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Predictors of Somatic Symptomatology in War-Affected Youth in Northern Uganda: Findings from the WAYS Study

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War experiences have been shown to have adverse long-term psychological sequelae. Nevertheless, the roles of different types of war events in predicting which mental health outcomes remain unclear. This study investigated the effects of different types of war events and socio-demographic characteristics on somatic symptoms in war-affected youth in Northern Uganda. A sample of 539 youth (mean age = 22.39; ± 2.03) participated in the study. Using maximum likelihood estimation in structural equation modelling, regression analyses were fitted to relate binary indicators of different types of war events to one latent factor capturing somatic symptoms. The results indicated that sex, marital status, and war types of “direct personal harm”, “deaths”, and “sexual abuse” independently and uniquely predicted somatic symptoms. Types of war events should be considered when planning interventions. Somatic symptoms may be a window into physical health and psychological sequelae. Implications for mental health service delivery are discussed.

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Availability of Data and Materials

The dataset supporting the conclusions of this article is available upon reasonable request by contacting the corresponding author.


  1. Amone-P’Olak, K. (2005). Psychological impact of war and sexual abuse on adolescent girls in Northern Uganda. Intervention,3(1), 33–45.

  2. Amone-P’Olak, K., & Elklit, A. (2018). Interpersonal sensitivity as mediator of the relations between war experiences and mental illness in war-affected youth in Northern Uganda: Findings from the WAYS Study. Traumatology,24(3), 200–208.

  3. Amone-P’Olak, K., Garnefski, N., & Kraaij, V. (2007). Adolescents caught between fires: Cognitive emotion regulation in response to war experiences in Northern Uganda. Journal of Adolescence,30(4), 655–669.

  4. Amone-P’Olak, K., Jones, P. B., Abbott, R., Meiser-Stedman, R., Ovuga, E., & Croudace, T. J. (2013). Cohort profile: mental health following extreme trauma in a northern Ugandan cohort of War-Affected Youth Study (The WAYS Study). SpringerPlus,2(1), 300.

  5. Amone-P’Olak, K., Lekhutlile, T. M., Ovuga, E., Abbott, R. A., Meiser-Stedman, R., Stewart, D. G., et al. (2016). Sexual violence and general functioning among formerly abducted girls in Northern Uganda: The mediating roles of stigma and community relations-the WAYS study. BMC Public Health,16(1), 64.

  6. Amone-P’Olak, K., & Omech, B.O. (2018). Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study. Journal of Health Psychology. Advance online publication [19 May 2018].

  7. Amone-P’Olak, K., Otim, B. N., Opio, G., Ovuga, E., & Meiser-Stedman, R. (2015a). War experiences and psychotic symptoms among former child soldiers in Northern Uganda: The mediating role of post-war hardships—The WAYS Study. South African Journal of Psychology,45(2), 155–167.

  8. Amone-P’Olak, K. (2004). A study of the psychological state of formerly abducted children at Gulu World Vision Trauma Centre. Torture,14(1), 24–34.

  9. Amone-P’Olak, K. (2009). Torture against children in rebel captivity in Northern Uganda: Physical and psychological effects and implications for clinical practice. Torture,19(2), 102–117.

  10. Amone-P’Olak, K., Ovuga, E., Croudace, T. J., Jones, P. B., & Abbott, R. (2014a). The influence of different types of war experiences on depression and anxiety in a Ugandan cohort of war-affected youth: The WAYS study. Social Psychiatry and Psychiatric Epidemiology,49(11), 1783–1792.

  11. Amone-P’Olak, K., Ovuga, E., & Jones, P. B. (2015b). The effects of sexual violence on psychosocial outcomes in formerly abducted girls in Northern Uganda: the WAYS study. BMC Psychology,3(1), 46.

  12. Amone-P’Olak, K., Stochl, J., Ovuga, E., Abbott, R., Meiser-Stedman, R., Croudace, T. J., et al. (2014b). Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: The WAYS study. Journal of Epidemiology and Community Health,68, 425–430.

  13. Betancourt, T. S., Agnew-Blais, J., Gilman, S. E., Williams, D. R., & Ellis, B. H. (2010). Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Social Science and Medicine,70(1), 17–26.

  14. Betancourt, T. S., Bass, J., Borisova, I., Neugebauer, R., Speelman, L., Onyango, G., et al. (2009a). Assessing local instrument reliability and validity: A field-based example from northern Uganda. Social Psychiatry and Psychiatric Epidemiology,44(8), 685–692.

  15. Betancourt, T. S., Speelman, L., Onyango, G., & Bolton, P. (2009b). A qualitative study of mental health problems among children displaced by war in northern Uganda. Transcultural Psychiatry,46(2), 238–256.

  16. Bonvanie, I. J., Janssens, K. A., Rosmalen, J. G., & Oldehinkel, A. J. (2017). Life events and functional somatic symptoms: A population study in older adolescents. British Journal of Psychology,108(2), 318–333.

