School-Based Intervention for the Treatment of Tsunami-Related Distress in Children: A Quasi-Randomized Controlled Trial

Abstract

Background: On December 26, 2004, a tsunami hit the southern coast of Sri Lanka, leaving thousands dead and injured. Previous research has found significant mental health problems among children exposed to major disasters. School-based universal interventions have shown promise in alleviating distress and posttraumatic symptomatology in children and adolescents. This study evaluated the efficacy of a school-based intervention in reducing stress-related symptomatology among Sri Lankan children exposed to the tsunami. Methods: In a quasi-randomized controlled trial 166 elementary school students (ages 9–15) with significant levels of tsunami exposure and previous traumatic background were randomly assigned to a 12-session structured program ‘ERASE Stress Sri Lanka’ (ES-SL) or to a waiting list (WL) religious class control group. Students were assessed 1 week prior and 3 months after the intervention on measures of posttraumatic symptomatology [including posttraumatic stress disorder (PTSD) and severity of posttraumatic symptomatology], depression, functional problems, somatic problems and hope. Results: This study shows a significant reduction on all outcome variables. PTSD severity, functional problems, somatic complaints, depression and hope scores were all significantly improved in the ES-SL group compared to the WL group. No new cases of PTSD were observed in the experimental group. Conclusion: This study adds to the growing body of evidence suggesting the efficacy of school-based universal approaches in helping children in regions touched by war, terror and disaster and suggests the need to adopt a two-stage approach toward dealing with trauma-exposed students, namely, starting with a universal intervention followed by targeted specialized interventions for those still suffering from posttraumatic distress.

Rehabilitation of vulnerable groups in emergencies and disasters: A systematic review

“…The majority of them also did not consider important confounding factors. None of the randomized controlled trial articles reported blinding of participants or assessors and two studies [35,36] lacked a control group. More details have shown in Table 1.…”

“…Details of each study and their special features were reported regarding authors, year, study type, vulnerable group, sample size, type of rehabilitation, setting and duration of rehabilitation, disaster type, and main concepts. The studies were mainly conducted in Asian countries and United States, including India, [15,19,20,[25][26][27]31] China, [18,22,23,34,36,37] Pakistan, [16,28,30] Iran, [13,17,21] Indonesia, [29,32] Sri Lanka [35] and United States. [14,24,33] The results of the studies showed that 56% of the studies are about rehabilitation programs for women, 32% is for children, 24% is for elderly, and 16% is for disabled people.…”

“…Berger et al [35] ( teaching behavioral and cognitive skills, providing training materials, thinking practices, bio-energetic practices and techniques. The result of this paper showed that compared with the control group, PTSD severity, somatic complaints, functional problems and depression decreased in intervention groups after performing rehabilitation actives.…”

Medical Rehabilitation in Natural Disasters: A Review

“…Three studies evaluated rehabilitation interventions in cohorts of limb fracture victims, 21-23 2 included SCI survivors, 24,25 1 evaluated newly diagnosed posttraumatic stress disorder (PTSD) victims, 26 and 1 included school children. 27 Rehabilitation interventions and outcome measures description Table 3 summarizes the rehabilitation interventions in included studies. Institution-based rehabilitation programs were evaluated in 6 studies, [21][22][23][24][25][26] 3 studies evaluated CBR, 20,27 and 1 study evaluated both institution-based rehabilitation and CBR.…”

Quality of life, vulnerability and resilience: a qualitative study of the tsunami impact on the affected population of Sri Lanka

“…As shown by a study on collective trauma in northen Sri Lanka, exposure to conflict, war and disaster situations impacts on fundamental family and community dynamics, which results in changes at a collective level [26]. Recent studis have also highlighted in particular the effects on children [27] and the need for targeted specialized interventions for children suffering from post-traumatic stress disorder [28,29].…”