A behavioral intervention for war-affected youth in Sierra Leone: a randomized controlled trial
Open accessAbstract
Objective Youth in war-affected regions are at risk for poor psychological, social, and educational outcomes. Effective interventions are needed to improve mental health, social behavior, and school functioning. This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy (CBT)-based group mental health intervention for multisymptomatic war-affected youth (aged 15-24 years) in Sierra Leone.Method War-affected youth identified by elevated distress and impairment via community screening were randomized (stratified by sex and age) to the Youth Readiness Intervention (YRI) (n = 222) or to a control condition (n = 214). After treatment, youth were again randomized and offered an education subsidy immediately (n = 220) or waitlisted (n = 216). Emotion regulation, psychological distress, prosocial attitudes/behaviors, social support, functional impairment, and posttraumatic stress disorder (PTSD) symptoms were assessed at pre- and postintervention and at 6-month follow-up. For youth in school, enrollment, attendance, and classroom performance were assessed after 8 months. Linear mixed-effects regressions evaluated outcomes.Results The YRI showed significant postintervention effects on emotion regulation, prosocial attitudes/behaviors, social support, and reduced functional impairment, and significant follow-up effects on school enrollment, school attendance, and classroom behavior. In contrast, education subsidy was associated with better attendance but had no effect on mental health or functioning, school retention, or classroom behavior. Interactions between education subsidy and YRI were not significant.Conclusion YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement and behavior, suggesting potential to prepare war-affected youth for educational and other opportunities. Clinical trial registration information-Trial of the Youth Readiness Intervention (YRI); http://clinicaltrials.gov; NCT01684488.
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Identified effect sizes were similar to psychoeducational courses evaluated in adversity-affected populations living in high-income countries (e.g., the coping with depression course has a pooled effect size of d 0·28) and some transdiagnostic interventions in conflict-affected low-resource settings.
“Identified effect sizes were similar to psychoeducational courses evaluated in adversity-affected populations living in high-income countries (eg, the coping with depression course has a pooled effect size of d 0·28), 20 and some transdiagnostic interventions in conflict-affected low-resource settings. 12”
From Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomised trial (2020) · cites this paper as [12]
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- Authors
- Betancourt, T. S., McBain, R., Newnham, E. A., Akinsulure-Smith, A. M., Brennan, R. T., Weisz, J. R., & Hansen, N. B.
- Affiliations
- Harvard University (US)
- University of Georgia (US)
- Corresponding author
- Betancourt, Theresa S.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 53
- Issue
- 12
- Pages
- 1288-1297
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC5022359
- OpenAlex
- W2111067924
- Cited by
- 165
- References
- 36
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 13 · 2023: 33 · 2022: 17 · 2021: 5 · 2020: 18 · 2019: 13 · 2018: 17 · 2017: 8 · 2016: 12 · 2015: 4 · 2014: 1
- FWCI
- 9.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- CUNY Academic Works (City University of New York) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Funders
- United States Institute of Peace
- City University of New York
- Harvard University
- Harvard Catalyst
- Yeshiva University
- University of Georgia
- Australian Psychological Society
- UBS Optimus Foundation
- National Institutes of Health (5f31mh097333-02)
- Faculty of Arts and Sciences
- Medical Research Council
- National Health and Medical Research Council
- National Institute on Aging (P30AG024409)
- National Institute of Mental Health (F31 MH097333, K01MH077246, 1F31MH097333-01A1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- war-affected youth, cognitive behavioral therapy, post-traumatic stress disorder, psychological distress, emotion regulation, prosocial behavior, social support, functional disability, school attendance, student enrollment, classroom behavior, Sierra Leone
- MeSH terms
- Adolescent, Adult, Mental Disorders, Female, Humans, Male, Sierra Leone, Warfare, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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