Intervention Effectiveness among War-Affected Children: A Cluster Randomized Controlled Trial on Improving Mental Health
Abstract
We examined the effectiveness of a psychosocial intervention in reducing mental health symptoms among war-affected children, and the role of peritraumatic dissociation in moderating the intervention impact on posttraumatic stress symptoms (PTSS). School classes were randomized into intervention (n = 242) and waitlist control (n = 240) conditions in Gaza, Palestine. The intervention group participated in 16 extracurriculum sessions of teaching recovery techniques (TRT) and the controls received normal school-provided support. Participants were 10- to 13-year-old Palestinian girls (49.4%) and boys (50.6%). Data on PTSS, depressive symptoms, and psychological distress were collected at baseline (T1), postintervention (T2), and 6-month follow-up (T3). Peritraumatic dissociation was assessed only at baseline. Regression analyses that took regression to the mean and cluster sampling into account were applied. The results on intervention effectiveness were specific to gender and peritraumatic dissociation. At T2, the intervention significantly reduced the proportion of clinical PTSS among boys, and both the symptom level (R(2) = .24), and proportion of clinical PTSS among girls who had a low level of peritraumatic dissociation. The results have implications for risk-specific tailoring of psychosocial interventions in war conditions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
CBT-based interventions have been found effective in reducing distress and subclinical symptoms in individuals who have experienced traumatic events.
“Furthermore, interventions based on cognitive behavioral therapy (CBT) have been found to be effective in reducing distress and subclinical symptoms in individuals who have experienced traumatic events, e.g., [8,9].”
Cites
The Strengths and Difficulties Questionnaire: A research note
Goodman, R. (1997) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1997.tb01545.x · Cited by 14,908 · see citing works
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
American Psychiatric Association (2000) · doi:10.1176/appi.books.9780890423349 · Cited by 11,069 · see citing works
A Modified Poisson Regression Approach to Prospective Studies with Binary Data
Zou, G. (2004) · American Journal of Epidemiology · doi:10.1093/aje/kwh090 · Cited by 9,760 · see citing works
Regression to the mean: what it is and how to deal with it
Barnett, A. G. (2004) · International Journal of Epidemiology · doi:10.1093/ije/dyh299 · Cited by 1,988 · see citing works
Children's Brain Development Benefits from Longer Gestation
Davis, E. P., Buß, C., Muftuler, L. T., Head, K., Hasso, A. N., Wing, D. A., Hobel, C. J., & Sandman, C. A. (2011) · Frontiers in Psychology · doi:10.3389/fpsyg.2011.00001 · Cited by 860 · see citing works
IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
Carll, E. K. (2008) · PsycEXTRA Dataset · doi:10.1037/e518422011-002 · Cited by 681 · see citing works
Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K. F., Neugebauer, R., Murray, L., & Verdeli, H. (2007) · JAMA · doi:10.1001/jama.298.5.519 · Cited by 589 · cited 2× · see citing works
“A Ugandan study (n = 314) showed that a 15-session interpersonal therapy (IPT) was effective in reducing depression among girls (Bolton et al., 2007).”
