Recruitment of child soldiers in Nepal: Mental health status and risk factors for voluntary participation of youth in armed groups

Preventing involuntary conscription and voluntary recruitment of youth into armed groups are global human-rights priorities. Pathways for self-reported voluntary recruitment and the impact of voluntary recruitment on mental health have received limited attention. The objective of this study was to identify risk factors for voluntarily joining armed groups, as well as to test association of conscription status and mental health. In Nepal, interviews were conducted with 258 former child soldiers who participated in a communist (Maoist) revolution. Of these child soldiers 80% joined "voluntarily." Girls were 2.07 times more likely to join voluntarily than boys (95% CI [1.03-4.16], p =.04). Among girls, 51% reported joining voluntarily because of personal connections to people who were members of an armed group, compared with 22% of boys. Other reasons included escaping difficult life situations (36%), inability to achieve other goals in life (28%), and an appealing philosophy of the armed group (32%). Poor economic conditions were more frequently endorsed among boys (22%) than girls (10%). Voluntary conscription was associated with decreased risk for posttraumatic stress disorder (PTSD) among boys, but not for girls. Prevention of voluntary association with armed groups could be supported through attending to difficulties in daily life, identifying nonviolent paths to achieve life goals, and challenging the political philosophy of armed groups. Among boys, addressing economic risk factors may prevent recruitment, and prevention efforts for girls need to address personal connections to armed groups, as it has important implications for preventing recruitment through new methods, such as social media.