Insecurity, distress and mental health: experimental and randomized controlled trials of a psychosocial intervention for youth affected by the Syrian crisis

Abstract

BackgroundStrengthening the evidence base for humanitarian interventions that provide psychosocial support to war‐affected youth is a key priority. We tested the impacts of an 8‐week programme of structured activities informed by a profound stress attunement (PSA) framework (Advancing Adolescents), delivered in group‐format to 12–18 year‐olds in communities heavily affected by the Syrian crisis. We included both Syrian refugee and Jordanian youth.MethodsWe followed an experimental design, comparing treatment youth and wait‐list controls over two programme implementation cycles, randomizing to study arm in cycle 2 (ClinicalTrials.gov ID: NCT03012451). We measured insecurity, distress, mental health difficulties, prosocial behaviour and post‐traumatic stress symptoms at three time‐points: baseline (n = 817 youth; 55% Syrian, 43% female), postintervention (n = 463; 54% Syrian, 47% female), and follow‐up (n = 212, 58% Syrian, 43% female). Regression models assessed: prospective intervention impacts, adjusting for baseline scores, trauma exposure, age, and gender; differential impacts across levels of trauma exposure and activity‐based modality; and sustained recovery 1 year later. We analysed cycle‐specific and cycle‐pooled data for youth exclusively engaged in Advancing Adolescents and for the intent‐to‐treat sample.ResultsWe found medium to small effect sizes for all psychosocial outcomes, namely Human Insecurity (β = −7.04 (95% CI: −10.90, −3.17), Cohen's d = −0.4), Human Distress (β = −5.78 (−9.02, −2.54), d = −0.3), and Perceived Stress (β = −1.92 (−3.05, −0.79), d = −0.3); and two secondary mental health outcomes (AYMH: β = −3.35 (−4.68, −2.02), d = −0.4; SDQ: β = −1.46 (−2.42, −0.50), d = −0.2). We found no programme impacts for prosocial behaviour or post‐traumatic stress reactions. Beneficial impacts were stronger for youth with exposure to four trauma events or more. While symptoms alleviated for both intervention and control groups over time, there were sustained effects of the intervention on Human Insecurity.ConclusionsFindings strengthen the evidence base for mental health and psychosocial programming for a generation affected by conflict and forced displacement. We discuss implications for programme implementation and evaluation research.

Minds Under Siege: Cognitive Signatures of Poverty and Trauma in Refugee and Non‐Refugee Adolescents

“…This study had many strengths, including assessments with a gender‐balanced, representative sample, using regionally validated measures of mental health and psychosocial well‐being (Panter‐Brick, Dajani, et al, ; Panter‐Brick, Hadfield, et al, ) and measures of EF sensitive to the demands of cognitive testing in under‐resourced areas (Ford et al, ). It also has several limitations.…”

“…For Syrian refugees, specifically, it is not known whether posttraumatic stress disorder (PTSD) or levels of insecurity are independently associated with cognitive performance, over and above exposure to traumatic events and poverty. This is important, as PTSD‐prevalence rates reported for child and adolescent refugees in the Middle East are high (41%–87%; Reed, Fazel, Jones, Panter‐Brick, & Stein, ), while levels of human insecurity—a measure of fear and worry for oneself and one’s family (Ziadni et al, )—are salient in this environment, and predict mental health recovery (Panter‐Brick, Dajani, et al, ).…”

FAAH, SLC6A4, and BDNF variants are not associated with psychosocial stress and mental health outcomes in a population of Syrian refugee youth

“…Accordingly, our research team has studied the impact of exposure to traumatic events and the factors underlying associations with psychosocial stress and mental health outcomes in Syrian refugee youth. Using a longitudinal method over the course of one year, our team identified factors related to genetics, a contextually-specific measure of resilience, and a psychosocial intervention (Clukay et al, in press;Panter-Brick et al, 2018a;Panter-Brick et al, 2017). Specifically, we found associations between MAOA genetic variants and levels of resilience with perceived stress in males in our study population (Clukay et al, in press).…”

New developments in the mental health of refugee children and adolescents

“…This exists even in high-income countries, where interventions may be delivered by statutory services, whereas in low and middle income countries (LMIC), they are likely to be delivered by NGOs with some involvement from UNHCR and governments 59. In LMIC, a key principle for treatment provision is task shifting, in which non-mental health professionals are trained to deliver interventions 60. In high-income countries, attention has been given to tiered systems in which community practitioners provide early interventions50 in accessible settings including schools and achieve timely referral for the more impaired children to specialist services.…”

“…For post-traumatic symptoms, one review that included children who experienced man-made and natural disasters found a moderate effect size for the intervention group compared with control groups, without a difference between the three interventions just mentioned 64. Interestingly a broader skills and activity-based non-CBT intervention delivered by lay adults was found to be effective for child refugees and non-refugee peers in Jordan in reducing psychological distress but not post-traumatic symptoms 60. There is a dearth of studies investigating interventions of psychological distress in URMs 65 66…”