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Wietse A. Tol - HealthNet TPO, Amsterdam, the Netherlands

Efficacy of Child Psychosocial Interventions: Synthesis of Cluster Randomized Trials in Burundi, Indonesia, Nepal, and Sri Lanka. Wietse A. Tol - HealthNet TPO, Amsterdam, the Netherlands Mark J.D. Jordans - HealthNet TPO, Amsterdam, the Netherlands

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Wietse A. Tol - HealthNet TPO, Amsterdam, the Netherlands

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  1. Efficacy of Child Psychosocial Interventions: Synthesis of Cluster Randomized Trials in Burundi, Indonesia, Nepal, and Sri Lanka Wietse A. Tol - HealthNet TPO, Amsterdam, the Netherlands Mark J.D. Jordans - HealthNet TPO, Amsterdam, the Netherlands Ivan H. Komproe - HealthNet TPO & Utrecht University, the Netherlands Joop T.V.M. de Jong - VU University, Amsterdam, the Netherlands & Boston University School of Medicine

  2. Introduction • In 2007, 34 armed conflicts • 191 million lives lost in 25 largest wars in 20th century • 60% not engaged in fighting • 67 million displaced, out of whom 26 million conflict-related Internally Displaced Persons

  3. Introduction • Psychiatric epidemiology with conflict-affected populations (Steel et al, JAMA 2009) • 161 articles, 81,866 individuals, 40 countries • Weighted percentages: PTSD 30.6%, depression 30.8% • Torture, potentially traumatic events, level of political terror in country are risk factors; time since conflict associated with decrease in symptoms

  4. Introduction • Despite the mental health burden of political violence, and evidence for mental health treatments in developing countries, there is a lack of evidence for treatments in war-affected settings • E.g. among children, only 4 rigorous studies have been published • 2 Bosnia (Layne et al, 2009) • 1 Uganda (Bolton et al, • 1 Indonesia (Tol et al, 2008)

  5. Methods: Intervention • A secondary preventive intervention; aimed at children with psychosocial problems, at risk of developing disorders • Combining: • Symptom reduction (e.g. PTSD, depression, anxiety) • Strengthening resilience (e.g. hope, coping, social support)

  6. Methods: Intervention • Structured intervention: 15 sessions over 5 weeks (specific themes) • In classrooms with groups of around 15 children • Combining cognitive-behavioral techniques (psycho-education, safety building, relaxation, exposure-based techniques) with creative-expressive therapy techniques

  7. Methods • As part of a larger public health project for children in war-affected settings www.psychosocialcarechildren.org • School-aged children in Burundi, Indonesia, Nepal, and Sri Lanka

  8. Methods: Cluster Randomized Trials

  9. Methods: Instruments * Locally validated instruments

  10. Results: Burundi

  11. Results: Burundi (age and gender) • Treatment effects for girls on anxiety • Treatment effects for boys on family connectedness • Negative effects on social support for boys • Statistically significant, but marginal differences

  12. Results: Indonesia

  13. Results: Indonesia (age and gender) • Treatment effects for girls on PTSD symptoms and function impairment

  14. Results: Nepal

  15. Results: Nepal (age and gender) • Treatment effects for girls on pro-social behavior • Treatment effects for boys on psychological difficulties and aggression • Treatment effects for older children on hope

  16. Results: Sri Lanka

  17. Results: Sri Lanka (age and gender) • Treatment effects for boys on anxiety and depressive complaints • Treatment effects for girls on social-moral complaints • Borderline significance for function impairment (boys)

  18. Overview of results * Locally validated instruments

  19. Discussion • Appropriateness of (resilience) measures, in comparison with community feedback • Influence of context on efficacy of treatment • Gender differences • Further work on treatment mechanisms • Debate on universal/selective vs. indicated interventions, must be informed by yet to be proven protective & risk indicators

  20. Acknowledgement • This project and research was conducted with financial assistance from PLAN Netherlands • Collaborators • TPO Burundi (Aline Ndayisaba, Seraphine Hakizimana) • Church World Service Indonesia (Dessy Susanty) • TPO Nepal (Nagendra Luitel) • Shanthiham (Anavarathan Vallipuram, Sambasivamoorthy Sivayokan)

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