{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:48:18Z","timestamp":1791517698442,"version":"4.3.4"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,8,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND:<\/jats:title><jats:p>War-affected youth often suffer from multiple co-occurring mental health problems. These youth often live in low-resource settings where it may be infeasible to provide mental health services that simultaneously address all of these co-occurring mental health issues. It is therefore important to identify the areas where targeted interventions would do the most good.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>This analysis uses observational data from 3 waves of a longitudinal study on mental health in a sample of 529 war-affected youth (24.2% female; ages 10\u201317 at T1, 2002) in Sierra Leone. We regressed 4 mental health outcomes at T3 (2008) on internalizing (depression\/anxiety) and externalizing (hostility\/aggression) problems and prosocial attitudes\/behaviors and community variables at T2 (2004) controlling for demographics, war exposures, and previous mental health scores at T1, allowing us to assess the relative impact of potential mental health intervention targets in shaping mental health outcomes over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Controlling for baseline covariates at T1 and all other exposures\/potential intervention targets at T2, we observed a significant association between internalizing problems at T2 and 3 of the 4 outcomes at T3: internalizing (\u03b2 = 0.27, 95% confidence interval [CI]: 0.11\u20130.42), prosocial attitudes (\u03b2 = \u20130.20, 95% CI: \u20130.33 to \u20130.07) and posttraumatic stress symptoms (\u03b2 = 0.22, 95% CI: 0.02\u20130.43). No other potential intervention target had similar substantial effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Reductions in internalizing may have multiple benefits for other mental health outcomes at a later point in time, even after controlling for confounding variables.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2014-1521","type":"journal-article","created":{"date-parts":[[2015,7,7]],"date-time":"2015-07-07T00:29:48Z","timestamp":1436228988000},"page":"e344-e350","source":"Crossref","is-referenced-by-count":16,"title":["Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study"],"prefix":"10.1542","volume":"136","author":[{"given":"Theresa S.","family":"Betancourt","sequence":"first","affiliation":[{"name":"Departments of Global Health and Population,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E.","family":"Gilman","sequence":"additional","affiliation":[{"name":"Social and Behavioral Sciences, and"},{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts;"},{"name":"Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert T.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Departments of Global Health and Population,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ista","family":"Zahn","sequence":"additional","affiliation":[{"name":"FXB Center for Health and Human Rights and"},{"name":"The Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler J.","family":"VanderWeele","sequence":"additional","affiliation":[{"name":"Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,8,1]]},"reference":[{"issue":"5","key":"2021120907135105200_B1","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1542\/peds.100.5.873","article-title":"War experiences and distress symptoms of Bosnian children.","volume":"100","author":"Goldstein","year":"1997","journal-title":"Pediatrics"},{"issue":"3","key":"2021120907135105200_B2","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1542\/peds.97.3.394","article-title":"Psychosocial problems in refugee children exposed to war.","volume":"97","author":"McCloskey","year":"1996","journal-title":"Pediatrics"},{"issue":"2","key":"2021120907135105200_B3","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/HRP.0b013e318283bf8f","article-title":"Interventions for children affected by war: an ecological perspective on psychosocial support and mental health care.","volume":"21","author":"Betancourt","year":"2013","journal-title":"Harv Rev Psychiatry"},{"issue":"1","key":"2021120907135105200_B4","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1467-8624.2012.01848.x","article-title":"Exposure to violence across the social ecosystem and the development of aggression: a test of ecological theory in the Israeli-Palestinian conflict.","volume":"84","author":"Boxer","year":"2013","journal-title":"Child Dev"},{"issue":"6","key":"2021120907135105200_B5","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1080\/15374416.2012.675571","article-title":"Cumulative effects of exposure to violence on posttraumatic stress in Palestinian and Israeli youth.","volume":"41","author":"Dubow","year":"2012","journal-title":"J Clin Child Adolesc Psychol"},{"issue":"4","key":"2021120907135105200_B6","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1037\/a0019668","article-title":"Political violence and child adjustment in Northern Ireland: Testing pathways in a social-ecological model including single-and two-parent families.","volume":"46","author":"Cummings","year":"2010","journal-title":"Dev Psychol"},{"issue":"6","key":"2021120907135105200_B7","first-page":"606","article-title":"Sierra Leone\u2019s former child soldiers: a longitudinal study of risk, protective factors, and mental health.","volume":"49","author":"Betancourt","year":"2010","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"2","key":"2021120907135105200_B8","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.1467-8624.2012.01861.x","article-title":"Trajectories of internalizing problems in war-affected Sierra Leonean youth: examining conflict and postconflict factors.","volume":"84","author":"Betancourt","year":"2013","journal-title":"Child Dev"},{"issue":"4","key":"2021120907135105200_B9","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1093\/jrs\/17.4.460","article-title":"Investigating psychosocial adjustment of former child soldiers in Sierra Leone and Uganda.","volume":"17","author":"MacMullin","year":"2004","journal-title":"J Refug Stud"},{"issue":"6","key":"2021120907135105200_B10","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jama.300.6.691","article-title":"Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal.","volume":"300","author":"Kohrt","year":"2008","journal-title":"JAMA"},{"key":"2021120907135105200_B11","volume-title":"UCLA PTSD Index for DSM-IV (Revision 