Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study

Abstract

BACKGROUND: War-affected youth often suffer from multiple co-occurring mental health problems.These youth often live in low-resource settings where it may be infeasible to provide mental health services that simultaneously address all of these co-occurring mental health issues. It is therefore important to identify the areas where targeted interventions would do the most good.METHODS: This analysis uses observational data from 3 waves of a longitudinal study on mental health in asampleof529 war-affectedyouth(24.2% female;ages10-17at T1,2002)inSierraLeone.Weregressed 4 mental health outcomes at T3 (2008) on internalizing (depression/anxiety) and externalizing (hostility/aggression) problems and prosocial attitudes/behaviors and community variables at T2 (2004) controlling for demographics, war exposures, and previous mental health scores at T1, allowing us to assess the relative impact of potential mental health intervention targets in shaping mental health outcomes over time.RESULTS: Controlling for baseline covariates at T1 and all other exposures/potential intervention targets at T2, we observed a significant association between internalizing problems at T2 and 3 of the 4 outcomes at T3: internalizing (b = 0.27, 95% confidence interval [CI]: 0.11-0.42), prosocial attitudes (b = -0.20, 95% CI: -0.33 to -0.07) and posttraumatic stress symptoms (b = 0.22, 95% CI: 0.02-0.43). No other potential intervention target had similar substantial effects.CONCLUSIONS: Reductions in internalizing may have multiple benefits for other mental health outcomes at a later point in time, even after controlling for confounding variables.WHAT'S KNOWN ON THIS SUBJECT: War-affected youth often suffer from multiple co-occurring mental health problems. The relationship of these conditions to later mental health has yet to be thoroughly investigated. There is a need to explore potential targets for mental health interventions. WHAT THIS STUDY ADDS:After controlling for preexisting conditions and contemporary confounders, internalizing (depression and anxiety) remained the major predictor of future mental health symptoms (internalizing symptoms, prosocial attitudes/behaviors, and posttraumatic stress symptoms). Interventions targeting internalizing in war-affected youth hold promise. Dr Betancourt conceptualized and designed the study, oversaw acquisition of the data, and contributed to statistical analysis and interpretation of the data, drafting of the manuscript, obtaining funding, and supervision of the study; Dr Gilman contributed to drafting of the manuscript and overview of data analysis and approved the final manuscript as submitted; Dr Brennan contributed to the analysis and interpretation of data, participated in the drafting the article, and revised it critically for intellectual content; Mr Zahn managed the data, conducted the analyses, and participated in the drafting the article; Dr VanderWeele conceived of and oversaw the analysis and interpretation of the data and contributed to drafting of the manuscript; and all ...

Outcome-wide Epidemiology

“…With cohort data for which repeated measures of exposures are available, another approach might be to examine a single outcome at the end of follow up and fit a series of regressions, each of which controls for all exposures simultaneously in one wave but then also includes a single subsequent exposure – one per regression – from the next wave. 15,16 One might refer to this as a “confounder-lagged exposure-wide epidemiologic design.” See Betancourt et al 27 for a recent example in which both this and an outcome-wide approach were simultaneously used in the study of mental health outcome for war-affected youth. Other variations that attempt to straightforwardly automate the confounder selection process for exposure-wide epidemiologic studies containing numerous exposures might also be considered.…”

Outcome-Wide Longitudinal Designs for Causal Inference: A New Template for Empirical Studies

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