Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial
Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial
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DOI：
10.1111/j.1469-7610.2010.02209.x
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发表时间：
2010-07-01
影响因子：
7.6
通讯作者：
de Jong, Joop T. V. M.
中科院分区：
文献类型：
--
作者：
Jordans, Mark J. D.;Komproe, Ivan H.;de Jong, Joop T. V. M.
背景：在持续暴力的情况下，儿童的心理社会和精神健康问题需要照顾。然而，低收入和中等收入国家的儿童缺乏适当干预措施的资源和证据。本研究评估了以学校为基础的心理社会干预在冲突影响，农村Nepal.Methods：一个集群随机对照试验被用来评估一系列指标的变化，包括精神症状（抑郁，焦虑，创伤后应激障碍），心理困难，弹性指标（希望，亲社会行为）和功能障碍。儿童（n = 325）（平均年龄= 12.7，SD = 1.04，范围11-14岁）与升高的心理困扰被分配到治疗或waitlist group.Results：比较粗变化分数显示显着的组间差异的几个结果指标，与中等的效果大小（科恩d = 0.41至0.58）。校正学校内的嵌套方差后，没有证据表明治疗效果对任何结果变量。其他分析显示了治疗对亲社会行为（平均变化差异：2.70; 95% CI，0.97至4.44）、心理困难（-2.19; 95% CI，-3.82至-0.56）和攻击性（-4.42; 95% CI，-6.16至-2.67）的性别影响。治疗的年龄效应被发现的希望（0.90; 95%CI，-1.54-0.26）。结论：以学校为基础的心理社会干预表现出温和的短期有益影响，改善社会行为和弹性指标之间的儿童暴露于武装冲突的亚组。干预减少了男孩的心理困难和攻击性，增加了女孩的亲社会行为，并增加了年龄较大的儿童的希望。干预并没有导致精神症状的减轻。
Background:In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal.Methods:A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, posttraumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children (n = 325) (mean age = 12.7, SD = 1.04, range 11-14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group.Results:Comparisons of crude change scores showed significant between-group differences on several outcome indicators, with moderate effect sizes (Cohen d = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on prosocial behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (-2.19; 95% CI, -3.82 to -.56), and aggression (-4.42; 95% CI, -6.16 to -2.67). An age effect for treatment was found for hope (.90; 95% CI, -1.54 to -.26).Conclusions:A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased prosocial behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms.