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Cited by 286Posttraumatic Stress Disorder ResearchChild Therapy and DevelopmentMigration, Health and Trauma

School-Based Mental Health Intervention for Children Affected by Political Violence in Indonesia: A Cluster Randomized Trial

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Tol, Wietse A., Komproe, Ivan H., Susanty, Dessy, Jordans, Mark J. D., Macy, Robert D., De Jong, Joop T. V. M.·2008·JAMA
DOI 10.1001/jama.300.6.655
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Abstract

CONTEXT: Little is known about the efficacy of mental health interventions for children exposed to armed conflicts in low- and middle-income settings. Childhood mental health problems are difficult to address in situations of ongoing poverty and political instability. OBJECTIVE: To assess the efficacy of a school-based intervention designed for conflict-exposed children, implemented in a low-income setting. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial involving 495 children (81.4% inclusion rate) who were a mean (SD) age of 9.9 (1.3) years, were attending randomly selected schools in political violence-affected communities in Poso, Indonesia, and were screened for exposure (> or = 1 events), posttraumatic stress disorder, and anxiety symptoms compared with a wait-listed control group. Nonblinded assessment took place before, 1 week after, and 6 months after treatment between March and December 2006. INTERVENTION: Fifteen sessions, over 5 weeks, of a manualized, school-based group intervention, including trauma-processing activities, cooperative play, and creative-expressive elements, implemented by locally trained paraprofessionals. MAIN OUTCOME MEASURES: We assessed psychiatric symptoms using the Child Posttraumatic Stress Scale, Depression Self-Rating Scale, the Self-Report for Anxiety Related Disorders 5-item version, and the Children's Hope Scale, and assessed function impairment as treatment outcomes using standardized symptom checklists and locally developed rating scales. RESULTS: Correcting for clustering of participants within schools, we found significantly more improvement in posttraumatic stress disorder symptoms (mean change difference, 2.78; 95% confidence interval [CI], 1.02 to 4.53) and maintained hope (mean change difference, -2.21; 95% CI, -3.52 to -0.91) in the treatment group than in the wait-listed group. Changes in traumatic idioms (stress-related physical symptoms) (mean change difference, 0.50; 95% CI, -0.12 to 1.11), depressive symptoms (mean change difference, 0.70; 95% CI, -0.08 to 1.49), anxiety (mean change difference, 0.12; 95% CI, -0.31 to 0.56), and functioning (mean change difference, 0.52; 95% CI, -0.43 to 1.46) were not different between the treatment and wait-listed groups. CONCLUSIONS: In this study of children in violence-affected communities, a school-based intervention reduced posttraumatic stress symptoms and helped maintain hope, but did not reduce traumatic-stress related symptoms, depressive symptoms, anxiety symptoms, or functional impairment. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN25172408.

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Authors
Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Macy, R. D., & De Jong, J. T. V. M.
Affiliations
  • HealthNet TPO (NL)
  • Church World Service (US)
  • Harvard University (US)
Corresponding author
Tol, Wietse A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2008-08-13
Volume
300
Issue
6
Pages
655
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.300.6.655
OpenAlex
W2053992958
Cited by
286
References
9
Citations by year
2026: 13 · 2025: 9 · 2024: 6 · 2023: 10 · 2022: 9 · 2021: 14 · 2020: 21 · 2019: 17 · 2018: 17 · 2017: 15 · 2016: 21 · 2015: 17 · 2014: 21 · 2013: 24 · 2012: 19
FWCI
19.67
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • Pure Amsterdam UMC (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
school-based mental health programs, post-traumatic stress disorder, anxiety symptoms, depression, hope, trauma processing, group intervention, paraprofessionals, low-income settings, armed conflict, Poso, Indonesia, school-based intervention, treatment efficacy, child mental health, functioning impairment, cooperative play, trauma-focused psychotherapy
MeSH terms
Adaptation, Psychological, Adolescent, Anxiety Disorders, Child, Female, Humans, Indonesia, Male, Mental Health Services, Politics, Poverty, Psychiatric Status Rating Scales, Psychotherapy, Research Design, School Health Services, Stress Disorders, Post-Traumatic, Violence, Diagnostic and Statistical Manual of Mental Disorders

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