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Cited by 290Posttraumatic Stress Disorder ResearchChild Therapy and DevelopmentChild Abuse and Trauma

Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka

Open access
Catani, Claudia, Kohiladevy, Mahendran, Ruf, Martina, Schauer, Elisabeth, Elbert, Thomas, Neuner, Frank·2009·BMC Psychiatry
DOI 10.1186/1471-244x-9-22PMC PMC2685130
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Abstract

BACKGROUND: The North-Eastern part of Sri Lanka had already been affected by civil war when the 2004 Tsunami wave hit the region, leading to high rates of posttraumatic stress disorder (PTSD) in children. In the acute aftermath of the Tsunami we tested the efficacy of two pragmatic short-term interventions when applied by trained local counselors. METHODS: A randomized treatment comparison was implemented in a refugee camp in a severely affected community. 31 children who presented with a preliminary diagnosis of PTSD were randomly assigned either to six sessions Narrative Exposure Therapy for children (KIDNET) or six sessions of meditation-relaxation (MED-RELAX). Outcome measures included severity of PTSD symptoms, level of functioning and physical health. RESULTS: In both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time. At 6 months follow-up, recovery rates were 81% for the children in the KIDNET group and 71% for those in the MED-RELAX group. There was no significant difference between the two therapy groups in any outcome measure. CONCLUSION: As recovery rates in the treatment groups exceeded the expected rates of natural recovery, the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters. TRIAL REGISTRATION: ClinicalTrials.gov Identifier:NCT00820391.

AI snapshot

Written from the paper’s full text.

TL;DR

In a randomized treatment comparison in post-tsunami north-east Sri Lanka, 31 children with preliminary PTSD received either six sessions of KIDNET or six sessions of meditation-relaxation (MED-RELAX), both delivered by trained local counselors. Both groups showed significant PTSD symptom reduction with no significant between-group differences; at 6-month follow-up, 81% of KIDNET children and 71% of MED-RELAX children no longer met the PTSD diagnostic threshold.

Key findings

  • PTSD symptoms decreased significantly in both groups: repeated-measures ANOVA showed a significant main effect of Time, F(2,56) = 54.15, p < 0.001, with no significant Time × Treatment interaction (p = 0.9).
  • At 6-month follow-up, recovery rates were 81% for KIDNET and 71% for MED-RELAX; differences between groups were non-significant.
  • Functioning problems also improved significantly across both conditions, F(2,54) = 19.54, p < 0.001; physical complaints showed only a slight improvement that did not reach significance, F(2,56) = 2.47, p = 0.09.
  • Within-group effect sizes were large and similar: KIDNET d = 1.76 at post-test and 1.96 at follow-up; MED-RELAX d = 1.83 at post-test and 2.20 at follow-up.

Methods

  • Randomized treatment comparison in two provisional refugee camps in Manadkadu, northern Sri Lanka; 31 children aged 8–14 with preliminary PTSD were randomly assigned by coin flip to six sessions of KIDNET (n = 16) or MED-RELAX (n = 15), each 60–90 minutes over about two weeks.
  • Treatments were delivered by six trained female local counselors; interviewers at post-test and follow-up were blind to treatment condition.
  • Outcomes included UCLA PTSD Index for DSM-IV (UPID) total and subscale scores, PTSD diagnosis, a five-item functioning-problems scale, and five physical complaints, assessed at pre-test, 1-month post-test, and 6-month follow-up using repeated-measures ANOVA and χ² tests.

Limitations

  • The paper states that the major limitation was the lack of a non-treated control or waiting-list group, due to ethical and logistical concerns, so spontaneous remission could not be controlled.
  • The paper also states that planned 1-year follow-up interviews could not be carried out because of increasing violence and political insecurity in Sri Lanka’s North-Eastern provinces.
  • Evident from the text: the sample was small (31 children; 16 KIDNET, 15 MED-RELAX), limiting statistical power to detect between-group differences, and the diagnosis was preliminary because the DSM-IV time criterion could not yet be applied.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-244x-9-22

Cites

35 of 36 references verified1 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    31 children met the diagnostic criteria of preliminary PTSD.

    “While no respondent met the exclusion criteria of mental retardation, psychosis or any neurological disorder, 31 children met the diagnostic criteria of preliminary PTSD and were informed about the randomized trial.”
    Quote in the paperSubstantial claim
  • Findingown data

    Effect sizes at post-test and 6-month follow-up were similarly high in both groups.

    “Effect sizes at post-test and 6-month follow up were similarly high in both groups.”
    Quote in the paperSubstantial claim
  • Findingown data

    Within this study, not all of the children considered the Tsunami as the worst experience.

    “In fact, within this study, not all of the children did consider the Tsunami as the worst experience”
    Quote in the paperSubstantial claim
  • Findingnone given

    On average, the Tamil children had experienced three distinctly different types of traumatic events in addition to the Tsunami.

    “On average, the Tamil children had experienced three distinctly different types of traumatic events in addition to the Tsunami”
    Quote in the paperSubstantial claim
  • Findingown data

    No significant differences between groups were found on UPID symptom scores.

    “No significant differences between groups were found.”
    Quote in the paperSubstantial claim
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 28

  • May combine two claims.

    Findingown data

    In both treatment conditions, PTSD symptoms were significantly reduced at 1 month post-test and remained stable over time.

    “Results showed that in both treatment conditions, PTSD symptoms were significantly reduced at 1 month post-test and remained stable over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time.

    “In both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For functional impairment, ANOVA showed a significant main effect of Time (F(2,54)=19.54; p<0.001) with no significant Time × Treatment interaction.

    “With respect to impairments in functioning, the ANOVA resulted in a significant main effect Time (F(2,54) = 19.54; p < 0.001) with no significant Time × Treatment interaction.”
    • Also stated in: § Discussion · plain
      “In addition to the reduction of psychopathology, we also found a decrease in impairments in psychosocial functioning.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Across both conditions, physical problems showed a slight improvement after treatment, but the Time effect did not reach significance (F(2,56)=2.47; p=0.09).

    “Across both conditions, a slight improvement for physical problems was visible after treatment. However, the Time effect did not reach significance (F (2,56) = 2.47; p = 0.09).”
    • Also stated in: § Discussion · hedged
      “We could also show, at least on a statistical trend level, that physical health improved through both therapeutic approaches.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Therapists and interviewers were recruited from school teachers who had previously been trained as master counselors to assist children with war-related trauma.

    “Therapists and interviewers were recruited from a group of school teachers who had previously (prior to the Tsunami) been trained as master counselors [25] to assist children with war-related trauma (cooperation between the Zonal Department of Education Vallikamam; Shantiham counseling centre, the German Technical Cooperation – GTZ, and the NGO vivo).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Schauer E, Kohiladevy M, Catani C, Onyut P, Schauer M, Neuner F, Elbert T: Building local capacity for mental health service provision in the face of large-scale traumatisation: a cascade-model from Sri Lanka. Annual Meeting of the European Society of Traumatic Stress Studies: 2005; Stockholm, Sweden. 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Meditation has been tried with Vietnam veterans and war-traumatized adolescents in Kosovo.

    “For example, meditation has been tried with Vietnam veterans [21] and war-traumatized adolescents in Kosovo [22].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Brooks J, Scarano H: Transcendental meditation in the treatment of post-Vietnam adjustment. Journal of Counseling and Development. 1990, 64: 212-215. source

      Not checked in the free run.

    • cites [22] Gordon JS, Staples JK, Blyta A, Bytyqi M: Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: a pilot study. J Trauma Stress. 2004, 17 (2): 143-147. 10.1023/B:JOTS.0000022620.13209.a0. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Mindful meditation interventions have been suggested as a useful tool to decrease avoidance in traumatized patients.

    “Mindful meditation interventions have been suggested as a useful tool to decrease avoidance in traumatized patients [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Follette F, Palm KM, Pearson AN: Mindfulness and Trauma: Implications for Treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2006, 24 (1): 45-61. 10.1007/s10942-006-0025-2. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Epidemiological studies have found high rates of psychological disorders, particularly PTSD, in children affected by war, natural disaster, or both.

    “Epidemiological studies have found epidemic rates of psychological disorders, particularly posttraumatic stress disorder (PTSD), in children who have been affected by war [1], natural disaster [2], and natural disaster and war combined [3,4].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [1] Saigh PA: The development of posttraumatic stress disorder following four different types of traumatization. Behav Res Ther. 1991, 29 (3): 213-216. 10.1016/0005-7967(91)90110-O. source

      Not checked in the free run.

    • cites [2] Goenjian AK, Molina L, Steinberg AM, Fairbanks LA, Alvarez ML, Goenjian HA, Pynoos RS: Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch. Am J Psychiatry. 2001, 158 (5): 788-794. 10.1176/appi.ajp.158.5.788. source

      Not checked in the free run.

    • cites [3] Goenjian AK, Steinberg AM, Najarian LM, Fairbanks LA, Tashjian M, Pynoos RS: Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. Am J Psychiatry. 2000, 157 (6): 911-916. 10.1176/appi.ajp.157.6.911. source

      Not checked in the free run.

    • cites [4] Neuner F, Schauer E, Catani C, Ruf M, Elbert T: Post-tsunami stress: a study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. J Trauma Stress. 2006, 19 (3): 339-347. 10.1002/jts.20121. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by the Ethical Review Board of the University of Konstanz and by the Ministry of Education of Sri Lanka.

    “The study was approved by the Ethical Review Board of the University of Konstanz and by the Ministry of Education of Sri Lanka.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The majority of tsunami-affected children had already been victimized by the civil war or other traumatic events.

    “We had to expect that the majority of the Tsunami affected children had already been victimized by the civil war or other traumatic events [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Neuner F, Schauer E, Catani C, Ruf M, Elbert T: Post-tsunami stress: a study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. J Trauma Stress. 2006, 19 (3): 339-347. 10.1002/jts.20121. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Written informed consent was obtained from all participating children and from one primary caregiver or parent of each child.

    “All of them were willing to participate and gave their written informed consent. In addition, informed consent was obtained from one of the primary caregivers or parents of each child.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    More complex traumatization involving multiple event types leads to more severe pathology and may be more difficult to treat.

    “In theory, a more complex traumatization involving multiple event types leads to a more severe pathology and may be more difficult to treat [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Neuner F, Catani C, Ruf M, Schauer E, Schauer M, Elbert T: Narrative Exposure Therapy for the treatment of child and adolescent war victims: From neurobiology to field intervention. Child and Adolescent Psychiatric Clinics of North America. 2008, 17: 641-664. 10.1016/j.chc.2008.03.001. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The counselors who participated in this study had not previously worked in the schools of Manadkadu and were not known beforehand to any of the children receiving therapies.

    “The counselors who participated in this study had not previously worked in the schools of Manadkadu and were, therefore, not known beforehand to any of the children receiving therapies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In that survey, 30% of the children had not been affected by the Tsunami.

    “out of which 30% had not even been affected by the Tsunami [29]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Catani C, Jacob N, Schauer E, Kohila M, Neuner F: Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry. 2008, 8: 33-10.1186/1471-244X-8-33. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Research on adult trauma treatment shows a clear advantage of trauma-focused procedures that contain trauma exposure, also in the immediate aftermath of the event.

    “This result is in contrast with research on adult trauma treatment that shows a clear advantage of trauma-focused procedures that contain trauma exposure [35], also in the immediate aftermath of the event.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S: Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry. 2007, 190: 97-104. 10.1192/bjp.bp.106.021402. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    All children agreed to participate and all completed the full treatment.

    “All children agreed to participate, and all of them completed the full treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In that survey, 49% reported war experiences that had occurred in the past year.

    “but 49% reported war experiences that had occurred in the past year.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Catani C, Jacob N, Schauer E, Kohila M, Neuner F: Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry. 2008, 8: 33-10.1186/1471-244X-8-33. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    DSM-IV diagnosis and severity of PTSD were assessed with the UCLA PTSD Index for DSM-IV (UPID) used in interview form.

    “DSM-IV diagnosis and severity of PTSD were assessed with the UCLA PTSD Index for DSM-IV (UPID) [27] used in interview form.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Pynoos RS, Rodriguez N, Steinberg A, Stuber ML, Frederick C: UCLA PTSD Index for DSM-IV. 1998

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous study using NET with an adult refugee population found an improvement of physical symptoms even several months after the intervention.

    “This is in agreement with a previous study using NET with an adult refugee population, where an improvement of physical symptoms was found even several months after the intervention [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T: Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol. 2008, 76 (4): 686-694. 10.1037/0022-006X.76.4.686. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    One child moved to an unknown place and could not be located for the 6-months follow-up.

    “One child moved to an unknown place and could not be located for the 6-months follow up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Five questions related to the Tsunami experience were added to estimate the severity of Tsunami exposure.

    “To estimate the severity of Tsunami exposure in the two post-Tsunami samples, five questions related to the Tsunami experience were added [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Catani C, Jacob N, Schauer E, Kohila M, Neuner F: Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry. 2008, 8: 33-10.1186/1471-244X-8-33. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Even taking into account natural recovery rates, the PTSD symptom remission obtained in the present trial supports the beneficial effect of both KIDNET and a meditation-relaxation protocol applied in the immediate aftermath of a natural disaster.

    “However, as outlined above, even taking into account natural recovery rates, we have reason to conclude that the PTSD symptom remission obtained in the present trial supports the beneficial effect of both, KIDNET and a meditation-relaxation protocol applied in the immediate aftermath of a natural disaster.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The context of a humanitarian emergency after a mass disaster in a country with limited resources probably interfered with recovery.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was no difference in results between treatment-completer and intent-to-treat analysis strategies using last-observation-carried forward.

    “However, as only a single case was missing, there was no difference in results between analysis strategies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study with child victims of accidents in London found a 50% rate of spontaneous recovery in the first six months.

    “A recent study with child victims of accidents in London has found a 50% rate of spontaneous recovery in the first six months [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Meiser-Stedman R, Yule W, Smith P, Glucksman E, Dalgleish T: Acute stress disorder and posttraumatic stress disorder in children and adolescents involved in assaults or motor vehicle accidents. Am J Psychiatry. 2005, 162 (7): 1381-1383. 10.1176/appi.ajp.162.7.1381. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Post-test assessments were carried out by local counselors who were blind to the individual participant's treatment condition.

    “Four to five weeks after the last treatment session, post-test including the same instruments as used in the pre-test were carried out by a group of local counselors who were blind for the individual participant's treatment condition.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Each child who fulfilled eligibility criteria and was willing to participate was randomly assigned (using a coin flip) either to KIDNET or meditation-relaxation.

    “Each child who fulfilled eligibility criteria and who was willing to participate was randomly assigned (using a coin flip) either to Narrative Exposure Therapy for children (KIDNET) or meditation-relaxation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A survey one year after the Tsunami in the North-East of Sri Lanka showed a PTSD prevalence of 30.4% in a sample of school children.

    “a survey conducted one year after the Tsunami in the North-East of Sri Lanka showed a PTSD prevalence of 30.4% in a sample of school children”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Catani C, Jacob N, Schauer E, Kohila M, Neuner F: Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry. 2008, 8: 33-10.1186/1471-244X-8-33. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The counselors had received extensive training (76 days) in counseling, mental health diagnosis, and trauma treatment including NET and meditation-relaxation.

    “The master counselor training consisted of 76 training days of approximately 10 hours each, usually spreading over a total period of 6–12 months.”
    • Also stated in: § Local team of interviewers and therapists · plain
      “Training topics were basic counseling skills, mental health diagnosis, and trauma treatment with a focus on Narrative Exposure Therapy, as well as a meditation-relaxation protocol that had been developed by the local team of clinical experts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The efficacy of NET has already been shown across cultures in Europe, Africa and Asia.

    “In contrast, the efficacy of NET has already been shown across cultures in Europe, Africa and Asia [15,16,18].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Bichescu D, Neuner F, Schauer M, Elbert T: Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behav Res Ther. 2007, 45 (9): 2212-2220. 10.1016/j.brat.2006.12.006. source

      Not checked in the free run.

    • cites [16] Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T: A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. J Consult Clin Psychol. 2004, 72 (4): 579-587. 10.1037/0022-006X.72.4.579. source

      Not checked in the free run.

    • cites [18] Neuner F, Catani C, Ruf M, Schauer E, Schauer M, Elbert T: Narrative Exposure Therapy for the treatment of child and adolescent war victims: From neurobiology to field intervention. Child and Adolescent Psychiatric Clinics of North America. 2008, 17: 641-664. 10.1016/j.chc.2008.03.001. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To rule out a possible therapist effect, each therapist provided approximately the same number of treatments in both conditions.

    “To rule out a possible therapist effect, each therapist provided approximately the same number of treatments in both conditions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All interviews were supervised by the local supervisor and by one clinical psychologist from Konstanz University.

    “All interviews were supervised by the local supervisor and by one clinical psychologist from Konstanz University.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Treatment adherence and quality were monitored through therapist session protocols, random observations by clinical psychologists and the local supervisor, and regular supervision meetings; no major deviations from treatment protocol were detected.

    “Treatment adherence and quality was monitored by requesting therapists to fill out a detailed protocol after each session. In addition, two clinical psychologists from the University of Konstanz, as well as the local clinical supervisor, carried out random observations of single therapy sessions. Throughout the entire treatment phase, regular supervision meetings were offered to the team of Therap”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Results are based on analysis of all 31 children for the post-test and 30 children with complete data for the follow-up.

    “Results reported here are based on the analysis of all 31 children for the post-test, and the 30 children with complete data for the follow-up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The UPID had been translated into Tamil following standard principles of instrument translation and validation.

    “In a previous study, this instrument had been translated into Tamil following standard principles of instrument translation and validation [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Elbert T, Schauer M, Schauer E, Huschka B, Hirth M, Neuner F: Trauma-related impairment in children – a survey in Sri Lankan provinces affected by armed conflict. Child Abuse Negl. 2009, 33 (4): 238-246. 10.1016/j.chiabu.2008.02.008. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    After randomization, 16 children were offered KIDNET and 15 children were offered meditation-relaxation therapy.

    “After randomization, 16 children were offered KIDNET, and 15 children were offered the meditation-relaxation therapy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This study provides preliminary support for the effectiveness of KIDNET as well as a meditation-relaxation protocol when carried out with traumatized children in the acute stage of mass disaster.

    “In conclusion, we can state that this study provides preliminary support for the effectiveness of a KIDNET as well as a meditation-relaxation protocol when carried out with traumatized children in the acute stage of mass disaster.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The context of a humanitarian emergency after a mass disaster in a country with limited resources probably interfered with recovery.
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  • The paper relies on this without support.

    The expected rates of natural recovery are lower than the recovery rates observed in the treatment groups.

    “As recovery rates in the treatment groups exceeded the expected rates of natural recovery, the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters.”

  • The paper relies on this without support.

    Meditation-relaxation techniques such as breathing exercise or mantra chanting are rooted in Tamil (Hindu) culture and are well known to both children and local counselors.

    “Meditation-relaxation techniques such as breathing exercise or mantra chanting represent exercises that are rooted in the Tamil (Hindu) culture and are well known to both children and local counselors.”

