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School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial
Open accessAbstract
BACKGROUND: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). METHODS: We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. RESULTS: No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. CONCLUSIONS: Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings. TRIAL REGISTRATION: The study was registered as ISRCTN42284825.
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“With regard to the second question, there is some evidence that treatments can be effective in situations of ongoing adversity [19],[20], whereas other studies have shown reduced treatment benefits for populations facing chronic adversity [21].”
From World Health Organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead (2014) · cites this paper as [21]
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Metadata
- Authors
- Tol, W. A., Komproe, I. H., Jordans, M. J., Ndayisaba, A., Ntamutumba, P., Sipsma, H., Smallegange, E. S., Macy, R. D., & de Jong, J. T.
- Affiliations
- Johns Hopkins University (US)
- Utrecht University (NL)
- King's College London (GB)
- University of Illinois Chicago (US)
- University of Amsterdam (NL)
- Harvard University (US)
- Corresponding author
- Tol, Wietse A
- Venue
- BMC Medicine
- Published
- 2014-04-01
- Volume
- 12
- Issue
- 1
- Pages
- 56-56
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC3994237
- OpenAlex
- W2119900946
- Cited by
- 170
- References
- 60
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 13 · 2023: 20 · 2022: 9 · 2021: 11 · 2020: 16 · 2019: 19 · 2018: 10 · 2017: 12 · 2016: 17 · 2015: 10 · 2014: 8
- FWCI
- 18.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- 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 Therapy and Development
- Keywords
- school-based mental health programs, children and adolescents, post-traumatic stress disorder, depressive symptoms, anxiety, hope, war-affected children, children in armed conflict, paraprofessionals, post-conflict societies, household size, parental co-residence, trauma exposure, displacement, Burundi
- MeSH terms
- Adolescent, Anxiety, Anxiety Disorders, Burundi, Child, Depression, Depressive Disorder, Female, Humans, Male, Mental Health, School Health Services, Schools, Stress Disorders, Post-Traumatic, Warfare
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