Improving outcomes for caregivers through treatment of young people affected by war: a randomized controlled trial in Sierra Leone

Ryan K McBain, Carmel Salhi, Katrina Hann, Jim Kellie, Alimamy Kamara, Joshua A Salomon, Jane J Kim, Theresa S Betancourt, Ryan K McBain, Carmel Salhi, Katrina Hann, Jim Kellie, Alimamy Kamara, Joshua A Salomon, Jane J Kim, Theresa S Betancourt

Abstract

Objective: To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living in a war-affected area.

Methods: Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention--a cognitive-behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems--in Freetown, Sierra Leone. Overall, 436 participants aged 15-24 years were randomized to receive the intervention (n = 222) or care as usual (n = 214). Household caregivers for the participants in the intervention arm (n = 101) or control arm (n = 103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later in a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional impairment. The caregivers' mental health--i.e. internalizing, externalizing and prosocial behaviour--was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects.

Findings: Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions in emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026-0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012-0.486) between the two surveys.

Conclusion: A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers.

Figures

Fig. 1
Fig. 1
Flowchart to assess the benefit for caregivers of young people enrolled in the Youth Readiness Intervention, Sierra Leone, 2012–2013

References

    1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012. December 15;380(9859):2197–223. 10.1016/S0140-6736(12)61689-4
    1. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al.WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004. June 2;291(21):2581–90. 10.1001/jama.291.21.2581
    1. Atlas: child and adolescent mental health resources: global concerns, implications for the future. Geneva: World Health Organization; 2005.
    1. Attanayake V, McKay R, Joffres M, Singh S, Burkle F Jr, Mills E. Prevalence of mental disorders among children exposed to war: a systematic review of 7,920 children. Med Confl Surviv. 2009. Jan-Mar;25(1):4–19. 10.1080/13623690802568913
    1. Panter-Brick C, Eggerman M, Gonzalez V, Safdar S. Violence, suffering, and mental health in Afghanistan: a school-based survey. Lancet. 2009. September 5;374(9692):807–16. 10.1016/S0140-6736(09)61080-1
    1. Razokhi AH, Taha IK, Taib NI, Sadik S, Al Gasseer N. Mental health of Iraqi children. Lancet. 2006. September 2;368(9538):838–9. 10.1016/S0140-6736(06)69320-3
    1. Collier P. The bottom billion. Oxford: Oxford University Press; 2008.
    1. Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty KF, et al. Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA. 2007. August 1;298(5):519–27. 10.1001/jama.298.5.519
    1. Neuner F, Catani C, Ruf M, Schauer E, Schauer M, Elbert T. Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): from neurocognitive theory to field intervention. Child Adolesc Psychiatr Clin N Am. 2008. July;17(3):641–64, x. 10.1016/j.chc.2008.03.001
    1. Fine PE. Herd immunity: history, theory, practice. Epidemiol Rev. 1993;15(2):265–302.
    1. Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008. May 22;358(21):2249–58. 10.1056/NEJMsa0706154
    1. Johnston DW, Schurer S, Shields MA. Exploring the intergenerational persistence of mental health: evidence from three generations. J Health Econ. 2013. December;32(6):1077–89. 10.1016/j.jhealeco.2013.09.001
    1. Pilowsky DJ, Wickramaratne PJ, Rush AJ, Hughes CW, Garber J, Malloy E, et al. Children of currently depressed mothers: a STAR*D ancillary study. J Clin Psychiatry. 2006. January;67(1):126–36. 10.4088/JCP.v67n0119
    1. McLaughlin J, O’Carroll RE, O’Connor RC. Intimate partner abuse and suicidality: a systematic review. Clin Psychol Rev. 2012. December;32(8):677–89. 10.1016/j.cpr.2012.08.002
    1. Pico-Alfonso MA, Garcia-Linares MI, Celda-Navarro N, Blasco-Ros C, Echeburúa E, Martinez M. The impact of physical, psychological, and sexual intimate male partner violence on women’s mental health: depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide. J Womens Health (Larchmt). 2006. June;15(5):599–611. 10.1089/jwh.2006.15.599
    1. Tucker CJ, Finkelhor D, Turner H, Shattuck A. Association of sibling aggression with child and adolescent mental health. Pediatrics. 2013. July;132(1):79–84. 10.1542/peds.2012-3801
    1. Al-Modallal H, Peden A, Anderson D. Impact of physical abuse on adulthood depressive symptoms among women. Issues Ment Health Nurs. 2008. March;29(3):299–314. 10.1080/01612840701869791
    1. Zendjidjian X, Richieri R, Adida M, Limousin S, Gaubert N, Parola N, et al. Quality of life among caregivers of individuals with affective disorders. J Affect Disord. 2012. February;136(3):660–5. 10.1016/j.jad.2011.10.011
    1. Seloilwe ES. Experiences and demands of families with mentally ill people at home in Botswana. J Nurs Scholarsh. 2006;38(3):262–8. 10.1111/j.1547-5069.2006.00112.x
