A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia
A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia
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DOI：
10.1371/journal.pone.0208483
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发表时间：
2018-12-10
期刊：
影响因子：
3.7
通讯作者：
Bolton, Paul
中科院分区：
文献类型：
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作者：
Bonilla-Escobar, Francisco J.;Fandino-Losada, Andres;Bolton, Paul
背景暴露于暴力对心理健康有负面影响。哥伦比亚的武装冲突广泛影响到太平洋区域的非洲人后裔。在低收入环境中，特别是在冲突活跃的地区，缺乏关于心理健康干预措施有效性的证据。本研究的目的是评估一个个性化的共同要素治疗方法（CETA），一个跨诊断的心理治疗模型的基础上认知行为疗法，为成人创伤survivor.Methods和findingsA参考样本的521名成年非洲后裔从布埃纳文图拉和基布多，哥伦比亚，经历重大的悲伤，痛苦或恐惧（总精神健康症状评分>0.77）、有创伤经历史和相关功能障碍的患者被随机分配到CETA干预组、无干预但每月监测一次的备用组或叙事社区团体治疗组。CETA由受过训练的非专业社会心理工作者提供，以前没有心理健康经验，由心理学家监督，每周12-14次，每次1.5小时。采用基于霍普金斯症状自评量表、哈佛创伤问卷、PTSD检查表-平民版、针对其他一般症状的定性研究和性别特异性功能障碍量表的本地验证调查评估症状。比较CETA与对照组的干预效果，并采用意向治疗分析的混合模型计算干预效果。参与者完成随访的比例为75.1%，13.2%自愿退出。当比较干预组和对照组时（平均差），两个城市的创伤后应激症状显着减少，其中布埃纳文图拉的效应量中等（科恩d = 0.70），而基布多的效应量较小（d = 0.31）。在布埃纳文图拉中，干预对抑郁（大效应量d = 1.03）、焦虑（大效应量d = 0.80）和功能障碍（中等效应量d = 0.70）也有显著影响。在Quibdo，它对这些结果没有显著影响。在总的心理健康症状的变化是不显着的city.ConclusionsThis试验表明，CETA，可以有效地改善抑郁症，焦虑，创伤后应激障碍和功能的受害者系统化的暴力在低收入和积极的冲突设置。尽管如此，两个干预城市之间的有效性差异可能表明，我们不能假设已知在一种环境中有效的心理健康干预措施在另一种环境中也会有效，即使在类似的环境和人口中也是如此。在不受控制的情况下实施和复制这些类型的干预措施时，这可能具有特别重要的意义。进一步的研究应该解决这些问题。政府决策者在为幸存者制定心理健康计划时可以使用这些结果。
BackgroundExposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors.Methods and findingsA referred sample of 521 adult Afro-descendants from Buenaventura and Quibdo, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d = 0.70) and a small effect size in Quibdo (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdo, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city.ConclusionsThis trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors.