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Trajectories of Internalizing Problems in War-Affected Sierra Leonean Youth: Examining Conflict and Postconflict Factors


  • We are grateful to the local research assistants who conducted interviews in Sierra Leone and our field-based project coordinators as well as our colleagues at the International Rescue Committee who collaborated in this data collection. In addition, we thank Sidney Atwood, who managed the data and supported the analyses. This study was funded by the United States Institute of Peace, USAID/DCOF, Grant 1K01MH077246-01A2 from the National Institute of Mental Health, the International Rescue Committee, the François-Xavier Bagnoud Center for Health and Human Rights and the American Australian Association.

Correspondence concerning this article should be addressed to Theresa S. Betancourt, Department of Global Health and Population/François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, 651 Huntington Ave, 7th Floor, Boston, MA 02115. Electronic mail may be sent to


Three waves of data from a prospective longitudinal study in Sierra Leone were used to examine internalizing trajectories in 529 war-affected youth (ages 10–17 at baseline; 25% female). Latent class growth analyses identified 4 trajectories: A large majority of youth maintained lower levels of internalizing problems (41.4%) or significantly improved over time (47.6%) despite very limited access to care, but smaller proportions continued to report severe difficulties 6 years postwar (4.5%) or their symptoms worsened (6.4%). Continued internalizing problems were associated with loss of a caregiver, family abuse and neglect, and community stigma. Despite the comparative resilience of most war-affected youth in the face of extreme adversity, there remains a compelling need for interventions that address family- and community-level stressors.

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