School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial

BMC Medicine

Joop TVM de Jong¹  Robert D Macy⁵  Eva S Smallegange³  Heather Sipsma⁷  Prudence Ntamutumba²  Aline Ndayisaba²  Mark JD Jordans⁸  Ivan H Komproe⁴  Wietse A Tol⁶ 

[1] Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands;HealthNet TPO Burundi, Bujumbura, Burundi;Department of Childhood and Educational Sciences, University of Amsterdam, Amsterdam, the Netherlands;Faculty for Behavioral & Social Sciences, Utrecht University, Utrecht, the Netherlands;International Trauma Center & Harvard School of Medicine, Boston, MA, USA;Department of Research & Development, HealthNet TPO, Amsterdam, the Netherlands;Department of Women, Children, and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA;Centre for Global Mental Health, Institute of Psychiatry, Kings College London, London, UK

关键词: War;    Violence;    Psychosocial intervention;    Prevention;    Treatment;    Efficacy;    Depression;    PTSD;    Children;   

Others  :  854927
DOI  :  10.1186/1741-7015-12-56

 received in 2013-08-31, accepted in 2014-02-25,  发布年份 2014

【 摘 要 】

Background

Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim).

Methods

We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention.

Results

No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes.

Conclusions

Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings.

Trial registration

The study was registered as ISRCTN42284825

【 授权许可】

   
2014 Tol et al.; licensee BioMed Central Ltd.

【 图 表 】

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