Evaluation of a classroom‐based psychosocial intervention in conflict‐affected Nepal: a cluster randomized controlled trial
Abstract
Background: In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low‐ and middle‐income countries. This study evaluated a school‐based psychosocial intervention in conflict‐affected, rural Nepal. Methods: A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, posttraumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children ( n = 325) (mean age = 12.7, SD = 1.04, range 11–14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group. Results: Comparisons of crude change scores showed significant between‐group differences on several outcome indicators, with moderate effect sizes (Cohen d = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on prosocial behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (−2.19; 95% CI, −3.82 to −.56), and aggression (−4.42; 95% CI, −6.16 to −2.67). An age effect for treatment was found for hope (.90; 95% CI, −1.54 to −.26). Conclusions: A school‐based psychosocial intervention demonstrated moderate short‐term beneficial effects for improving social‐behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased prosocial behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms.
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The Nepali trial found no main effects for the classroom-based intervention.
“In Nepal, the same classroom-based intervention was not associated with any main effects,”
From Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care (2013) · cites this paper as [57]
Older Nepali children in the intervention had greater hope than wait-list controls.
“older children displayed an increased sense of hope compared to those in a wait-list control group.57”
From Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care (2013) · cites this paper as [57]
Nepali boys in the intervention showed improvements in psychological difficulties and aggression.
“boys improved on psychological difficulties and aggression,”
From Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care (2013) · cites this paper as [57]
Nepali girls in the intervention showed better pro-social behavior.
“girls receiving the intervention improved on pro-social behavior,”
From Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care (2013) · cites this paper as [57]
The child and adolescent studies focused mainly on two school-based interventions, ERASE Stress and the classroom-based intervention, with PTSD as a primary outcome.
“The studies in children and adolescents focused mainly on two school-based interventions (ERASE Stress62 and the classroom-based intervention57–60) that had PTSD as one of the primary outcomes.”
From Mental health and psychosocial support in humanitarian settings: linking practice and research (2011) · cites this paper as [57]
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Self-citation
- Authors
- 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.
- Affiliations
- HealthNet TPO (NL)
- Utrecht University (NL)
- Emory University (US)
- Harvard University (US)
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2010-06-07
- Volume
- 51
- Issue
- 7
- Pages
- 818-826
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2115543887
- Cited by
- 337
- References
- 36
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 12 · 2023: 36 · 2022: 25 · 2021: 17 · 2020: 48 · 2019: 22 · 2018: 17 · 2017: 23 · 2016: 16 · 2015: 16 · 2014: 24 · 2013: 21 · 2012: 12
- FWCI
- 19.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- post-traumatic stress disorder, depression, anxiety, resilience, hope, prosocial behavior, aggression, psychosocial distress, rural Nepal, gender differences, age differences
- MeSH terms
- Adaptation, Psychological, Adolescent, Anxiety Disorders, Mental Disorders, Child, Civil Disorders, Combined Modality Therapy, Developing Countries, Female, Humans, Male, Nepal, Psychotherapy, Group, Rural Population, School Health Services, Social Behavior, Socialization, Stress Disorders, Post-Traumatic, Violence, Cognitive Behavioral Therapy, Resilience, Psychological
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