BackgroundResultThe Children's Revised Impact of Event Scale (CRIES): Validity as a Screening Instrument for PTSD
Perrin, S. G., Meiser‐Stedman, R., & Smith, P. A. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465805002419 · Cited by 570 · see citing works
The Strengths and Difficulties Questionnaire: U.S. Normative Data and Psychometric Properties
Bourdon, K. H., Goodman, R., Rae, D. S., Simpson, G., & Koretz, D. S. (2005) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000159157.57075.c8 · Cited by 536 · see citing works
Ehntholt, K. A., & Yule, W. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01638.x · Cited by 497 · see citing works
Psychometric properties of a Swedish version of the "Strengths and Difficulties Questionnaire"
Smedje, H., Broman, J., Hetta, J. E., & von Knorring, A. ‐. (1999) · European Child & Adolescent Psychiatry · doi:10.1007/s007870050086 · Cited by 416 · see citing works
Prevalence of mental disorders among children exposed to war: a systematic review of 7,920 children
Attanayake, V., McKay, R., Joffres, M., Singh, S., Burkle, F., & Mills, E. (2009) · Medicine, Conflict and Survival · doi:10.1080/13623690802568913 · Cited by 362 · see citing works
Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pašalić, A., Duraković, E., Mušić, M., Ćampara, N., Dapo, N., Arslanagić, B., et al. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31817eecae · Cited by 355 · see citing works
Jordans, M. J. D., Komproe, I. H., Tol, W. A., Kohrt, B. A., Luitel, N. P., Macy, R. D., & De Jong, J. T. V. M. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02209.x · Cited by 337 · see citing works
Birleson, P., Hudson, I. L., Buchanan, D. G., & Wolff, S. (1987) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1987.tb00651.x · Cited by 330 · see citing works
Ehntholt, K. A., Smith, P. A., & Yule, W. (2005) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104505051214 · Cited by 298 · see citing works
Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Macy, R. D., & De Jong, J. T. V. M. (2008) · JAMA · doi:10.1001/jama.300.6.655 · Cited by 286 · see citing works
Berger, R., Pat‐Horenczyk, R., & Gelkopf, M. (2007) · Journal of Traumatic Stress · doi:10.1002/jts.20225 · Cited by 275 · see citing works
Principal components analysis of the impact of event scale with children in war
Smith, P. A., Perrin, S. G., Dyregrov, A., & Yule, W. (2002) · Personality and Individual Differences · doi:10.1016/s0191-8869(02)00047-8 · Cited by 269 · see citing works
Data with Hierarchical Structure: Impact of Intraclass Correlation and Sample Size on Type-I Error
Musca, S. C., Kamiejski, R., Nugier, A., Méot, A., Er-Rafiy, A., & Brauer, M. (2011) · Frontiers in Psychology · doi:10.3389/fpsyg.2011.00074 · Cited by 259 · see citing works
Marmar, C. R., Weiss, D. S., Metzler, T. J., & Delucchi, K. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.7.94 · Cited by 257 · see citing works
Jordans, M. J. D., Tol, W. A., Komproe, I. H., & De Jong, J. V. T. M. (2009) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2008.00515.x · Cited by 222 · see citing works
Punamäki, R., Komproe, I. H., Qouta, S., El‐Masri, M., & de Jong, J. T. V. M. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.3.545 · Cited by 192 · see citing works
Self-citationGelkopf, M., & Berger, R. (2009) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2008.02021.x · Cited by 174 · see citing works
Is Peritraumatic Dissociation a Risk Factor for PTSD?
Breh, D. C., & Seidler, G. H. (2007) · Journal of Trauma & Dissociation · doi:10.1300/j229v08n01_04 · Cited by 169 · see citing works
Group crisis intervention for children during ongoing war conflict
Thabet, A. A., Vostanis, P., & Karim, K. (2005) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-005-0466-7 · Cited by 168 · see citing works
Hageman, W. J. J. M., & Arrindell, W. A. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00032-7 · Cited by 164 · see citing works
Thabet, A. A. M., Stretch, D. D., & Vostanis, P. (2000) · International Journal of Social Psychiatry · doi:10.1177/002076400004600404 · Cited by 161 · see citing works
Preventive interventions among children exposed to trauma of armed conflict: a literature review
Peltonen, K., & Punamäki, R. (2010) · Aggressive Behavior · doi:10.1002/ab.20334 · Cited by 159 · see citing works
Self-citationWolmer, L., Hamiel, D., Barchas, J. D., Slone, M., & Laor, N. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20638 · Cited by 151 · see citing works
Ukoumunne, O. C., Gulliford, M. C., Chinn, S. H. F., Sterne, J. A. C., Burney, P., & DONNER, A. P. (1999) · BMJ · doi:10.1136/bmj.319.7206.376 · Cited by 148 · see citing works
The impact of structured activities among Palestinian children in a time of conflict
Loughry, M., Ager, A., Flouri, E., Khamis, V., Afana, A. H., & Qouta, S. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01656.x · Cited by 131 · see citing works
Self-citationGiannopoulou, I., Dikaiakou, A., & Yule, W. (2006) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104506067876 · Cited by 105 · see citing works
Michelson, L., June, K., Vives, A., Testa, S., & Marchione, N. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00073-4 · Cited by 98 · see citing works
Mediators and moderators of a psychosocial intervention for children affected by political violence.
Tol, W. A., Komproe, I. H., Jordans, M. J. D., Gross, A. L., Susanty, D., Macy, R. D., & de Jong, J. T. V. M. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0021348 · Cited by 95 · see citing works
Reliable changes in psychotherapy: Taking into account regression toward the mean.