  17. Brown, R. J. (2004). Psychological mechanisms of medically unexplained symptoms: An integrative conceptual model. Psychological Bulletin,130(5), 793.

  18. Brown, C. (2012). Rape as a weapon of war in the Democratic Republic of the Congo. Torture,22(1), 24–37.

  19. Dyregrov, A., Gjestad, R., & Raundalen, M. (2002). Children exposed to warfare: A longitudinal study. Journal of Traumatic Stress,15(1), 59–68.

  20. Epstein, R. M., Quill, T. E., & McWhinney, I. R. (1999). Somatization reconsidered: Incorporating the patient’s experience of illness. Archives of Internal Medicine,159(3), 215–222.

  21. Gillespie, N., Kirk, K. M., Heath, A. C., Martin, N. G., & Hickie, I. (1999). Somatic distress as a distinct psychological dimension. Social Psychiatry and Psychiatric Epidemiology,34(9), 451–458.

  22. Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry,164(1), 150–153.

  23. Hu, L. T., & Bentler, P. M. (1995). Evaluating model fit. In R. H. Hoyle (Ed.), Structural Equation Modelling: Concepts, issues, and applications (pp. 76–99). Thousand Oaks: Sage.

  24. Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review,28(1), 36–47.

  25. Kirmayer, L. J. (1996). Confusion of the senses: Implications of ethnocultural variations in somatoform and dissociative disorders for PTSD. Ethnocultural aspects of posttraumatic stress disorder: Issues, Research, and Clinical Applications,22, 131–163.

  26. Kline, R. B. (2015). Principles and practice of structural equation modelling. New York: Guilford Publications.

  27. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine,64(2), 258–266.

  28. Leserman, J., Li, Z., Drossman, D. A., & Hu, Y. J. (1998). Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: the impact on subsequent health care visits. Psychological Medicine,28(2), 417–425.

  29. Muthén, L. K., & Muthén, B. O. (2010). Mplus User’s Guide (6th ed.). Los Angeles, CA: Muthén & Muthén.

  30. Nakao, M., Fricchione, G., Zuttermeister, P. C., Myers, P., Barsky, A. J., & Benson, H. (2001). Effects of gender and marital status on somatic symptoms of patients attending a mind/body medicine clinic. Behavioural Medicine,26(4), 159–168.

  31. Roelofs, K., & Spinhoven, P. (2007). Trauma and medically unexplained symptoms: Towards an integration of cognitive and neuro-biological accounts. Clinical Psychology Review,27(7), 798–820.

  32. Simon, G. E., VonKorff, M., Piccinelli, M., Fullerton, C., & Ormel, J. (1999). An international study of the relation between somatic symptoms and depression. New England Journal of Medicine,341(18), 1329–1335.

  33. Steptoe, A., & Noll, A. (1997). The perception of bodily sensations, with special reference to hypochondriasis. Behaviour Research and Therapy,35(10), 901–910.

  34. UNICEF. (2010). UNICEF B&H post-war screening survey. New York, NY: UNICEF.

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We thank the war-affected youths for accepting to participate in this study and the following research assistants for collecting data: George Opio, Balaam Nyeko Otim (RIP), John Bismarck Okumu, Terrence Okot Akidi, Allan Silverman Obwoya, Denis Komakech, Sandra Abalo, Christine Laura Okello, Patrick Opira, Charles Opira, Justin Ongom, Dennis Nyero, Pamela Akumu, Christine Lamwaka, Brenda Akello, Agnes Areta, Kevin Aculu, Irene Faith Alinga, Douglas Too-rach, Sam Ford Komakech, and Mary Fiona Aber.


This study was funded by The Welcome Trust (Grant No. 087540/Z/08/Z) as part of the African Institutional Initiative for the project Training Health Researchers in Vocational Excellence (THRiVE) in East Africa.

Author information

KAP designed the project, carried out the research, performed analyses, and drafted the manuscript. BO contributed to project design, revised the drafted manuscript, corrected, and offered suggestions to improve the drafts. Both authors read and approved the final manuscript.

Correspondence to Kennedy Amone-P’Olak.

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Competing interests

The authors declare that they have no competing interests.

Ethics Approval and Consent to Participate

Ethical approval for this study was obtained from Gulu University’s Institutional Review Board, an affiliate of Uganda National Council for Science and Technology which oversees all research activities in Uganda. Written informed consent was obtained from all participants following ethical guidelines and approvals.

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Amone-P’Olak, K., Omech, B. Predictors of Somatic Symptomatology in War-Affected Youth in Northern Uganda: Findings from the WAYS Study. Psychol Stud (2020).

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  • War events
  • Demographic characteristics
  • Youths
  • Somatic symptomatology
  • Uganda