Tuesday, September 22, 2009

Combination of Education and Trauma Healing Activities Decreases Trauma Symptoms in War-Affected Children in Sierra Leone

Though research indicates that higher levels of traumatic events among war-affected children leads to greater incidence of negative mental health outcomes, there is little evidence about the effectiveness of psychosocial interventions to mitigate these consequences. Gupta and Zimmer (2008) focus on determining the effectiveness of a psychosocial intervention study among children affected by the conflict in Sierra Leone. The sample was randomly drawn from school registration lists provided by the Ministry of Education, which contains all school-age children residing in the Grafton and Trade Center camps for internally displaced persons. The sample focused on an equal number of boys and girls ages 8-17, for a total sample size of 315 children. The Rapid-Ed intervention consisted of an education module enhanced with eight sessions of structured trauma healing activities and unstructured recreation activities. Children were interviewed for the pre- and post-test by trained camp teachers using a semi-structured questionnaire, which was translated and back-translated into the local language (Creole). The pre-test was administered approximately 9-12 months after the start of armed conflict, and the post-test was administered 4-6 weeks after participants completed the intervention. Results show that 96% of children reported a significant reductions in concentration problems, sleep disturbances, bad dreams, and intrusive images after participating in the Rapid-Ed intervention. The study also found that there was a slight increase in avoidance symptoms after the intervention.

The study addresses selection bias by randomly selecting children from the target communities. Also, the low attrition rate (3%) was a strength, and most likely due to the accessibility and reliability of finding the students in formal schooling programs. However, the results of this study would be strengthened with the addition of a control group. Use of a control group would indicate whether it was the intervention that caused the decreased psychological distress or whether other factors were responsible. Firstly, maturation poses a threat to the internal validity, because the study is unable to discern whether the intervention was the cause of improved psychosocial outcomes or whether it was due to the subjects’ internal healing processes. Secondly, statistical regression may pose a threat to the internal validity, because the change due to the intervention cannot be distinguished from the effect of scores reverting toward the mean. A control group would have addressed these concerns and greatly improved the study’s internal reliability. However, the sensitive context creates ethical challenges in regards to whether one group can receive the intervention and the other one doesn’t.

Gupta, L. and Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra Leone. The British Journal of Psychiatry, 192, 212-216.

No comments: