The aftermath of war; mental health, substance use and their correlates with social support and resilience among adolescents in a post-conflict region of Sri Lanka

Background Armed conflicts impact health and well-being, with adolescent mental health a significant yet under-explored area. Disorders developing during adolescence can lead to behavioral problems, risky decision-making, under-age substance use and poor educational attainment. This study estimated the prevalence of common mental disorders, substance use, and their correlates with social support and resilience among adolescents (12–19 years) in Vavuniya, a post-conflict region of Sri Lanka. Methods A population-based cross-sectional study was conducted using a modified cluster sampling approach. Eight culturally adapted instruments were used. A total of 585 adolescents participated. Analyses used SPSS v23 with two-sided tests (p<0.05), chi-square tests for associations, and Spearman correlations among depression, hopelessness, quality of life, social support, and resilience. Results Mean age was 15.02 (±2.13) years. Ninety-one (15.6%) reported exposure to ≥1 war-related event; 85 (93.4%) of these reported internal displacement. Fifty-two (8.9%) had dropped out of school. Prevalence of depression (3.9%) and lifetime substance use (7.0%) were low. Depression and hopelessness were significantly negatively correlated with social support, resilience, and quality of life (p<0.01). Linear regression suggested 40% of the variance in resilience was explained by perceived social support. Conclusion Low prevalence of hopelessness and depression highlights resilience in this group. Significant negative correlations of hopelessness and depression with perceived social support and resilience suggest these may be protective factors against mental health issues.

Lasith Dissanayake, Sameeha Jabir, Thomas Shepherd, Toby Helliwell, Lavan Selvaratnam, Kaushalya Jayaweera, Nihal Abeysinghe, Christian Mallen, Athula Sumathipala