Mediators and Moderators of a Psychosocial Intervention for Children Affected by Political Violence
Mediators and Moderators of a Psychosocial Intervention for Children Affected by Political Violence
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DOI：
10.1037/a0021348
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发表时间：
2010-12-01
影响因子：
5.9
通讯作者：
de Jong, Joop T. V. M.
中科院分区：
文献类型：
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作者：
Tol, Wietse A.;Komproe, Ivan H.;de Jong, Joop T. V. M.
目的：作者根据生态复原力理论框架，研究了针对受政治暴力影响的儿童的学校心理社会干预的调节者和调解者。方法：作者检查了一项整群随机试验的数据，该试验涉及印度尼西亚苏拉威西中部 8-13 岁的儿童（治疗条件 n = 182，候补对照条件 n = 221）。在平行过程潜在生长曲线模型中检查了创伤后应激症状和功能障碍治疗结果的中介因素（希望、应对、同伴/情感/游戏社会支持）和调节因素（性别、年龄、家庭联系、家庭规模、其他形式的社会支持、政治暴力暴露和流离失所）。结果：与等待组相比，接受治疗的人表现出保持希望、增加积极应对、维持同伴社会支持和增加游戏社会支持。在这些假定的中介因素中，只有游戏社会支持被发现可以调节治疗效果，因此游戏社会支持的增加与创伤后应激障碍（PTSD）症状的较小程度的减少相关。此外，作者还确定了一些调节因素： 女孩对 PTSD 症状表现出更大的治疗效果；女童、小家庭中的儿童以及接受家庭外成年人社会支持的儿童在功能障碍方面表现出更大的治疗效果。结论：研究结果为生态恢复力理论框架提供了有限的证据。基于这些发现，作者建议将普遍预防（例如通过游戏增强复原力）与选择性/针对性预防（例如旨在减少创伤后应激症状的干预措施）分开。基于游戏的干预措施应小心排除有心理困扰的儿童。此外，通过选择女孩和社会弱势儿童可以增强治疗效果。
Objective: The authors examined moderators and mediators of a school-based psychosocial intervention for children affected by political violence, according to an ecological resilience theoretical framework. Method: The authors examined data from a cluster randomized trial, involving children aged 8-13 in Central Sulawesi, Indonesia (treatment condition n = 182, waitlist control condition n = 221). Mediators (hope, coping, peer/emotional/play social support) and moderators (gender, age, family connectedness, household size, other forms of social support, exposure to political violence, and displacement) of treatment outcome on posttraumatic stress symptoms and function impairment were examined in parallel process latent growth curve models. Results: Compared with the waitlist group, those receiving treatment showed maintained hope, increased positive coping, maintained peer social support, and increased play social support. Of these putative mediators, only play social support was found to mediate treatment effects, such that increases in play social support were associated with smaller reductions in posttraumatic stress disorder (PTSD) symptoms. Furthermore, the authors identified a number of moderators: Girls showed larger treatment benefits on PTSD symptoms; girls, children in smaller households, and children receiving social support from adults outside the household showed larger treatment benefits on function impairment. Conclusions: Findings provide limited evidence for an ecological resilience theoretical framework. On the basis of these findings, the authors recommend a stronger separation between universal prevention (e.g.. resilience promotion through play) and selective/indicated prevention (e.g., interventions aimed at decreasing posttraumatic stress symptoms). Play-based interventions should be careful to exclude children with psychological distress. In addition, treatment effects may be augmented by selecting girls and socially vulnerable children.