War-related violence is an impediment to the health and development of young people; it threatens their adult functioning and the well-being of future generations. Prior research has demonstrated high rates of emotional and behavioral problems among war-affected youth. These problems may be exacerbated in the post-conflict setting, where dramatic societal disruptions are compounded by poverty, poor educational access, and loss of key sources of familial and community support. Currently, 15 African countries are involved in war, or are experiencing post-conflict instability. Despite the high burden of conflict in sub-Saharan Africa, understanding of the intergenerational effects of such experiences is limited to studies in industrialized countries, such as those focused on the effects of the Holocaust in Europe. In diverse populations, understanding how childhood war-related experiences and post-conflict stressors influence the well-being and functioning of adults as well as the health and development of their offspring is crucial to designing effective interventions. I particular, as war-affected youth start families of their own, opportunities exist to examine how child rearing is influenced by childhood war experiences and interruptions in social relationships due to war. The proposed research will significantly advance knowledge of the intergenerational effects of war in diverse cultural groups using ecological developmental theory to study mechanisms of the intergenerational transmission of violence as well as resilience operating in individuals, families, and communities. Building on a rare prospective longitudinal study of former child soldiers and other youth exposed to war in Sierra Leone, the study will conduct a fourth wave of data collection in a cohort (N=529), first interviewed in 2002 as 10-17 year- olds, to examine the long-term effects of war experiences on adult and family mental health and functioning. A key innovation of the proposed study is the enrollment of the offspring and intimate partners of the original cohort. An expanded survey battery will assess family dynamics, parenting, intimate partner relationships, family violence, and the physical, cognitive, and emotional development of offspring. Analyses will explore mechanisms linking individual, family, and child outcomes to conflict-related experiences and post-conflict adversities and resources. The research is intended to identify parental factors, family processes, and societal mechanisms to target in interventions to help war-affected children and families achieve their full potential or healthy and productive lives. Active participation of Community Advisory Boards and strong collaborations between investigators and local institutions will inform the study design, ensure strong retention of participants and provide channels for dissemination. Research findings will identify priorities for interventions to assist diverse populations affected by war, including refugees from war-torn regions who have resettled in the US.

Public Health Relevance

The proposed research is the first known effort in sub-Saharan Africa to examine the mechanisms by which adult functioning, mental health, parenting practices, intimate partner relationships, and the health and development of offspring, have been influenced by the legacy of war. The significance to US public health interests is both domestic and global. Some 9.9 million refugees and asylum seekers-many from war-torn regions-have entered the US since 1997. The US Government also actively seeks to improve security, human rights, and economic development of many nations affected by violent conflict. Study findings may also have implications for US military personnel and their families.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
Program Officer
Griffin, James
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Harvard University
Schools of Public Health
United States
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Betancourt, Theresa S; Gilman, Stephen E; Brennan, Robert T et al. (2015) Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study. Pediatrics 136:e344-50
Betancourt, Theresa S; McBain, Ryan; Newnham, Elizabeth A et al. (2014) Context matters: community characteristics and mental health among war-affected youth in Sierra Leone. J Child Psychol Psychiatry 55:217-26
Borisova, Ivelina I; Betancourt, Theresa S; Willett, John B (2013) Efforts to Promote Reintegration and Rehabilitation of Traumatized Former Child Soldiers: Reintegration of Former Child Soldiers in Sierra Leone: The Role of Caregivers and Their Awareness of the Violence Adolescents Experienced During the War. J Aggress Maltreat Trauma 22:803-828
Betancourt, Theresa S; McBain, Ryan; Newnham, Elizabeth A et al. (2013) Trajectories of internalizing problems in war-affected Sierra Leonean youth: examining conflict and postconflict factors. Child Dev 84:455-70
Betancourt, Theresa S; Meyers-Ohki, Sarah E; Charrow, Alexandra P et al. (2013) Interventions for children affected by war: an ecological perspective on psychosocial support and mental health care. Harv Rev Psychiatry 21:70-91