Context Prior qualitative work with internally displaced persons in war-affected northern Uganda showed significant mental health and psychosocial problems.Objective To assess effect of locally feasible interventions on depression, anxiety, and conduct problem symptoms among adolescent survivors of war and displacement in northern Uganda. Design, Setting, and ParticipantsA randomized controlled trial from May 2005 through December 2005 of 314 adolescents (aged 14-17 years) in 2 camps for internally displaced persons in northern Uganda. Interventions Locally developed screening tools assessed the effectiveness of interventions in reducing symptoms of depression and anxiety, ameliorating conduct problems, and improving function among those who met study criteria and were randomly allocated (105, psychotherapy-based intervention [group interpersonal psychotherapy]; 105, activity-based intervention [creative play]; 104, wait-control group [individuals wait listed to receive treatment at study end]). Intervention groups met weekly for 16 weeks. Participants and controls were reassessed at end of study.Main Outcome Measures Primary measure was a decrease in score (denoting improvement) on a depression symptom scale. Secondary measures were improvements in scores on anxiety, conduct problem symptoms, and function scales. Depression, anxiety, and conduct problems were assessed using the Acholi Psychosocial Assessment Instrument with a minimum score of 32 as the lower limit for clinically significant symptoms (maximum scale score, 105).Results Difference in change in adjusted mean score for depression symptoms between group interpersonal psychotherapy and control groups was 9.79 points (95% confidence interval [CI], 1.66-17.93). Girls receiving group interpersonal psychotherapy showed substantial and significant improvement in depression symptoms compared with controls (12.61 points; 95% CI, 2.09-23.14). Improvement among boys was not statistically significant (5.72 points; 95% CI, −1.86 to 13.30). Creative play showed no effect on depression severity (−2.51 points; 95% CI, −11.42 to 6.39). There were no statistically different improvements in anxiety in either intervention group. Neither intervention improved conduct problem or function scores.Conclusions Both interventions were locally feasible. Group interpersonal psychotherapy was effective for depression symptoms among adolescent girls affected by war and displacement. Other interventions should be investigated to assist adolescent boys in this population who have symptoms of depression.

EPRESSION IS A LEADING cause of disability in both developed and developing regions of the world, including Africa. 1,2 In 2000, we conducted a community-based survey in an impoverished part of southwest Uganda that has been severely affected by the human immunodeficiency virus (HIV) epidemic. Using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) major depression criteria, we found a current depression prevalence rate of 21% (P.B., unpublished data, 2000), consistent with previous research implicating socioeconomic disadvantage and bereavement in depressive symptoms.World Vision International, a nongovernmental humanitarian organization, was interested in addressing this substantial mental health burden in Uganda. Both antidepressants and psychotherapy have been shown to be efficacious in numerous controlled trials in developed countries, including evidence of equivalence in reducing the symptoms of acute depression. 3 However, use of antidepressants is not feasible in this region because of high cost Author Affiliations are listed at the end of this article.

Prenatal nutritional deficiency may play a role in the origin of some cases of schizophrenia.

Examined the longitudinal relation between children's self-report of witnessing community violence, family environment, and parent report of child antisocial behavior in a sample of 6- to 10-year-old urban American boys (N = 97) at familial risk for antisocial behavior. Boys reported high rates of lifetime exposure to community violence. Boys' reports of witnessing community violence were significantly positively related to changes over 15 months in child antisocial behavior, even after controlling for the possible effects of 3 aspects of parent-child interactions shown previously to be related to problematic child behavior. Furthermore, family environment, particularly the degree to which parents engaged in conflict with their sons, moderated the effect of witnessed violence on changes in antisocial behavior. In families with low conflict, higher levels of witnessed violence predicted increases in antisocial behavior over time. In contrast, in families with relatively high levels of parent-child conflict, high-witnessed violence had no additional influence on antisocial outcome. This is the first prospective longitudinal study to document an association between witnessed community violence and changes in antisocial behavior in young, urban boys at familial risk for antisocial behavior.

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