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Cited by 355Posttraumatic Stress Disorder ResearchChild Therapy and DevelopmentMigration, Health and Trauma

Effectiveness of a School-Based Group Psychotherapy Program for War-Exposed Adolescents: A Randomized Controlled Trial

Layne, Christopher M., Saltzman, William R., Poppleton, Landon, Burlingame, Gary M., Pašalić, Alma, Duraković, Elvira, Mušić, Mirjana, Ćampara, Nihada +4 more·2008·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1097/chi.0b013e31817eecae
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Abstract

Objective To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group treatment (tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity.Method A total of 127 war-exposed and predominantly ethnic Muslim secondary school students attending 10 schools in central Bosnia who reported severe symptoms of posttraumatic stress disorder (PTSD), depression, or maladaptive grief and significant impairment in school or relationships were randomly assigned to one of two experimental conditions. These included either an active-treatment comparison condition (tier 1), consisting of a classroom-based psychoeducation and skills intervention alone (n = 61, 66% girls, mean age 16.0 years, SD 1.13) or a treatment condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2), trauma and grief component therapy for adolescents (n = 66, 63% girls, mean age 15.9 years, SD 1.11). Both interventions were implemented throughout the school year. Distressed students who were excluded from the study due to acute risk for harm (n = 9) were referred for community-based mental health services (tier 3).Results Program effectiveness was measured via reductions in symptoms of PTSD, depression, and maladaptive grief assessed at pretreatment, posttreatment, and 4-month follow-up. Analysis of mean-level treatment effects showed significant pre- to posttreatment and posttreatment to 4-month follow-up reductions in PTSD and depression symptoms in both the treatment and comparison conditions. Significant pre- to posttreatment reductions in maladaptive grief reactions were found only in the treatment condition. Analyzed at the individual case level, the percentages of students in the treatment condition who reported significant (p <.05) pre- to posttreatment reductions in PTSD symptoms (58% at posttreatment, 81% at 4-month follow-up) compare favorably to those reported in controlled treatment efficacy trials, whereas the percentages who reported significant reductions in depression symptoms (23% at posttreatment, 61% at follow-up) are comparable to, or higher than, those found in community treatment settings. Lower but substantial percentages of significant symptom reduction were found for PTSD (33% at posttreatment, 48% at follow-up) and depression symptoms (13% at posttreatment; 47% at follow-up) in students in the comparison condition. The odds of significant symptom reduction were higher for PTSD symptoms at both posttreatment and 4-month follow-up and for maladaptive grief at posttreatment (no follow-up was conducted on maladaptive grief). Rates of significantly worsened cases were generally rare in both the treatment and comparison conditions.Conclusions A three-tiered, integrative mental health program composed of schoolwide dissemination of psychoeducation and coping skills (tier 1), specialized trauma- and grief-focused intervention for severely traumatized and traumatically bereaved youths (tier 2), and referral of youths at acute risk for community-based mental health services (tier 3) constitutes an effective and efficient method for promoting adolescent recovery in postwar settings.

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  • Compared with controls, both Israeli preventive school-based trials significantly moderated psychological distress.

    “Significant intervention effects in moderating psychological distress were observed as compared to control groups in both studies.”

    From Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care (2013) · cites this paper as [43]

  • In an RCT with 127 war-exposed secondary school students, significant reductions in PTSD and depressive symptoms and improvements in maladaptive grief were found among intervention participants compared to an active-treatment comparison group.

    “Significant reductions in PTSD and depressive symptoms, as well as improvements in maladaptive grief, were perceived among intervention participants as compared to an active-treatment comparison group that did not participate in the intervention.”

    From Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care (2013) · cites this paper as [60]

  • In war-affected 13-18-year-olds in Bosnia and Herzegovina, a classroom skills and psychoeducation intervention was compared with that intervention plus group trauma- and grief-focused treatment; PTSD and depression improved in both cohorts, with the largest effect in the group treatment cohort.

    “In waraffected 13–18-year-olds in Bosnia and Herzegovina, a classroom-based skills and psychoeducation intervention (focused on trauma and loss and the traumatic stress and grief reactions they can cause) were compared with a combination of this intervention and a group-based trauma-focused and grief-focused treatment.68 In both cohorts, PTSD and depression symptoms improved, with the largest”

    From Mental health and psychosocial support in humanitarian settings: linking practice and research (2011) · cites this paper as [68]

  • In that Bosnia and Herzegovina study, maladaptive grief improved only among those receiving the additional group treatment.

    “Improvements in maladaptive grief were seen only in those receiving the additional group treatment.”

    From Mental health and psychosocial support in humanitarian settings: linking practice and research (2011) · cites this paper as [68]

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Authors
Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pašalić, A., Duraković, E., Mušić, M., Ćampara, N., Dapo, N., Arslanagić, B., Steinberg, A. M., & Pynoos, R. S.
Affiliations
Brigham Young University (US)
Corresponding author
Layne, Christopher M.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2008-09
Volume
47
Issue
9
Pages
1048-1062
ISSN
0890-8567 (ISSN-L)
DOI
10.1097/chi.0b013e31817eecae
OpenAlex
W1967994282
Cited by
355
References
54
Citations by year
2026: 4 · 2025: 9 · 2024: 20 · 2023: 16 · 2022: 10 · 2021: 11 · 2020: 20 · 2019: 12 · 2018: 12 · 2017: 53 · 2016: 23 · 2015: 18 · 2014: 19 · 2013: 38 · 2012: 23
FWCI
24.11
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
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
post-traumatic stress disorder, depression, traumatic bereavement, Bosnia, Muslim adolescents, treatment effectiveness, high school students, community mental health services, follow-up outcomes
MeSH terms
Adaptation, Psychological, Adolescent, Bereavement, Combined Modality Therapy, Female, Grief, Health Education, Humans, Islam, Life Change Events, Male, Psychotherapy, Group, School Health Services, Stress Disorders, Post-Traumatic, Warfare, Bosnia and Herzegovina

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