Psychological Distress
Conditions
Keywords
community-based, war-affected, psychosocial support, family-focused, psychological distress, adolescents, Democratic Republic of Congo, family functioning, community functioning, daily functioning
Brief summary
The main research question of the study is whether a family-based, life-skills focused psychosocial intervention is effective in reducing psychological distress and stigma and improving inter-personal relations and functioning among war-affected children in the Democratic Republic of Congo.
Interventions
BEHAVIORALFamily-Focused, Community-Based, Resilience-Targetting Psychosocial Intervention
A 12-module manualised intervention focusing on reducing psychological distress, improving family and community functioning and boosting daily functioning of adolescents through the use of Mobile Cinema Screenings and task-based, participatory, group-sessions
Sponsors
Harvard School of Public Health (HSPH)
Discover the Journey
Queen's University, Belfast
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
7 Years to 99 Years
Healthy volunteers
Yes
Inclusion criteria
* War-affected * eastern Democratic Republic of Congo * Formerly abducted child or vulnerable child
Exclusion criteria
* severe/violent behavioural problems * severe learning difficulties
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reduction in Post-traumatic Stress Reaction Symptoms Among Participants | 1-week before intervention, 3-weeks later | To assess post-traumatic stress reaction symptoms the 8-item Impact of Events Scale (CRIES-8) was used (Yule, 1997). Respondents indicating how frequently they experience a symptom on a 4-point Likert scale (0, 1, 2, 3). Thus the minimum score was 0 while the maximum score was 24. A high score indicates a high level of post-traumatic stress symptoms. This 8-item CRIES, which was designed for children over 7 years of age, has an identical factor structure to the 22-item version (Yule, 1997) which was previously validated with a sample of 1,046 war-affected adolescents in the eastern Democratic Republic of Congo (Mels, Derluyn, Broekaert & Rosseel, 2010) (internal reliability range: 0·79 to 0·84; Cronbach's alpha for the total scale: 0·93). In the current study, internal consistency was 0·557. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| African Youth Psychosocial Assessment Inventory - Depression and Anxiety Subscales | pre-intervention, 3 weeks later | Internalising symptoms were assessed using the African Youth Psychosocial Assessment Instrument (AYPA) (Betancourt et al., 2009).This 17 item Likert (0 = minimum, 51 = maximum) measure was developed in northern Uganda after extensive qualitative consultation with young people, caregivers and mental health workers. A high score on the AYPA indicates a high level of internalizing symptoms. It is the only African developed, validated questionnaire available, had been used in separate studies with war-affected children in the DR Congo (McMullen et al., 2013; O'Callaghan, McMullen, Shannon, Rafferty & Black; 2013) and includes symptoms of distress which do not appear in Western-developed measures (e.g. muttering to oneself, feeling pain in your heart, sitting with your head in your hand etc.). Test-retest reliability (carried out with a subset of 30 participants) for the AYPA was 0·91, inter-rater reliability was 0·58 (n = 26) and internal consistency was 0·787 (internalising symptoms). |
Countries
Republic of the Congo
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Family-Focused Psychosocial Intervention Intervention Group
Family-Focused, Community-Based, Resilience-Targetting Psychosocial Intervention: A 12-module manualised intervention focusing on reducing psychological distress, improving family and community functioning and boosting daily functioning of adolescents through the use of Mobile Cinema Screenings and task-based, participatory, group-sessions | 79 |
| Waiting List Control | 80 |
| Total | 159 |
Baseline characteristics
| Characteristic | Family-Focused Psychosocial Intervention | Waiting List Control | Total |
|---|---|---|---|
| Age, Continuous | 13.16 years STANDARD_DEVIATION 2.85 | 13.76 years STANDARD_DEVIATION 2.76 | 13.42 years STANDARD_DEVIATION 2.79 |
| Region of Enrollment Congo | 79 participants | 80 participants | 159 participants |
| Sex: Female, Male Female | 36 Participants | 35 Participants | 71 Participants |
| Sex: Female, Male Male | 43 Participants | 45 Participants | 88 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 79 | 0 / 80 |
| other Total, other adverse events | 0 / 79 | 0 / 80 |
| serious Total, serious adverse events | 0 / 79 | 0 / 80 |
Outcome results
Primary
Reduction in Post-traumatic Stress Reaction Symptoms Among Participants
To assess post-traumatic stress reaction symptoms the 8-item Impact of Events Scale (CRIES-8) was used (Yule, 1997). Respondents indicating how frequently they experience a symptom on a 4-point Likert scale (0, 1, 2, 3). Thus the minimum score was 0 while the maximum score was 24. A high score indicates a high level of post-traumatic stress symptoms. This 8-item CRIES, which was designed for children over 7 years of age, has an identical factor structure to the 22-item version (Yule, 1997) which was previously validated with a sample of 1,046 war-affected adolescents in the eastern Democratic Republic of Congo (Mels, Derluyn, Broekaert & Rosseel, 2010) (internal reliability range: 0·79 to 0·84; Cronbach's alpha for the total scale: 0·93). In the current study, internal consistency was 0·557.
