School-Based Mental Health Intervention for Children Affected by Political Violence in Indonesia

Tol, Wietse A.; Komproe, Ivan H.; Susanty, Dessy; Jordans, Mark J. D.; Macy, Robert; Jong, Joop T. V. M. de

doi:10.1001/jama.300.6.655

Cited by 251 publications

(213 citation statements)

References 35 publications

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“…Descriptive data for the 71 60,70,71,92,115-117, 120,134,136 There were relatively few studies focusing on post-traumatic stress disorder (PTSD) (n = 2), 86,128 self-harm (n = 4) 72,74,78,137 and generic mental health problems (i.e. interventions designed for any mental health problem; n = 3).…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

“…Many could be -indeed some were -described as tasks, a word that can have negative connotations. There were a few exceptions -the explicit use of games in Rooney 2006 105 and the use of drama, dance and music in Tol 2008, 128 for example -though it is worth noting that a lack of reference to creativity and fun in the descriptions of the interventions may be more to do with the sober writing style demanded of academic journals than with design faults in the interventions.…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

“…65,[95][96][97][98]101,102 Resilience data were collected from CYP in seven studies, 83,84,86,87,103,106,108,109,137 from a parent in one study 83,84 and from a clinician in one study. 128 General well-being data were obtained solely from child self-report and in only three studies. 51,87,107 Self-esteem data were collected by child self-report in 10 studies 51,57,[60][61][62][63][64]106,[129][130][131]134,136 and from a parent in one study.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Table 4, the majority of outcome measures focused on mental health symptomatology in the CYP, whether directly or indirectly related to the condition of interest. General functioning was measured in a sizeable number (n = 28; 39%) of the papers 51,[53][54][55]65,66,[70][71][72]74,78,[85][86][87]91,[95][96][97][98][99][100][101][102]104,106,[108][109][110][111]113,114,[116][117][118][119][128][129][130][131] but few focused on CYP's resilience, general well-being or self-esteem. Most of the outcome measures were obtained directly from the CYP with clinicians or parents being the most frequent secondary source.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Pryjmachuk

Elvey

Kirk

et al. 2014

Health Services and Delivery Research

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BackgroundThe mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health.ObjectivesTo identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision.DesignTwo inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study.SettingGlobal (systematic reviews); England and Wales (mapping exercise and case study).Participants (case study)Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites.Main outcome measures (meta-analysis)A measure of CYP’s mental health symptomatology.Data sources (literature reviews)MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC).Review methodsTitles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review.ResultsSixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support.ConclusionsMental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes.Future workFuture work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness.Study registrationPROSPERO number (for the effectiveness review) CRD42012001981.FundingThe NIHR Health Services and Delivery Research programme.

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Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

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Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Pryjmachuk

Elvey

Kirk

et al. 2014

Health Services and Delivery Research

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“…It was excluded for methodological bias, as the end of the war may account for any effects detected in this study. Five publications were excluded because displaced persons represented a minority (up to 31%) in the study sample (Diab, Peltonen, Qouta, Palosaari, & Punamäki, 2015; Kangaslampi, Punamäki, Qouta, Diab, & Peltonen, 2016; Newnham et al, 2015; Punamäki, Peltonen, Diab, & Qouta, 2014; Tol et al, 2008). Two studies were excluded because only a minority (up to 35%) reported war-related traumata (Unterhitzenberger et al, 2015; Ruf et al, 2010).…”

Section: Resultsmentioning

confidence: 99%

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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Community-Implemented Trauma Therapy for Former Child Soldiers in Northern Uganda

Ertl

Pfeiffer²,

Schauer³

et al. 2011

JAMA

277

288

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School-Based Mental Health Intervention for Children Affected by Political Violence in Indonesia

Cited by 251 publications

References 35 publications

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

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

Community-Implemented Trauma Therapy for Former Child Soldiers in Northern Uganda

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