A Randomized Controlled Trial of a Trauma-Informed Support, Skills, and Psychoeducation Intervention for Survivors of Torture and Related Trauma in Kurdistan, Northern Iraq

Abstract

Providing survivors of torture, imprisonment, and/or military attacks with a counseling program that includes support, skills and psychoeducation by well-trained and supervised community mental health workers can result in moderate yet meaningful improvements in depression and dysfunction.

Meta-analysis of interventions for posttraumatic stress disorder and depression in adult survivors of mass violence in low- and middle-income countries

“…Seventeen of the trials assessed PTSD and 13 trials assessed depression. Of the 12 trials assessing symptoms of both PTSD and depression, seven trials had focused on both PTSD and depression (Acarturk et al., ; Acarturk et al., ; Bass et al., ; Bass et al., ; Bolton et al., ; Meffert et al., ; Weiss et al., ), four reported treatment of PTSD as the major focus and additionally measured the efficacy of the intervention for depression among individuals with PTSD (Bryant et al., ; Connolly & Sakai, ; Hagl, Powell, Rosner, & Butollo, ; Knaevelsrud, Brand, Lange, Ruwaard, & Wagner, ), and one reported treatment of depression as the main focus and assessed symptoms of PTSD as secondary outcome (Bolton et al., ). Five trials assessed PTSD only (Igreja, Kleijn, Schreuder, Van Dijk, & Verschuur, ; Jacob, Neuner, Maedl, Schaal, & Elbert, ; Neuner et al., ; Neuner, Schauer, Klaschik, Karunakara, & Elbert, ; Yeomans, Forman, Herbert, & Yuen, ), whereas one trial assessed depression only (Bolton et al., ).…”

Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis

“…However, several were designed to be trauma-informed, by addressing cognitive processing of traumatic events, 21 habituating traumatic memories, 22 focusing on traumatic experiences, 29 or debriefing. 28 The remaining interventions had a more practical focus and were likely to benefit women disclosing intimate partner violence through problemsolving, 25,31 behavioural activation, 21,26,32,34 coping skills, 27,30 or a mixture of methods. 33 Given that anxiety is an important manifestation of trauma, more trauma-focused interventions might yield even greater gains than generic interventions in women experiencing intimate partner violence.…”

“…27,28,31 or Violence, War, Abduction and Exposure Scale. 22 Most studies asked a single question about intimate partner violence 32,33 or domestic violence 21,26,29,30,34 exposure, which might have included abuse by non-partners. Some studies 26,33,34 asked about intimate partner violence in the past 3 months only.…”

“…Included interventions were delivered by various staff: a public health professional and researcher, 28 psychology Masters-educated therapists, 29 community mental health workers, 21,30 general health workers, 31,33 other community workers, 27 and lay individuals. 22,25,26,32,34 Five studies [25][26][27]32,34 compared the control intervention (enhanced usual care [EUC]) with the intervention plus EUC, but the content of EUC, and other studies' control interventions, varied from face-to-face or telephone-delivered basic counselling 31,33 to diagnosis and the opportunity for WHO mental health gap action programme intervention guided treatment, 26,32,34 a home visit, 27 film screenings, 28 and waiting lists.…”

“…22,25,26,32,34 Five studies [25][26][27]32,34 compared the control intervention (enhanced usual care [EUC]) with the intervention plus EUC, but the content of EUC, and other studies' control interventions, varied from face-to-face or telephone-delivered basic counselling 31,33 to diagnosis and the opportunity for WHO mental health gap action programme intervention guided treatment, 26,32,34 a home visit, 27 film screenings, 28 and waiting lists. 21,22,29,30 Numbers of sessions ranged from three 28 to 14, 33 delivered at clinics, 21,30 in community settings, 25,27,28 at home, 22,31,34 or a mixture of locations. 26,32,33 Most interventions were delivered individually, with two in groups 27,28 and one mixed.…”