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Christophe Pierre Bayer, LLB; Fionna Klasen, Dipl-Psych; Hubertus Adam, MD

JAMA. 2007;298:555-559.

Context  Tens of thousands of the estimated 250 000 child soldiers worldwide are abused or have been abused during the last decade in Africa's Great Lakes Region. In the process of rebuilding the war-torn societies, it is important to understand how psychological trauma may shape the former child soldiers' ability to reconcile.

Objective  To investigate the association of posttraumatic stress disorder (PTSD) symptoms and openness to reconciliation and feelings of revenge in former Ugandan and Congolese child soldiers.

Design, Setting, and Participants  Cross-sectional field study of 169 former child soldiers (aged 11-18 years) in rehabilitation centers in Uganda and the Democratic Republic of the Congo, conducted in 2005.

Main Outcome Measures  Potentially traumatic war-related experiences assessed via a sample-specific events scale; PTSD symptoms assessed using the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI), with a score of 35 or higher indicating clinically important PTSD symptoms; and openness to reconciliation and feelings of revenge assessed via structured questionnaires.

Results  Children participating in this study were a mean of 15.3 years old. These former child soldiers reported that they had been (violently) recruited by armed forces at a young age (mean [SD], 12.1 [2] years), had served a mean of 38 months (SD, 24 months), and had been demobilized a mean of 2.3 months before data collection (SD, 2.4 months). The children were exposed to a high level of potentially traumatic events (mean [SD], 11.1 [2.99]). The most commonly reported traumatic experiences were having witnessed shooting (92.9%), having witnessed someone wounded (89.9%), and having been seriously beaten (84%). A total of 54.4% reported having killed someone, and 27.8% reported that they were forced to engage in sexual contact. Of the 169 interviewed, 59 (34.9%; 95% confidence interval, 34.4%-35.4%) had a PTSD symptom score higher than 35. Children who showed more PTSD symptoms had significantly less openness to reconciliation (= –0.34, P < .001) and more feelings of revenge (= 0.29, P < .001).

Conclusions  PTSD symptoms are associated with less openness to reconciliation and more feelings of revenge among former Ugandan and Congolese child soldiers. The effect of psychological trauma should be considered when these children are rehabilitated and reintegrated into civilian society.

Author Affiliations: Outpatient Clinic for Refugee Children and Their Families, Department of Child and Adolescent Psychiatry, University Clinic Hamburg, Germany (Mr Bayer, Ms Klasen, and Dr Adam); Children for Tomorrow Foundation, Hamburg, Germany (Ms Klasen and Dr Adam); and Hospital for Psychiatry, Neurology and Child and Adolescent Psychiatry, Eberswalde, Germany (Dr Adam).

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