A Randomized Controlled Trial of a Trauma-Informed Support, Skills, and Psychoeducation Intervention for Survivors of Torture and Related Trauma in Kurdistan, Northern Iraq.
A Randomized Controlled Trial of a Trauma-Informed Support, Skills, and Psychoeducation Intervention for Survivors of Torture and Related Trauma in Kurdistan, Northern Iraq.
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DOI：
10.9745/ghsp-d-16-00017
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发表时间：
2016-09-28
期刊：
影响因子：
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通讯作者：
Bolton P
中科院分区：
文献类型：
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作者：
Bass J;Murray SM;Mohammed TA;Bunn M;Gorman W;Ahmed AM;Murray L;Bolton P
向酷刑、监禁和/或军事袭击的幸存者提供咨询方案，其中包括由训练有素和受到监督的社区精神卫生工作者提供支持、技能和心理教育，可使抑郁症和功能障碍得到适度但有意义的改善。向酷刑、监禁和/或军事袭击的幸存者提供咨询方案，其中包括由训练有素和受到监督的社区精神卫生工作者提供支持、技能和心理教育，可使抑郁症和功能障碍得到适度但有意义的改善。经常提供支持性咨询类干预措施，以满足紧急情况和冲突后情况下人群的心理健康需求，但很少对其进行严格评估。来自低收入和中等收入国家的现有评估提供了有效性的混合证据。虽然伊拉克库尔德斯坦在萨达姆·侯赛因政府倒台后经历了相对稳定，但由于与邻国土耳其的冲突以及最近与isis有关的暴力事件，北部杜胡克地区的人口继续经历周期性暴力事件。我们评估了由社区精神卫生工作者（CMHWs）提供的创伤知情支持、技能和心理教育干预对抑郁症状和功能障碍（主要结局）以及创伤后应激、创伤性悲伤和焦虑症状（次要结局）的影响。在2009年6月至2010年6月期间，对295名成年人进行了筛查；209例（71%）符合资格标准（创伤暴露和症状严重程度评分，表明严重的痛苦和功能障碍等）并同意参加。其中，159人被随机分配到支持性咨询组，50人被随机分配到候补控制组。比较干预组和候补组治疗后的平均症状严重程度评分，支持性咨询对抑郁（Cohen’s d, 0.57; P = 0.02）和功能障碍（Cohen’s d, 0.53; P = 0.03）的主要结局有统计学意义和临床意义，对焦虑的影响有统计学意义，但影响较小。虽然同一研究小组在库尔德斯坦其他地区和伊拉克南部进行的心理治疗干预研究发现了更大的效果，但这项研究为全球心理健康和社会心理支持研究文献增添了新的内容，并表明一个训练有素、监督良好的创伤信息支持、技能和心理教育项目，强调治疗关系也可以是有效的。
Providing survivors of torture, imprisonment, and/or military attacks with a counseling program that includes support, skills and psychoeducation by well-trained and supervised community mental health workers can result in moderate yet meaningful improvements in depression and dysfunction. Providing survivors of torture, imprisonment, and/or military attacks with a counseling program that includes support, skills and psychoeducation by well-trained and supervised community mental health workers can result in moderate yet meaningful improvements in depression and dysfunction. Supportive counseling type interventions are frequently provided to meet the mental health needs of populations in emergency and post-conflicts contexts, but it has seldom been rigorously evaluated. Existing evaluations from low- and middle-income countries provide mixed evidence of effectiveness. While Iraqi Kurdistan experienced relative stability following the fall of Saddam Hussein’s government, the population in the northern Dohuk region has continued to experience periodic violence due to conflicts with neighboring Turkey as well as more recent ISIS-associated violence. We evaluated the impact of a trauma-informed support, skills, and psychoeducation intervention provided by community mental health workers (CMHWs) on depressive symptoms and dysfunction (primary outcomes) as well as post-traumatic stress, traumatic grief, and anxiety symptoms (secondary outcomes). Between June 2009 and June 2010, 295 adults were screened; 209 (71%) met eligibility criteria (trauma exposure and a symptom severity score indicating significant distress and functional impairment, among others) and consented to participate. Of these, 159 were randomized to supportive counseling while 50 were randomized to a waitlist control condition. Comparing average symptom severity scores post-treatment among those in the intervention group with those in the waitlist control group, the supportive counseling program had statistically and clinically significant impacts on the primary outcomes of depression (Cohen’s d, 0.57; P = .02) and dysfunction (Cohen’s d, 0.53; P = .03) and significant but smaller impacts on anxiety. Although studies by the same research team of psychotherapeutic interventions in other parts of Kurdistan and in southern Iraq found larger effects, this study adds to the global research literature on mental health and psychosocial support and shows that a well-trained and supervised program of trauma-informed support, skills, and psychoeducation that emphasizes the therapeutic relationship can also be effective.