    1. Oshodi YO, Adeyemi JD, Aina OF, Suleiman TF, Erinfolami AR, Umeh C. Burden and psychological effects: caregiver experiences in a psychiatric outpatient unit in Lagos, Nigeria. Afr J Psychiatry (Johannesbg). 2012. March;15(2):99–105. 10.4314/ajpsy.v15i2.13
    1. Mavundla TR, Toth F, Mphelane ML. Caregiver experience in mental illness: a perspective from a rural community in South Africa. Int J Ment Health Nurs. 2009. October;18(5):357–67. 10.1111/j.1447-0349.2009.00624.x
    1. Newnham EA, McBain RK, Hann K, Akinsulure-Smith AM, Weisz J, Lilienthal GM, et al. The Youth Readiness Intervention for war-affected youth. J Adolesc Health. 2015. June;56(6):606–11. 10.1016/j.jadohealth.2015.01.020
    1. Betancourt TS, Borisova II, Williams TP, Brennan RT, Whitfield TH, de la Soudiere M, et al. Sierra Leone’s former child soldiers: a follow-up study of psychosocial adjustment and community reintegration. Child Dev. 2010. Jul-Aug;81(4):1077–95. 10.1111/j.1467-8624.2010.01455.x
    1. Betancourt TS, Brennan RT, Rubin-Smith J, Fitzmaurice GM, Gilman SE. Sierra Leone’s former child soldiers: a longitudinal study of risk, protective factors, and mental health. J Am Acad Child Adolesc Psychiatry. 2010. June;49(6):606–15.
    1. Chorpita BF, Becker KD, Daleiden EL, Hamilton JD. Understanding the common elements of evidence-based practice: misconceptions and clinical examples. J Am Acad Child Adolesc Psychiatry. 2007. May;46(5):647–52. 10.1097/chi.0b013e318033ff71
    1. Chorpita BF, Daleiden EL, Weisz JR. Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Ment Health Serv Res. 2005. March;7(1):5–20. 10.1007/s11020-005-1962-6
    1. Cloitre M, Koenen KC, Cohen LR, Han H. Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. J Consult Clin Psychol. 2002. October;70(5):1067–74. 10.1037/0022-006X.70.5.1067
    1. Briere J, Scott C. Principles of trauma therapy: a guide to symptoms, evaluation and treatment. London: Sage; 2006.
    1. Process of translation and adaptation of instruments. Geneva: World Health Organization; 2012.
    1. Betancourt TS, McBain R, Newnham EA, Akinsulure-Smith AM, Brennan RT, Weisz JR, et al. A behavioral intervention for war-affected youth in Sierra Leone: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2014. December;53(12):1288–97. 10.1016/j.jaac.2014.09.011
    1. Reinhard SC, Gubman GD, Horwitz AV, Minsky S. Burden assessment scale for families of the seriously mentally ill. Eval Program Plann. 1994;17(3):261–9. 10.1016/0149-7189(94)90004-3
    1. Reise SP, Waller NG, Comrey AL. Factor analysis and scale revision. Psychol Assess. 2000. September;12(3):287–97. 10.1037/1040-3590.12.3.287
    1. Ruscio J, Roche B. Determining the number of factors to retain in an exploratory factor analysis using comparison data of known factorial structure. Psychol Assess. 2012. June;24(2):282–92. 10.1037/a0025697
    1. MacMullin C, Loughry M. Investigating psychosocial adjustment of former child soldiers in Sierra Leone and Uganda. J Refug Stud. 2004;17(4):460–72. 10.1093/jrs/17.4.460
    1. Angrist JD, Pischke JS. Mostly harmless econometrics: an empiricist's companion. Princeton: Princeton University Press; 2008.
    1. Little RJA, Rubin DB. Statistical analysis with missing data. 2nd ed. Hoboken: Whiley-InterScience; 200210.1002/9781119013563
    1. Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 198710.1002/9780470316696
    1. Weisz JR, Jensen-Doss A, Hawley KM. Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons. Am Psychol. 2006. October;61(7):671–89. 10.1037/0003-066X.61.7.671
    1. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995. January 4;273(1):59–65. 10.1001/jama.1995.03520250075037
    1. Stewart-Brown S. Emotional wellbeing and its relation to health. Physical disease may well result from emotional distress. BMJ. 1998. December 12;317(7173):1608–9. 10.1136/bmj.317.7173.1608
    1. Huppert FA. Psychological well-being: evidence regarding its causes and consequences. Appl Psychol Health Well-Being. 2009;1(2):137–64. 10.1111/j.1758-0854.2009.01008.x
    1. De Silva MJ, McKenzie K, Harpham T, Huttly SR. Social capital and mental illness: a systematic review. J Epidemiol Community Health. 2005. August;59(8):619–27. 10.1136/jech.2004.029678
    1. Granic I, Dishion TJ, Hollenstein T. The family ecology of adolescence: a dynamic systems perspective on normative development. In: Adams GR, Berzonsky MD, editors. Blackwell handbook of adolescence. London: Blackwell; 2003.
    1. Boothby N, Crawford J, Halperin J. Mozambique child soldier life outcome study: lessons learned in rehabilitation and reintegration efforts. Glob Public Health. 2006;1(1):87–107. 10.1080/17441690500324347
    1. Betancourt TS, Newnham EA, McBain R, Brennan RT. Post-traumatic stress symptoms among former child soldiers in Sierra Leone: follow-up study. Br J Psychiatry. 2013. September;203(3):196–202. 10.1192/bjp.bp.112.113514
    1. Spratt M, Carpenter J, Sterne JA, Carlin JB, Heron J, Henderson J, et al. Strategies for multiple imputation in longitudinal studies. Am J Epidemiol. 2010. August 15;172(4):478–87. 10.1093/aje/kwq137

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