Time frame: 1-week before intervention, 3-weeks later
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Family-Focused Psychosocial Intervention | Reduction in Post-traumatic Stress Reaction Symptoms Among Participants | Pre-Intervention Mean Scores | 11.79 units on a scale | Standard Deviation 5.28 |
| Family-Focused Psychosocial Intervention | Reduction in Post-traumatic Stress Reaction Symptoms Among Participants | Post-Intervention Mean Scores | 12.17 units on a scale | Standard Deviation 5.7 |
| Waiting List Control Group | Reduction in Post-traumatic Stress Reaction Symptoms Among Participants | Pre-Intervention Mean Scores | 11.80 units on a scale | Standard Deviation 5.56 |
| Waiting List Control Group | Reduction in Post-traumatic Stress Reaction Symptoms Among Participants | Post-Intervention Mean Scores | 10.03 units on a scale | Standard Deviation 4.76 |
Secondary
African Youth Psychosocial Assessment Inventory - Depression and Anxiety Subscales
Internalising symptoms were assessed using the African Youth Psychosocial Assessment Instrument (AYPA) (Betancourt et al., 2009).This 17 item Likert (0 = minimum, 51 = maximum) measure was developed in northern Uganda after extensive qualitative consultation with young people, caregivers and mental health workers. A high score on the AYPA indicates a high level of internalizing symptoms. It is the only African developed, validated questionnaire available, had been used in separate studies with war-affected children in the DR Congo (McMullen et al., 2013; O'Callaghan, McMullen, Shannon, Rafferty & Black; 2013) and includes symptoms of distress which do not appear in Western-developed measures (e.g. muttering to oneself, feeling pain in your heart, sitting with your head in your hand etc.). Test-retest reliability (carried out with a subset of 30 participants) for the AYPA was 0·91, inter-rater reliability was 0·58 (n = 26) and internal consistency was 0·787 (internalising symptoms).
Time frame: pre-intervention, 3 weeks later
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Family-Focused Psychosocial Intervention | African Youth Psychosocial Assessment Inventory - Depression and Anxiety Subscales | Pre-Intervention Scores | 14.88 units on a scale | Standard Deviation 7.07 |
| Family-Focused Psychosocial Intervention | African Youth Psychosocial Assessment Inventory - Depression and Anxiety Subscales | 3 week Post-Intervention Scores | 12.09 units on a scale | Standard Deviation 6.26 |
| Waiting List Control Group | African Youth Psychosocial Assessment Inventory - Depression and Anxiety Subscales | Pre-Intervention Scores | 13.53 units on a scale | Standard Deviation 6.19 |
| Waiting List Control Group | African Youth Psychosocial Assessment Inventory - Depression and Anxiety Subscales | 3 week Post-Intervention Scores | 11.57 units on a scale | Standard Deviation 5.36 |