  • The paper relies on this without support.

    Resources for the provision of mental health assistance in mass disasters are usually very low despite high need.

    “As most mass disasters strike low-income countries, and because emergency situations call for a variety of humanitarian aid beyond psychological interventions, resources for the provision of mental health assistance are usually very low despite the high need.”

  • The paper relies on this without support.

    Most mass disasters strike low-income countries.

    “As most mass disasters strike low-income countries, and because emergency situations call for a variety of humanitarian aid beyond psychological interventions, resources for the provision of mental health assistance are usually very low despite the high need.”

  • The paper relies on this without support.

    Emergency situations call for a variety of humanitarian aid beyond psychological interventions.

    “As most mass disasters strike low-income countries, and because emergency situations call for a variety of humanitarian aid beyond psychological interventions, resources for the provision of mental health assistance are usually very low despite the high need.”

  • The authors state this as an assumption.

    The context of a humanitarian emergency after a mass disaster in a country with limited resources probably interfered with recovery.

    “it is reasonable to assume that the context of a humanitarian emergency after a mass disaster in a country with limited resources has probably also interfered with recovery”
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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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • MED-RELAX baseline PTSD mean differs between tables

    Minor

    Table 1 reports a baseline PTSD symptom mean of 36.7 for MED-RELAX, while Table 2 reports 36.58. Rounded to one decimal place, 36.58 is 36.6, not 36.7.

  • Functioning analysis implies fewer complete cases than reported

    Minor

    For a three-time-point repeated-measures ANOVA with two treatment groups, the reported denominator degrees of freedom of 54 imply 29 analyzed children. The Results section says the follow-up analysis used 30 children with complete data; the other reported three-time-point ANOVAs have denominator degrees of freedom of 56, consistent with 30.

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Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Schauer E, Kohiladevy M, Catani C, Onyut P, Schauer M, Neuner F, Elbert T: Building local capacity for mental health service provision in the face of large-scale traumatisation: a cascade-model from Sri Lanka. Annual Meeting of the European Society of Traumatic Stress Studies: 2005; Stockholm, Sweden. 2005
  2. Sivajokan S, Mahendrarajah K, Somasundaram D: Child Mental Health: Teacher's handbook to help primary school children. 2003, Shanthiham, Jaffna: GTZ/BECARE, Vavuniya
  3. Pynoos RS, Rodriguez N, Steinberg A, Stuber ML, Frederick C: UCLA PTSD Index for DSM-IV. 1998

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Related

Authors
Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F.
Affiliations
  • Bielefeld University (DE)
  • University of Konstanz (DE)
Corresponding author
Catani, Claudia
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2009-05-13
Volume
9
Issue
1
Pages
22-22
ISSN
1471-244X (ISSN-L)
DOI
10.1186/1471-244x-9-22
PMC
PMC2685130
OpenAlex
W2022822901
Semantic Scholar
9df26ab07ea597d3d37f74604fcf4ad5835467d7
Cited by
290
References
34
Citations by year
2026: 7 · 2025: 12 · 2024: 17 · 2023: 19 · 2022: 18 · 2021: 14 · 2020: 14 · 2019: 18 · 2018: 13 · 2017: 25 · 2016: 17 · 2015: 25 · 2014: 20 · 2013: 23 · 2012: 15
FWCI
16.58
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KOPS (University of Konstanz) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion, other-oa)
  • Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion, other-oa)
Funders
Deutsche Forschungsgemeinschaft
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
post-traumatic stress disorder, children, 2004 Indian Ocean tsunami, narrative exposure therapy, trauma treatment, disaster aftermath, refugee camps
MeSH terms
Adaptation, Psychological, Child, Disasters, Female, Humans, Implosive Therapy, Life Change Events, Male, Psychotherapy, Group, Surveys and Questionnaires, Relaxation Therapy, Sri Lanka, Stress Disorders, Post-Traumatic, Warfare, Treatment Outcome, Meditation, Tidal Waves

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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 ›

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