Hsu, L. M. (1989) · Behavioral Assessment · Cited by 95 · see citing works
Persson, T. J., & Rousseau, C. (2009) · PubMed · Cited by 65 · see citing works
Knol, M. J., Duijnhoven, R. G., Grobbee, D. E., Moons, K. G. M., & Groenwold, R. H. H. (2011) · PLoS ONE · doi:10.1371/journal.pone.0021248 · Cited by 64 · see citing works
Schäfer, I., Barkmann, C., Riedesser, P., & Schulte‐Markwort, M. (2006) · Psychopathology · doi:10.1159/000092676 · Cited by 60 · see citing works
Healing in familiar settings: Support for children and youth in the classroom and community
Macy, R. D., Macy, D. J., Gross, S. I., & Brighton, P. (2003) · New Directions for Youth Development · doi:10.1002/yd.44 · Cited by 52 · see citing works
(2004) · Journal of Trauma & Dissociation · doi:10.1300/j229v05n03_09 · Cited by 37 · see citing works
Trauma, cognition and chronic PTSD: A study of former East German political prisoners
Boos, A., Ehlers, A., Maercker, A. R. A., & Schützwohl, M. (1998) · Zeitschrift Fur Klinische Psychologie-forschung Und Praxis · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-835 · Cited by 569 · see citing works
Morina, N., Koerssen, R., & Pollet, T. V. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.05.006 · Cited by 256 · see citing works
Mental Health Prevention and Promotion—A Narrative Review
Singh, V., Kumar, A., & Gupta, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.898009 · Cited by 255 · see citing works
Jordans, M. J. D., Pigott, H., & Tol, W. A. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-015-0648-z · Cited by 216 · see citing works
Psychological therapies for children and adolescents exposed to trauma
Gillies, D., Maiocchi, L., Bhandari, A. P., Taylor, F., Gray, C., & O'Brien, L. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012371 · Cited by 143 · see citing works
Petersen, I., Evans-Lacko, S., Semrau, M., Barry, M. M., Chisholm, D., Gronholm, P., Egbe, C. O., & Thornicroft, G. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0060-z · Cited by 100 · see citing works
Sarkadi, A., Ådahl, K., Stenvall, E., Ssegonja, R., Batti, H., Gavra, P., Fängström, K., & Salari, R. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1093-9 · Cited by 94 · see citing works
Lawton, K., & Spencer, A. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01151-5 · Cited by 39 · see citing works
Lotzin, A., Franc de Pommereau, A., & Laskowsky, I. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075339 · Cited by 25 · see citing works
Davaasambuu, S., Phillip, H., Ravindran, A., & Szatmari, P. (2019) · Community Mental Health Journal · doi:10.1007/s10597-019-00420-w · Cited by 23 · see citing works
Solhaug, A. K., Røysamb, E., & Oppedal, B. (2023) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-023-00595-x · Cited by 11 · see citing works
- Authors
- Qouta, S. R., Palosaari, E., Diab, M., & Punamäki, R.
- Affiliations
- Islamic University of Gaza (PS)
- Tampere University (FI)
- University of Helsinki (FI)
- Corresponding author
- Punamäki, Raija‐Leena
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2012-05-30
- Volume
- 25
- Issue
- 3
- Pages
- 288-298
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- OpenAlex
- W2040355748
- Cited by
- 197
- References
- 42
- Citations by year
- 2026: 15 · 2025: 7 · 2024: 9 · 2023: 19 · 2022: 9 · 2021: 13 · 2020: 51 · 2019: 14 · 2018: 8 · 2017: 11 · 2016: 13 · 2015: 11 · 2014: 9 · 2013: 7
- FWCI
- 9.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- war-affected children, posttraumatic stress symptoms, peritraumatic dissociation, psychosocial interventions, Teaching Recovery Techniques, school-based intervention, gender differences, depressive symptoms, psychological distress, Gaza Strip, children in armed conflict, intervention moderators
- MeSH terms
- Adolescent, Child, Depression, Female, Humans, Male, Mental Health, Middle East, Surveys and Questionnaires, Regression Analysis, Stress Disorders, Post-Traumatic, Warfare, Cognitive Behavioral Therapy, Cluster Analysis, Outcome Assessment, Health Care, Arabs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
