EDITORIAL Editorial: When Child Soldiers Grow Up: A Longitudinal Analysis of Postwar Adult Mental Health and Social Functioning Myriam S. Denov, PhD n 2017, approximately 420 million children— nearly one in five—were living in conflict-affected areas, an increase of 30 million from the previous year. 1 In contexts of war, children are killed, injured, orphaned, separated from family, and sexually assaulted. Vast numbers of boys and girls are also recruited into armed groups as child soldiers. Exposed to brutal forms of violence as wit- nesses, victims, and participants – most often simultaneously – child soldiers take on a multiplicity of roles as fighters, porters, messengers, spies, caregivers to younger children, domestic workers, and are frequently sexually exploited. Exposure to war is a known risk factor for long-term mental health problems and psychosocial distress, 2 with child soldiers reporting higher levels of anxiety, posttraumatic stress, depressive, and somatic symptoms than control groups. 3 Yet research has also demonstrated the resilience of former child soldiers and their ability to cope well despite wartime adversity and individual, familial, and structural stressors. 4 The post-war context has an important influence on the social functioning and mental health outcomes of child soldiers, 5 with community and family stigma being identified as significant barriers to accep- tance, belonging, and well-being. 6,7 This growing body of research has helped to uncover and illuminate the immediate and short-term effects of war on former child soldiers. How- ever, knowledge of the long-term effects remains poorly un- derstood. The study by Betancourt et al. 8 provides insight into the long-term adult mental health and social functioning of former child soldiers in Sierra Leone. The study offers nuance regarding why some former child soldiers may, over time, fare better than others. Betancourt et al. 8 show that adult mental health and social functioning in Sierra Leone’s former child soldiers were related to (1) wartime experiences, and (2) post- conflict risk and protective factors. Although previous litera- ture has demonstrated this when considering the lives of former child soldiers over the short-term, this study reaffirms these realities over the long term. Media portrayals would have us believe that child sol- diers are destined to a life of crime, violence, and insta- bility. 9 However, does wartime exposure continue to negatively affect the lives and mental health outcomes of former child soldiers in adulthood? As adults, do former child soldiers demonstrate an ability to “bounce back” and to overcome the consequences of their wartime victimiza- tion and/or participation? In one of the few longitudinal studies of former child soldiers, Boothby 10 found that although the majority of his 40 male participants in post- conflict Mozambique became productive, capable, and caring adults, all struggled with long-term psychological distress. Such studies offer important glimpses into the lives of child soldiers as adults; however, more information is needed to inform post-war interventions, and prevention. Filling vital research gaps, the study in this issue con- ducted assessments of a sample of former child soldiers at four time points (T1: 2002, T2: 2004, T3: 2008, and T4: 2016/2017). At T4, 323 of the sample of 491 former child soldiers were reassessed. Mixed methods were used to establish culturally meaningful and valid assessments of mental health, risk, and protective factors, and social functioning over time. Participants were compared with an age- and sex-standardized population of respondents through the nationally representative 2013 Sierra Leone Demographic and Health Survey (DHS). Logistic regres- sion analyses were conducted to evaluate whether wartime experiences were associated with later mental health chal- lenges, violence, and educational and employment out- comes, controlling for both sex and age. The findings of Betancourt et al. 8 are illustrative. At T4, the sample was predominantly male (72%) and had a mean age of 28 years. Participants, whose mean age at the time of their abduction/recruitment was 10.9 years, had endured profound forms of wartime violence as children, with 26% reporting killing or injuring others and 67% being victims of life- I 694 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry Volume 59 / Number 6 / June 2020