Outcomes and moderators of a preventive school‐based mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial

Tol, Wietse A.; Komproe, Ivan H.; Jordans, Mark J. D.; Vallipuram, Anavarathan; Sipsma, Heather; Sivayokan, Sambasivamoorthy; Macy, Robert; Jong, Joop de

doi:10.1016/j.wpsyc.2012.05.008

Cited by 131 publications

(120 citation statements)

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“…The studies included children of diverse psychopathological status: children stemming from a war-affected area irrespective of their individual distress to children with full-blown PTSD diagnosis. Sample sizes ranged from N = 4 (Ooi, 2012) to N = 399 (Tol et al, 2012). …”

Section: Resultsmentioning

confidence: 99%

“…Among the eight RCTs, three studies did not provide full details of the randomization method (Kalantari, Yule, Dyregrov, Neshatdoost, & Ahmadi, 2012; Lange-Nielsen et al, 2012; Tol et al, 2012) and three used small experimental and control groups ( n < 30) (Catani et al, 2009; Schauer, 2008; Schottelkorb, Doumas, & Garcia, 2012), which means that the randomization may not have been successful. However, no significant group differences on putatively relevant characteristics were detected in either of these studies.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen out of 23 studies examined the effect of evidence-based treatments, such as interpersonal therapy (IPT) (Betancourt et al, 2012a), strict cognitive behavioural therapy (CBT) (Catani et al, 2009; Onyut et al, 2005; Pfeiffer & Goldbeck, 2017; Schauer, 2008; Schottelkorb et al, 2012), eclectic CBT with other elements (Ehntholt, Smith, & Yule, 2005; Möhlen, Parzer, Resch, & Brunner, 2005; Ooi, 2012; Ooi et al, 2016; Šehović, 2002; Tol et al, 2012), or eye movement desensitization and reprocessing (EMDR; within a psychodynamic therapy) (Oras, De Ezpeleta, & Ahmad, 2004). …”

Section: Resultsmentioning

confidence: 99%

“…In 13 studies, the interventions were provided in a school setting (Ehntholt et al, 2005; Ellis et al, 2013; Fazel et al, 2009; Išpanović-Radojković et al, 2002; Kalantari et al, 2012; Lange-Nielsen et al, 2012; O’Shea et al, 2000; Ooi, 2012; pilot; Ooi et al, 2016; Schauer, 2008; Schottelkorb et al, 2012; Thabet et al, 2005; Tol et al, 2012). In 12 studies, trained lay persons (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…In 12 studies, trained lay persons (e.g. teachers, social workers) provided the main intervention (Betancourt et al, 2012a; Catani et al, 2009; Dybdahl, 2001; Ellis et al, 2013; Gupta & Zimmer, 2008; Išpanović-Radojković et al, 2002; Möhlen et al, 2005; Pfeiffer & Goldbeck, 2017; Schauer, 2008; Schottelkorb et al, 2012; Thabet et al, 2005; in the psychoeducation group; Tol et al, 2012). …”

Section: Resultsmentioning

confidence: 99%

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The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Nocon

Eberle-Sejari

Unterhitzenberger

et al. 2017

European Journal of Psychotraumatology

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Background: The United Nations reported that in 2016 over 65 million people worldwide have forcibly left home. Over 50% are children and adolescents; a substantial number has been traumatized and displaced by war. Objective: To provide an overview of the effectiveness of psychosocial interventions in this group we conducted a narrative review and a meta-analysis of intervention studies providing data on posttraumatic stress symptoms (PTSS), depression, anxiety, grief, and general distress. Method: We searched PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA, and SA for studies on treatment outcomes for war-traumatized displaced children and adolescents. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. Overall pre-post ES were calculated using a random effects model. Results: The narrative review covers 23 studies with a variety of treatments. Out of the 35 calculated between-group ES, only six were significant, all compared to untreated controls. Two of them indicated significant adverse effects on symptoms of general distress or depression. When calculating pre-post effect sizes, the positive between-group results of cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) were reproduced and singular other treatments showed significant positive effects. However, the mean pre-post effects for PTSS and depression could not be interpreted due to the high heterogeneity of the included studies (PTSS: ES = 0.78; I2 = 88.6%; depression: ES = 0.35; I2 = 93.1%). Only the mean pre-post effect for seven active CBT treatment groups for depression (ES = 0.30, 95% CI [0.18, 0.43]) was interpretable (Q = 3.3, df = 6, p = .77). Conclusion: Given the large number of children and adolescents displaced by war there were regrettably few treatment studies available, and many of them were of low methodological quality. The effect sizes lagged behind the effects observed in traumatized minors in general, and often were small or non-significant. However, CBT and IPT showed promising results that need further replication.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Nocon

Eberle-Sejari

Unterhitzenberger

et al. 2017

European Journal of Psychotraumatology

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Evolving Research on the Treatment of Health Effects of Violence and Human Rights Abuses

Cole¹,

Flanagin²

2012

JAMA

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cians and patients, their intensity of intervention, and clinical setting and training issues may ultimately be as or more relevant than comparative efficacy in choosing a course of treatment for PTSD. In the current era, there is a focus on short-term treatments (in part an antidote to the overly long psychotherapies of much of the 20th century). However, it is not clear how long treatment needs to be maintained to produce enduring positive outcomes, especially for patients with PTSD and comorbidities and difficult social circumstances. The field of PTSD therapy is still young, and the pursuit of clinically meaningful treatments for all types of patients, like the process of recovery for patients with PTSD, is an ongoing challenge. Conflict of Interest Disclosures:The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported receiving royalties from Guilford Press and New Harbinger Press and that she is director of Treatment Innovations, which provides consultation, training, and materials related to psychotherapy. REFERENCES

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Association of the World War II Finnish Evacuation of Children With Psychiatric Hospitalization in the Next Generation

Santavirta

Gilman

2018

JAMA Psychiatry

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In a prior follow-up study of the Finnish evacuees, girls evacuated to Swedish foster families during World War II were more likely to be hospitalized for a psychiatric disorder-in particular, a mood disorder-in adulthood than their nonevacuated sisters. The present study found that the offspring of these individuals were also at risk for mental health problems that required hospitalization and suggests that early-life adversities, including war-related exposures, may be associated with mental health disorders that persist across generations.

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Outcomes and moderators of a preventive school‐based mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial

Abstract: We aimed to examine outcomes, moderators and mediators of a preventive school-based mental health intervention implemented by paraprofessionals in a war-affected setting in northern Sri

Cited by 131 publications

References 45 publications

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Evolving Research on the Treatment of Health Effects of Violence and Human Rights Abuses

Association of the World War II Finnish Evacuation of Children With Psychiatric Hospitalization in the Next Generation

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