1. War
Conditions
Interventions
The intervention is a therapeutic group approach, tailored to survivors of systematic violence. Verbal exchange, debate, exercises, games and practical support are key elements. Trauma symptoms are ad
they have received a 3 months’ training from Equator staff and are regularly supervised.
Sponsors
Academic Medical Centre Amsterdam
Eligibility
Inclusion criteria
Inclusion criteria: Inclusion criteria for sociotherapy groups: 1. Within a 6 years period all areas of Byumba province will be covered by the sociotherapy program. The sequence of areas is dictated by matters of actual convenience, and determined by the program’s local counterpart; 2. Group participants are aged 16 years or older; 3. The composition of groups is mixed (both sexes, various ethnic backgrounds, wide age distribution); No strict criteria for participation in a sociotherapy group exist. There are two routes towards participation: 1. Sociotherapy group leaders, who are selected from persons generally regarded and accepted as leaders within their community, invite community members to participate on account of the seriousness of their psychosocial problems; 2. Community members themselves apply for participation because they think it will help solve their psychosocial problems, and group leaders subsequently include them. Apart from emotional problems arising from the past confrontation with atrocities and losses during the war and genocide, community members currently experience a variety of problems such as poverty, bad housing, infectious diseases like HIV/AIDS, single parenthood, having to care for another family’s children, having a spouse in detention, sudden arrests, bearing a curse from ancestors, neighbours or the family in law, etc. No criteria have been defined to consider a person a problem case, the main reason being that it would automatically mean that people could also be excluded form group participation – a consequence lcoally considered as extremely undesirable. Another reason is formed by the still paranoid societal atmosphere in the region. People appear not to be willing to inform others about the nature of their problems or past traumatic experiences. They will only do so within the context of a sociotherapy group, after mutual confidence has been gained over a certain time. Therefore, it would be useless to ask detailed questions to possible future participants - it might even discourage participation. As a result, no criteria to enter a group have been defined, other than being considered or acknowledged a serious problem case by group leaders. Consequently, no case definition exists on the basis of which a control group can be composed. There will be three study groups: 1. DE: participants of sociotherapy groups, directly exposed (DE) to the intervention; 2. IE: individuals living close to the group participants, indirectly exposed (IE) to the intervention; 3. NE: individuals that are not reached by the intervention program: the control group, or non-exposed (NE). Ad 1 (DE): All participants (n=100) of 10 sociotherapy groups will be included in the DE group, without any further selection. Ad 2 (IE): The IE study group (n=100) will be formed according to the following stepped procedure: 1) All respondents of the DE study group will be asked to list 5 people they live or work with and feel close to. These may be relatives they share the house with, neighbours they are daily in touch with, close friends they meet at least twice a week, or colleagues they closely collaborate with. 2) Then the collected lists will be blindly piled in a random order. 3)Then 1 person is selected from each list, by choosing the name of the 1st person from the first list, the 2nd from the second list, the 3rd from the third list, et
Exclusion criteria
Exclusion criteria: N/A
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Primary outcome measure is mental health, as measured by use of the Self Reporting Questionnaire 20 items (SRQ-20). This is a structured interview developed by the World Health Organization (WHO) as a screening tool for common mental disorders in primary health care settings, especially in developing countries. When patients are literate it can be self-administered, but in developing countries it is usually administered by lay interviewers. The instrument consists of 20 yes/no questions about mood, thinking capacity, feelings of anxiety and physical well-being. The SRQ-20 has been used in numerous settings, also as a screening instrument in community samples. Cut-off points vary considerably depending on setting (community, primary care, hospital) and culture. A cut-off point of 8 is widely used. During our pilot study we validated the instrument locally. We interviewed 99 respondents, who were also clinically assessed by clinicians who were blind for the SRQ-scores. We established a local cut-off score for caseness/non-caseness. The capacity of the SRQ-20 to identify probable psychopathology in this setting proved to be sufficient. The AUC was 0.76. When analysed separately for men and women the SRQ-20 showed to perform equally well in men (AUC=0.74) and women (AUC=0.76). In evaluating the instrument as a potential screener for psychiatric disorder the most appropriate cut-off point is a trade-off between a high sensitivity and an acceptable specificity. From our analyses the optimal cut-off point for the SRQ-20 appeared to be 10/11 (sensitivity 0.69; specificity 0.79). However, when men and women were analysed separately the cut-off points differed. The optimal cut-off point for men is 8/9 (sensitivity 0.69; specificity 0.65), while the optimal cut-off point for women is 10/11 (sensitivity 0.81; specificity 0.80). Reliability is considered to be good: alpha=0.83 (men: alpha=0.81; women: alpha=0.85). | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Social functioning, as measured by the Byumba Social Functioning Questionnaire (BSFQ). This instrument contains questions which have been derived from a list that resulted from previous research in Rwanda. The actual questions have been compiled and listed during focus group interviews with people living in Byumba. Questions concern common daily activities for women and men, respectively, such as dressing oneself or taking care of the children. Data from our pilot study revealed that the instrument’s reliability is sufficient to good: alpha=0.77 (men: alpha=0.77; women: alpha=0.73). 2. Social functioning will also be measured with the Medical Outcomes Study (MOS) Social Functioning Scale 36 items (SF-36). This internationally widely used instrument is based on the WHO definition of health. Within this definition, health is divided into three domains: physical, mental, and social health. The SF-36 contains questions about functional impairment related to physical or psychological problems. In this study the instrument will be used to further found the validity of the BSFQ. For use in Rwanda, items of the SF-36 will be adapted if containing contextually inadequate phrases ('pushing a vacuum cleaner', 'walking blocks', 'playing golf'). Alternatives will be determined during discussions with local community members. 3. Social capital, as measured by use of the Social Capital Assessment Tool, short adapted version (SA-SCAT). This instrument contains questions used to get an impression of the respondents’ connectedness to their social environment. They have been derived from a list of questions that resulted from previous research in various countries. The actual questions were compiled and listed during focus group discussions with people living in Byumba. This has resulted in a locally adapted version. Questions concern the way people feel connected to others in their living area, feel supported by others, get along and undertake common actions with others. Data f | — |
Contacts
Public ContactW.F. Scholte
AMC de Meren Meibergdreef 5
Outcome results
None listed