Project Summary

Building off of the National Institute of Mental Health (NIMH) funded Longitudinal Study of War-affected Youth (LSWAY) that began in 2002 at the end of Sierra Leone’s civil war, our newest research is our fifth wave of data on this population,  titled,  Social and Biological Mechanisms Driving the Intergenerational Impact of War on Child Mental Health: Implications for Developing Family-Based Interventions, which will examine both the mechanisms by which emotional and behavioral disruptions may be transmitted from parents to offspring; and the risk and protective factors that shape child mental health outcomes. We are investigating how toxic stress 'gets under the skin' and transfers over generations. This research is the first known effort in Sub-Saharan Africa to examine modifiable risk and protective biobehavioral mechanisms driving the intergenerational effects of war on the mental health of offspring aged 7–24.

Approach & Aims

The fifth wave of this study will follow up with our cohort as well as their offspring aged 7-24. Inclusion criteria are (a) being a war-affected young adult previously interviewed at one or more waves of the LSWAY who still resides in Sierra Leone; (b) being a cohabitating intimate partner of the index participant; or (c) being a biological child (aged 7-24) of the index participant. Participant Incentives will be (a) equivalent of $7 USD per adult and $3 per child for families who participate in psychosocial assessments; (b) a health check-up and malaria test for all participating in collection of biomarkers; and (c) $3 USD and up to $3 USD for transportation for Key Informant interviews or Focus Group participation. We will provide beverages and snacks to all participants. Our proposed study survey will repeat LSWAY measures and add new mental health and cognitive development measures.


  • Investigate the biological embedding and long-term mental health consequences of war-related trauma in a longitudinal sample of war-affected youth who have become parents (N=394).
  • Examine associations between parental war-related trauma exposure, mental health and biological and physiological indicators of emotion, cognition and social functioning in offspring aged 7–24 (N=410). 
  • Identify and examine how modifiable risk and protective factors operate to identify priority intervention targets to improve physical and mental health of war-affected children and to develop screening tools to identify families at risk.

Measurement & Metrics

Mixed methods were used to establish culturally meaningful and valid assessments of mental health, risk, protective factors, and social functioning. All measures were self-reported and selected in consultations with local staff and community members. Items from the Child War Trauma Questionnaire, Post-War Adversities Scale, Perceived Stress Scale, SWAY Parenting, Dyadic Adjustment Scale, Adapted UNICEF Multiple Indicator Cluster Surveys, PARQ-Short Form, Demographic and Health Survey Sierra Leone, Hopkins Symptom Checklist Center for Epidemiological Studies Depression Scale-Child Version, UCLA PTSD Index, Child Behavior Cheklist, Brief COPE Scale, Difficulties in Emotion Regulation Scale, Normative Beliefs about Aggression Scale, Oxford Measure of Psychosocial Adjustment, RACER, Adapted Youth Risk Behavior Survey, WHO Disability Adjustment Scale, and Child Rating Scale were adapted for use in this project. 

Key Findings

  • LSWAY findings—drawn from four waves (T1:2002–T4:2016/17) of data collection and analysis—indicate that a healthy transition to adulthood was linked to engagement in prosocial behavior and community involvement, while problems with hostility, poor emotion regulation, and social withdrawal created barriers to achieving healthy and productive lives
  • The new research will allow us to examine how biobehavioral mechanisms operate among war-affected parents to shape parenting and the mental health of offspring. We will link prior waves of behavioral assessments and observations of war-affected youth who became parents to data on their intimate partners and biological children added at wave 4.

Publications & Media

Principal Investigator

Project Support

The National Institute of Mental Health (NIMH) has funded this project for 5th consequetive waves of data. The current NIMH funded study is an R01.


Caritas Freetown, Kenema General Hospital, Tulane University, Vanderbilt University, University of Makeni.


Kashiya Nwanguma
Program Manager

Based in Freetown, Sierra Leone

Facts & Figures