1)","author":"Pynoos","year":"1998"},{"issue":"4","key":"2021120907135105200_B12","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1111\/j.1467-8624.2010.01454.x","article-title":"Unpacking trauma exposure risk factors and differential pathways of influence: predicting postwar mental distress in Bosnian adolescents.","volume":"81","author":"Layne","year":"2010","journal-title":"Child Dev"},{"key":"2021120907135105200_B13","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.socscimed.2010.07.020","article-title":"Mental health and armed conflict: The importance of distinguishing between war exposure and other sources of adversity: a response to Neuner.","volume":"71(8)","author":"Miller","year":"2010","journal-title":"Soc Sci Med"},{"issue":"4","key":"2021120907135105200_B14","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1111\/j.1467-8624.2010.01455.x","article-title":"Sierra Leone\u2019s former child soldiers: a follow-up study of psychosocial adjustment and community reintegration.","volume":"81","author":"Betancourt","year":"2010","journal-title":"Child Dev"},{"issue":"1","key":"2021120907135105200_B15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.socscimed.2009.09.038","article-title":"Past horrors, present struggles: the role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone.","volume":"70","author":"Betancourt","year":"2010","journal-title":"Soc Sci Med"},{"issue":"4","key":"2021120907135105200_B16","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/sim.4780100410","article-title":"Multiple imputation in health-care databases: an overview and some applications.","volume":"10","author":"Rubin","year":"1991","journal-title":"Stat Med"},{"issue":"39(1","key":"2021120907135105200_B17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.2517-6161.1977.tb01600.x","article-title":"Maximum likelihood from incomplete data via the EM algorithm.","author":"Dempster","year":"1977","journal-title":"J R Stat Soc, B"},{"issue":"10","key":"2021120907135105200_B18","doi-asserted-by":"crossref","first-page":"e1000159","DOI":"10.1371\/journal.pmed.1000159","article-title":"Packages of care for depression in low- and middle-income countries.","volume":"6","author":"Patel","year":"2009","journal-title":"PLoS Med"},{"issue":"5","key":"2021120907135105200_B19","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1001\/jama.298.5.519","article-title":"Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial.","volume":"298","author":"Bolton","year":"2007","journal-title":"JAMA"},{"issue":"4","key":"2021120907135105200_B20","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1037\/0022-006X.76.4.686","article-title":"Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial.","volume":"76","author":"Neuner","year":"2008","journal-title":"J Consult Clin Psychol"},{"issue":"3","key":"2021120907135105200_B21","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/WTF.0b013e3282f211c8","article-title":"Pathways to embodied empathy and reconciliation after atrocity: former boy soldiers in a dance\/movement therapy group in Sierra Leone.","volume":"5","author":"Harris","year":"2007","journal-title":"Intervention"},{"issue":"4","key":"2021120907135105200_B22","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1037\/1089-2699.5.4.277","article-title":"Trauma\/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents.","volume":"5","author":"Layne","year":"2001","journal-title":"Group Dyn"},{"issue":"3","key":"2021120907135105200_B23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1521\/ijgp.2007.57.3.319","article-title":"Effectiveness of a trauma\/grief-focused group intervention: a qualitative study with war-exposed Bosnian adolescents.","volume":"57","author":"Cox","year":"2007","journal-title":"Int J Group Psychother"},{"issue":"4","key":"2021120907135105200_B24","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/13623699908409477","article-title":"Psychological trauma and social healing in Croatia.","volume":"15","author":"Woodside","year":"1999","journal-title":"Med Confl Surviv"},{"issue":"2","key":"2021120907135105200_B25","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1023\/B:JOTS.0000022620.13209.a0","article-title":"Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: a pilot study.","volume":"17","author":"Gordon","year":"2004","journal-title":"J Trauma Stress"},{"issue":"1","key":"2021120907135105200_B26","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/1471-244X-10-92","article-title":"Protocol for a randomised controlled trial of risk screening and early intervention comparing child- and family-focused cognitive-behavioural therapy for PTSD in children following accidental injury.","volume":"10","author":"Kenardy","year":"2010","journal-title":"BMC Psychiatry"},{"issue":"5","key":"2021120907135105200_B27","doi-asserted-by":"crossref","first-page":"e1001222","DOI":"10.1371\/journal.pmed.1001222","article-title":"Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa.","volume":"9","author":"Honikman","year":"2012","journal-title":"PLoS Med"},{"issue":"1","key":"2021120907135105200_B28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.socscimed.2009.09.029","article-title":"War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks.","volume":"70","author":"Miller","year":"2010","journal-title":"Soc Sci Med"},{"issue":"4","key":"2021120907135105200_B29","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1177\/1363461508100785","article-title":"Daily stressors, war experiences, and mental health in Afghanistan.","volume":"45","author":"Miller","year":"2008","journal-title":"Transcult Psychiatry"},{"key":"2021120907135105200_B30","first-page":"157","article-title":"Addressing the consequences of violence and adversity: the development of a group mental health intervention for war-affected youth in Sierra Leone","volume-title":"From Research to Practice in Child and Adolescent Mental Health","author":"Betancourt","year":"2014"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/2\/e344\/917487\/peds_2014-1521.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/2\/e344\/917487\/peds_2014-1521.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,9]],"date-time":"2024-06-09T21:46:09Z","timestamp":1717969569000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/136\/2\/e344\/33733\/Identifying-Priorities-for-Mental-Health"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,8,1]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2015,8,1]]},"published-print":{"date-parts":[[2015,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2014-1521","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,8,1]]}}}