors. Journal of Clinical Child and Adolescent Psychology, 41, 402–416.CrossRefGoogle ScholarPubMed
Dubow, E. F., & Rubinlicht, M. (2011). Coping. In Brown, B. B. & Prinstein, M. J. (Eds.), Encyclopedia of adolescence (Vol. 3, pp. 109–118). San Diego, CA: Academic Press.CrossRefGoogle Scholar
Fillion, L., Kovacs, A. H., Gagnon, P., & Endler, N. S. (2002). Validation of the shortened cope for use with breast cancer patients undergoing radiation therapy. Current Psychology: Developmental, Learning, Personality, Social, 21, 17–34.CrossRefGoogle Scholar
Finset, A., Steine, S., Haugli, L., Steen, E., & Laerum, E. (2002). The brief approach/avoidance coping questionnaire: Development and validation. Psychology, Health & Medicine, 7, 75–85.CrossRefGoogle Scholar
Folkman, S. (1984). Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology, 46, 839.CrossRefGoogle ScholarPubMed
Folkman, S., & Lazarus, R. S. (1988). Ways of coping questionnaire. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Folkman, S., & Moskowitz, J. T. (2004). Coping: Pitfalls and promise. Annual Review of Psychology, 55, 745–774.CrossRefGoogle ScholarPubMed
Goeke-Morey, M. C., Taylor, L. K., Merrilees, C. E., Shirlow, P., & Cummings, E. M. (2014). Adolescents' relationship with God and internalizing adjustment over time: The moderating role of maternal religious coping. Journal of Family Psychology, 28, 749–758.CrossRefGoogle ScholarPubMed
Hanson, D. R., & Gottesman, I. I. (2012). Biologically flavored perspectives on Garmezian resilience. Development and Psychopathology, 24, 363–369.CrossRefGoogle ScholarPubMed
Harrop, E., Addis, S., Elliott, E., & Williams, G. (2006). Resilience, coping and salutogenic approaches to maintaining and generating health: A review. Cardiff, Wales: Cardiff University.Google Scholar
Hofmann, S. G., Litz, B. T., & Weathers, F. W. (2003). Social anxiety, depression, and PTSD in Vietnam veterans. Journal of Anxiety Disorders, 17, 573–582.CrossRefGoogle ScholarPubMed
Horowitz, M. J. (1979). Psychological response to serious life events. In Hamilton, V. & Warburton, D. M. (Eds.), Human stress and cognition: An information processing approach (pp. 235–263). Chichester: Wiley.Google Scholar
Johnson, K., Asher, J., Rosborough, S., Raja, A., Panjabi, R., Beadling, C., & Lawry, L. (2008). Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. Journal of the American Medical Association, 300, 676–690.CrossRefGoogle ScholarPubMed
Kapsou, M., Panayiotou, G., Kokkinos, C. M., & Demetriou, A. G. (2010). Dimensionality of coping an empirical contribution to the construct validation of the brief-cope with a Greek-speaking sample. Journal of Health Psychology, 15, 215–229.CrossRefGoogle Scholar
Kliewer, W., Parrish, K. A., Taylor, K. W., Jackson, K., Walker, J. M., & Shivy, V. A. (2006). Socialization of coping with community violence: Influences of caregiver coaching, modeling, and family context. Child Development, 77, 605–623.CrossRefGoogle ScholarPubMed
Kohrt, B. A., Jordans, M. J., Tol, W. A., Speckman, R. A., Maharjan, S. M., Worthman, C. M., & Komproe, I. H. (2008). Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. Journal of the American Medical Association, 300, 691–702.CrossRefGoogle ScholarPubMed
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
Luthar, S. S., & Borwn, P. J. (2007). Maximizing resilience through diverse levels of inquiry: Prevailing paradigms, possibilities, and priorities for the future. Development and Psychopathology, 19, 931–955.CrossRefGoogle ScholarPubMed
Luthar, S. S., Doernberger, C. H., & Zigler, E. (1993). Resilience is not a unidimensional construct: Insights from a prospective study of inner-city adolescents. Development and Psychopathology, 5, 703–717.CrossRefGoogle Scholar
Lynch, M., & Cicchetti, D. (1998). An ecological–transactional analysis of children and contexts: The longitudinal interplay among child maltreatment, community violence, and children's symptomatology. Development and Psychopathology, 10, 235–257.CrossRefGoogle ScholarPubMed
Macksoud, M. S. (1992). Assessing war trauma in children: A case study of Lebanese children. Journal of Refugee Studies, 5, 1–15.CrossRefGoogle Scholar
Macksoud, M. S., & Aber, J. L. (1996). The war experiences and psychosocial development of children in Lebanon. Child Development, 67, 70–88.CrossRefGoogle ScholarPubMed
MacMullin, C., & Loughry, M. (2004). Investigating psychosocial adjustment of former child soldiers in Sierra Leone and Uganda. Journal of Refugee Studies, 17, 460–472.CrossRefGoogle Scholar
Manne, S. L., Ostroff, J., Winkel, G., Grana, G., & Fox, K. (2005). Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: Patient and partner perspectives. Health Psychology, 24, 635.CrossRefGoogle ScholarPubMed
Masten, A. S. (2006). Promoting resilience in development: A general framework for systems of care. In Flynn, R. J., Dudding, P. M., & Barber, J. G. (Eds.), Promoting resilience in child welfare (pp. 3–17). Ottawa, Canada: University of Ottawa Press.Google Scholar
Masten, A. S. (2007). Resilience in developing systems: Progress and promise as the fourth wave rises. Development and Psychopathology, 19, 921–930.CrossRefGoogle ScholarPubMed
