A Behavioral Intervention for War-Affected Youth in Sierra Leone: A Randomized Controlled Trial

Abstract

Objective Youth in war-affected regions are at risk for poor psychological, social, and educational outcomes. Effective interventions are needed to improve mental health, social behavior, and school functioning. This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy (CBT)–based group mental health intervention for multisymptomatic war-affected youth (aged 15–24 years) in Sierra Leone. Method War-affected youth identified by elevated distress and impairment via community screening were randomized (stratified by sex and age) to the Youth Readiness Intervention (YRI) (n = 222) or to a control condition (n = 214). After treatment, youth were again randomized and offered an education subsidy immediately (n = 220) or waitlisted (n = 216). Emotion regulation, psychological distress, prosocial attitudes/behaviors, social support, functional impairment, and posttraumatic stress disorder (PTSD) symptoms were assessed at pre- and postintervention and at 6-month follow-up. For youth in school, enrollment, attendance, and classroom performance were assessed after 8 months. Linear mixed-effects regressions evaluated outcomes. Results The YRI showed significant postintervention effects on emotion regulation, prosocial attitudes/behaviors, social support, and reduced functional impairment, and significant follow-up effects on school enrollment, school attendance, and classroom behavior. In contrast, education subsidy was associated with better attendance but had no effect on mental health or functioning, school retention, or classroom behavior. Interactions between education subsidy and YRI were not significant. Conclusion YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement and behavior, suggesting potential to prepare war-affected youth for educational and other opportunities. Clinical trial registration information-Trial of the Youth Readiness Intervention (YRI); http://clinicaltrials.gov; NCT01684488.

Validation of the Brazilian Version of WHODAS 2.0 in Patients with Mental Disorders: Should the 12-Item Scale be an Alternative to 36-Item Scale in DSM-5?

“…Therefore, the editors of the DSM-5 should consider the WHODAS 2.0 12-item as a sensible alternative to the WHODAS 2.0 36-item scale in new versions of this manual. Furthermore, despite isolated studies with people aged 15 to 17 years [23][24][25] and the release of an unofficial version directed at children and adolescents [26], one limitation of the WHODAS 2.0 is the fact that it is only recommended by the WHO for application in adults [4,5] and, consequently, use of the GAF should not yet be discontinued.…”

The Impact of Mental Health and Psychosocial Support Interventions on People Affected by Humanitarian Emergencies: A systematic review

“…No intervention effects were found for well-being 109 (medium risk of bias study) or social support 81,115 (two medium risk of bias studies). One study found an improvement through CBT on somatic complaints 80 (SMD = -0.78, 95 percent CI (-1.14, -0.41); high risk of bias).…”

“…A further 15 studies delivered programmes in community settings generally 81,96,101,103 (n=4) or in refugee camps 82,88,95,98,114 (n=5), family homes 83,85,87 (n=3), outdoor areas for story-telling and drawing, 108 at football games 110 or in church. 104 A total of seven studies did not specify where the programmes were delivered.…”

“…Thirteen studies 80,81,85,94,96,102,105,106,108,109,[115][116][117] assessed the impact of CBT. The findings from the meta-analysis suggested that CBT approaches might reduce PTSD (++) and emotional problems (+).…”

Examining Bidirectional Pathways Between Exposure to Political Violence and Adolescent Adjustment in Northern Ireland

“…Research has repeatedly documented there is an elevated risk for adjustment problems among children and adolescents living in contexts of political violence (Betancourt, Meyers-Ohki, Charrow, & Tol, 2013;Betancourt et al, 2014;Dubow, Huesmann, and Boxer, 2009;Jordans, Tol, Komproe, & De Jong, 2009). These findings call attention to the significant challenges for children's adjustment posed by political violence and the urgency for effective intervention for child adjustment problems.…”