57th Commission on the Status of Women

Worldwide, it is estimated that one in every three women has been beaten, coerced into sex or abused in some other way. Women and girls who have been displaced by conflict are at particular risk of gender-based violence (GBV). From the Democratic Republic of Congo to Syria, forms of GBV such as rape, sexual exploitation and forced prostitution turn women’s lives upside down, leaving lasting physical and emotional scars. GBV doesn't just affect women, but it has deep and lasting effects on families, communities, and societies.

Violence against women can and should be prevented. Also, survivors of GBV must be able to access the care and services that they need, including medical and mental health services.

Today, non-governmental organizations and activists are gathering at the United Nations for the first day of the 57th Commission on the Status of Women. As one of the participants in the Commission, the Women's Refugee Commission is also starting a social media initiative called "Power of Prevention: Ending Violence Against Women and Girls in Crises", which aims to raise awareness about the prevention of GBV in crisis settings and highlight tools and resources to help make displaced women and girls safer.

Parental Involvement with the Criminal Justice System and The Effects on their Children

My latest article details the effects of parental incarceration on children, and describes the collaborative model developed by the Child Psychiatric Epidemiology Group (CPEG) and The Bronx Defenders to research these families. The article can be downloaded here.

Study Finds Group Interpersonal Psychotherapy Reduces Symptoms of Depression Among Adolescent Girls Affected by War in Northern Uganda

Prior research indicates that war-affected youth are at increased risk of mental health issues, and many humanitarian organizations have been implementing interventions to ameliorate these problems. Yet, few rigorous evaluations have been conducted and even fewer have implemented a randomized control design. Using a randomized control design, Bolton et al. (2007) examined the effectiveness of a group interpersonal psychotherapy intervention (IPT-G) and a creative play intervention (CP), as compared to a wait-list control group, in decreasing depression symptoms, anxiety symptoms, and conduct problems among war-affected adolescents. The authors first developed locally derived measures for depression, anxiety, conduct problems, and functioning to create the Acholi Psychosocial Assessment Instrument (APAI), which was found to have strong test-retest reliability and criterion validity. Stage one of the screening asked community leaders, teachers, community workers, and adolescents to create a list of 14 to 17-year-olds who exhibited at least one of the locally-derived depression symptoms. Stage two of the screening process administered the locally derived instrument to community-identified children to determine who should be included in the study. The study employed a pretest-posttest control group design, with participants randomly assigned to one of the three groups. The authors found that all three groups experienced decreased symptoms of depression. However, only girls experienced statistically significant reductions in their depressive symptoms after participating in IPT-G. Neither IPT-G nor CP were associated with improvement in anxiety, conduct problems, or functioning.

Based on previous RCTs in sub-Saharan populations, the authors recognized that attrition could pose a threat to the study’s validity by decreasing sample size and power and compromising the integrity of the random assignment. To address this, the authors employed intent-to-treat analysis, using pretreatment data from subjects who have dropped out as both pre- and post-test data. Intent-to-treat analysis also provided a conservative test of the hypothesis, making the effect of IPT-G all the more compelling. To decrease attrition further, the experimenters used a unique method of obtaining informed consent from the sample, both before the administration of the pre-intervention measure and after random assignment to one of the three groups. This study contributes to the growing knowledge base about ways to address the effects of war among adolescents, and proves that randomized control study designs can be implemented in difficult contexts with vulnerable populations.

Reference:
Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K.F., Neugebauer, R., Murray, L., and Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in Northern Uganda: A randomized control trial. Journal of the American Medical Association, 298(5), 519-527

Parental Education Program Improves Mental Health and Adjustment in Parents of Children with Autism

Research indicates that parents of children with autism experience a high level of stress. Parent training interventions reflect an attempt to address this stress and improve parental mental health. In Tonge et al.’s (2006) study, parents of preschool children recently diagnosed with autism were sampled from four geographically separate metropolitan and rural regional assessment services for young children suspected of having autism. The sample was assigned to either the intervention group (n=70) or control group (n=35). Parents from the intervention group were further randomly assigned to a parent education and behavior management (PEBM) group (n=35) or a parent education and counseling (PEC) group (n=35). Subjects were administered a questionnaire at pre-intervention, post-intervention, and six-month follow-up. Parental health was determined using the General Health Questionnaire, a widely-used reliable, and valid self-administered adult screening test designed to detect mental health issues in community settings. Results showed that both interventions improved the mental health and well-being of parents with children recently diagnosed with autism, especially among parents who had preexisting mental health problems. There were no statistically significant results supporting the superiority of either PEBM or PEC.

The authors anticipate several potential threats to validity, and attempt to minimize these threats through the study design. First, by sampling populations in geographically distant rural and urban communities, the investigators attempted to control cross-contamination of groups as a threat to validity. Second, the investigators made attempts to control for any threats to internal or construct validity by training therapists to strictly follow guidelines for the specific interventions and providing supervision and training to therapists throughout the study. Therapists also administered both treatments and were rotated between therapies. The investigators videotaped a random 10% of the intervention group for content review and intervention adherence. Third, the authors address timing of measurement as a potential threat to external validity by testing all subjects six months after the study. Consequently, results showed that alleviation of symptoms became more apparent over the long-term, reflecting a possible cumulative effect of treatment. Nevertheless, the study also exhibits limitations. By selecting samples from rural and urban communities, access to services may have created notable differences between the groups. Because parents were included in the study based on their children’s diagnosis, the group may exhibit wide variation in regards to mental health. This diversity of subject characteristics made it difficult for the investigators to determine a difference between groups. Overall, the study reveals promising findings about the effectiveness of parent training as an important element of interventions for children with autism.

Reference:
Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., King, N., and Rinehart, N. (2006). Effects of parental mental health of an education and skills training program for parents of young children with autism: A randomized control trial. Journal of the American Academy of Child and Adoelscent Psychiatry, 45(5), 561-569.