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School-based mental health intervention reduces post-traumatic stress
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CHICAGO—A school-based intervention for children in communities affected by political violence in Indonesia reduced post-traumatic stress symptoms and helped maintain hope, but did not reduce traumatic stress-related symptoms, depressive symptoms, anxiety symptoms or functional impairment, according to a study in the August 13 issue of JAMA, a theme issue on violence and human rights.

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"Mental health and psychosocial interventions for children and adolescents globally have received little research attention, even though mental health problems are one of the most significant contributors to the global burden of disease," the authors write. "Little is known about the efficacy of mental health interventions for children exposed to armed conflicts in low- and middle-income settings. Childhood mental health problems are difficult to address in situations of ongoing poverty and political instability."

Wietse A. Tol, M.A., of HealthNet TPO, Vrije Universiteit Medical Center, Amsterdam, the Netherlands, and colleagues conducted a study to assess the efficacy of a school-based intervention designed for children exposed to conflict, and implemented in a low-income setting. The study involved 495 children (average age 9.9 years) attending randomly selected schools in communities affected by political violence in Poso, Indonesia. The children were screened for exposure to violent events, post-traumatic stress disorder (PTSD), and anxiety symptoms, and compared with a wait-list control group. The school-based intervention consisted of 15 sessions over five weeks and included trauma-processing activities, cooperative play, and creative-expressive elements, implemented by locally trained paraprofessionals.

The intervention resulted in a moderate reduction in PTSD symptoms and function impairment for girls and retained hope for boys and girls. "No changes were found on the other outcome variables; traumatic idioms, depressive, anxiety symptoms, and functioning (the latter for boys)," the authors report.

"We hypothesize that these results may show that psychosocial interventions alone are unable to reverse the challenges to psychosocial well-being presented by chronic poverty and political instability," they write.

The researchers noted significantly more improvement in post-traumatic stress disorder symptoms and maintained hope in the treatment group than in the control group. Gender influenced both changes in PTSD symptoms and function impairment, with girls benefiting more from the intervention than boys. The study found no effects for age.

"In short, a school-based psychosocial intervention was able to moderately reduce PTSD symptoms, retain hope, and improve functioning for girls, and retain hope for boys affected by communal violence in a low-income context," the authors conclude. "Further adaptations and research to address the full range of post-traumatic outcomes and functioning are necessary."
(JAMA. 2008;300[6]:655-662.

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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