A Behavioral Intervention for War-Affected Youth in Sierra Leone: A Randomized Controlled Trial
A Behavioral Intervention for War-Affected Youth in Sierra Leone: A Randomized Controlled Trial
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DOI：
10.1016/j.jaac.2014.09.011
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发表时间：
2014-12-01
影响因子：
13.3
通讯作者：
Hansen, Nathan B.
中科院分区：
文献类型：
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作者：
Betancourt, Theresa S.;McBain, Ryan;Hansen, Nathan B.
目标：受战争影响地区的青年面临心理、社会和教育结果不良的风险。需要有效的干预措施来改善心理健康，社会行为和学校运作。这项随机对照试验测试了塞拉利昂受战争影响的多症状青年（15-24岁）的10次认知行为疗法（CBT）的有效性。方法：通过社区筛查确定的受战争影响的青年的痛苦和损害升高随机（按性别和年龄分层）到青年准备干预（YRI）（n = 222）或对照条件（n = 214）。治疗后，年轻人再次随机分配，并立即提供教育补贴（n = 220）或等待（n = 216）。情绪调节，心理困扰，亲社会的态度/行为，社会支持，功能障碍和创伤后应激障碍（PTSD）症状进行了评估，在干预前和干预后，并在6个月的随访。对于在校青少年，入学率，出勤率和课堂表现在8个月后进行了评估。线性混合效应回归评价结果。结果如下：YRI在情绪调节、亲社会态度/行为、社会支持和减少功能障碍方面表现出显著的干预后效果，在入学率、出勤率和课堂行为方面表现出显著的随访效果。相比之下，教育补贴与更好的出勤率有关，但对心理健康或功能，学校保留或课堂行为没有影响。教育补助与YRI的交互作用不显著。结论：YRI在心理健康和功能方面取得了显著改善，并对学校参与和行为产生了长期影响，这表明有可能为受战争影响的青年提供教育和其他机会。
Objective: Youth in war-affected regions are at risk for poor psychological, social, and educational outcomes. Effective interventions are needed to improve mental health, social behavior, and school functioning. This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy (CBT)-based group mental health intervention for multisymptomatic war-affected youth (aged 15-24 years) in Sierra Leone. Method: War-affected youth identified by elevated distress and impairment via community screening were randomized (stratified by sex and age) to the Youth Readiness Intervention (YRI) (n = 222) or to a control condition (n = 214). After treatment, youth were again randomized and offered an education subsidy immediately (n = 220) or waitlisted (n = 216). Emotion regulation, psychological distress, prosocial attitudes/behaviors, social support, functional impairment, and posttraumatic stress disorder (PTSD) symptoms were assessed at pre- and postintervention and at 6-month follow-up. For youth in school, enrollment, attendance, and classroom performance were assessed after 8 months. Linear mixed-effects regressions evaluated outcomes. Results: The YRI showed significant postintervention effects on emotion regulation, prosocial attitudes/behaviors, social support, and reduced functional impairment, and significant follow-up effects on school enrollment, school attendance, and classroom behavior. In contrast, education subsidy was associated with better attendance but had no effect on mental health or functioning, school retention, or classroom behavior. Interactions between education subsidy and YRI were not significant. Conclusion: YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement and behavior, suggesting potential to prepare war-affected youth for educational and other opportunities.