A behavioral intervention for war-affected youth in Sierra Leone: a randomized controlled trial

Abstract

Objective: Youth in war-affected regions are at risk for poor psychological, social, and educational outcomes. Effective interventions are needed to improve mental health, social behavior, and school functioning. This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy (CBT)-based group mental health intervention for multisymptomatic war-affected youth (aged 15-24 years) in Sierra Leone.

Method: War-affected youth identified by elevated distress and impairment via community screening were randomized (stratified by sex and age) to the Youth Readiness Intervention (YRI) (n = 222) or to a control condition (n = 214). After treatment, youth were again randomized and offered an education subsidy immediately (n = 220) or waitlisted (n = 216). Emotion regulation, psychological distress, prosocial attitudes/behaviors, social support, functional impairment, and posttraumatic stress disorder (PTSD) symptoms were assessed at pre- and postintervention and at 6-month follow-up. For youth in school, enrollment, attendance, and classroom performance were assessed after 8 months. Linear mixed-effects regressions evaluated outcomes.

Results: The YRI showed significant postintervention effects on emotion regulation, prosocial attitudes/behaviors, social support, and reduced functional impairment, and significant follow-up effects on school enrollment, school attendance, and classroom behavior. In contrast, education subsidy was associated with better attendance but had no effect on mental health or functioning, school retention, or classroom behavior. Interactions between education subsidy and YRI were not significant.

Conclusion: YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement and behavior, suggesting potential to prepare war-affected youth for educational and other opportunities. Clinical trial registration information-Trial of the Youth Readiness Intervention (YRI); https://ichgcp.net/clinical-trials-registry/NCT01684488" title="See in ClinicalTrials.gov">NCT01684488.

Keywords: intervention; mental health; randomized controlled trial; war-affected; youth.

Conflict of interest statement

Drs. Betancourt, Newnham, Akinsulure-Smith, Brennan, Weisz, Hansen, and McBain report no biomedical interests or potential conflicts of interest.

Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1

Consolidated Standards of Reporting (CONSORT) flow diagram. Note: Those excluded did not meet inclusion criteria (described in study eligibility criteria section of Methods). Primary analyses included all randomized participants, using 100 multiply imputed data sets to account for missingness. YRI = Youth Readiness Intervention.

FIGURE 2

Overview of Youth Readiness Intervention (YRI).