Conflict-Related Traumatic Grief Among Congolese Former Child Soldiers: A Target-Trial Emulation Estimating Mental Health Service Contact Under Exposure-Response Uncertainty

Conflict-related traumatic grief among former child soldiers in the eastern Democratic Republic of Congo is frequently complicated by prolonged exposure to abduction, forced combat and bereavement, yet the causal effect of grief severity on subsequent mental health service contact remains poorly identified because exposure is neither randomised nor stable over time. Using a declared variance structure with a between-cluster standard deviation of 6.0, a residual standard deviation of 4.5 and an intraclass correlation of 0.64, power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The design required 54 clusters to detect a 5-percentage-point effect at 80% power. Exposure-contrast misspecification, not sampling variance, dominates the bias budget, and it specifies the sensitivity analyses that would bound that bias in a future field implementation.