Masten, A. S., & Narayan, A. J. (2012). Child development in the context of disaster, war, and terrorism: Pathways of risk and resilience. Annual Review of Psychology, 63, 227–257. doi:10.1146/annu-rev-psych-120710-100356 CrossRefGoogle ScholarPubMed
McKay, S., & Mazurana, D. (2004). Where are the girls? Girls in fighting forces in Northern Uganda, Sierra Leone and Mozambique: Their lives during and after war. Montreal: International Centre for Human Rights and Democratic Development.Google Scholar
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15, 351–377.Google ScholarPubMed
Miyazaki, Y., Bodenhorn, N., Zalaquett, C., & Ng, K. M. (2008). Factorial structure of Brief COPE for international students attending US colleges. College Student Journal, 42, 795–806.Google Scholar
Morina, N., Rudari, V., Bleichhardt, G., & Prigerson, H. G. (2010). Prolonged grief disorder, depression, and posttraumatic stress disorder among bereaved Kosovar civilian war survivors: A preliminary investigation. International Journal of Social Psychiatry, 56, 288–297.CrossRefGoogle ScholarPubMed
Panter-Brick, C., & Leckman, J. F. (2013). Editorial commentary: Resilience in child development—Interconnected pathways to wellbeing. Journal of Child Psychology and Psychiatry, 54, 333–336.CrossRefGoogle ScholarPubMed
Pargament, K. I. (2001). The psychology of religion and coping: Theory, research, practice. New York: Guilford Press.Google Scholar
Park, C. L., & Cohen, L. H. (1993). Religious and nonreligious coping with the death of a friend. Cognitive Therapy and Research, 17, 561–577.CrossRefGoogle Scholar
Patel, V., & Goodman, A. (2007). Researching protective and promotive factors in mental health. International Journal of Epidemiology, 36, 703–707.CrossRefGoogle ScholarPubMed
Ptacek, J. T., Smith, R. E., & Zanas, J. (1992). Gender, appraisal, and coping: A longitudinal analysis. Journal of Personality, 60, 747–770.CrossRefGoogle Scholar
Rayburn, N. R., Wenzel, S. L., Elliott, M. N., Hambarsoomians, K., Marshall, G. N., & Tucker, J. S. (2005). Trauma, depression, coping, and mental health service seeking among impoverished women. Journal of Consulting and Clinical Psychology, 73, 667.CrossRefGoogle ScholarPubMed
Reid-Quiñones, K., Kliewer, W., Shields, B. J., Goodman, K., Ray, M. H., & Wheat, E. (2011). Cognitive, affective, and behavioral responses to witnessed versus experienced violence. American Journal of Orthopsychiatry, 81, 51–60.CrossRefGoogle ScholarPubMed
Roth, S., & Cohen, L. J. (1986). Approach, avoidance, and coping with stress. American Psychologist, 41, 813–819.CrossRefGoogle ScholarPubMed
Santacruz, M. L., & Arana, R. E. (2002). Experiences and psychosocial impact of the El Salvador civil war on child soldiers. Biomedica, 22(Suppl. 2), 283–397.Google Scholar
Scarpa, A., & Haden, S. C. (2006). Community violence victimization and aggressive behavior: The moderating effects of coping and social support. Aggressive Behavior, 32, 502–515.CrossRefGoogle Scholar
Seybold, K. S., & Hill, P. C. (2001). The role of religion and spirituality in mental and physical health. Current Directions in Psychological Science, 10, 21–24.CrossRefGoogle Scholar
Shaw, J. A. (2003). Children exposed to war/terrorism. Clinical Child and Family Psychology, 6, 237–246.CrossRefGoogle ScholarPubMed
Siefert, K., Finlayson, T. L., Williams, D. R., Delva, J., & Ismail, A. I. (2007). Modifiable risk and protective factors for depressive symptoms in low-income African American mothers. American Journal of Orthopsychiatry, 77, 113.CrossRefGoogle ScholarPubMed
Sloan-Power, E., Boxer, P., McGuirl, C., & Church, R. (2013) Coping zone construction and mapping: An exploratory study of contextual coping, PTSD, and childhood violence exposure in urban areas. Journal of Interpersonal Violence, 28, 1741–1764.CrossRefGoogle ScholarPubMed
Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In Leinhart, S. (Ed.), Sociological methodology, 1982 (pp. 290–312). San Francisco, CA: Jossey–Bass.Google Scholar
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302, 537–549.CrossRefGoogle ScholarPubMed
Stroebe, M. S., & Schut, H. (2001). Meaning making in the dual process model of coping with bereavement. In Neimeyer, R. A. (Ed.), Meaning reconstruction, the experience of loss (pp. 55–73). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology, 3, 377–401.CrossRefGoogle ScholarPubMed
Ungar, M., Ghazinour, M., & Richter, J. (2013). Annual Research Review: What is resilience with the social ecology of human development? Journal of Psychology and Psychiatry, 54, 348–366.CrossRefGoogle ScholarPubMed
UNICEF. (2007). Paris principles: Principles and guidelines on children associated with armed forces or armed conflict. New York: Guilford Press.Google Scholar
VanderWeele, T. J. (2009). Marginal structural models for the estimation of direct and indirect effects. Epidemiology, 20, 18–26.CrossRefGoogle ScholarPubMed
VanderWeele, T. J. (2015). Explanation in causal inference methods for mediation and interaction (pp. 20–65). New York: Oxford University Press.Google Scholar
World Health Organization. (2009). Sierra Leone: Country cooperation strategy 2008–2013. Brazzaville, Congo: Author.Google Scholar
Zeidner, M., & Endler, N. S. (Eds.). (1996). Handbook of copying: Theory, research, applications (Wiley Series on Personality Processes No. 195). New York: Wiley.Google Scholar