Study Finds Sexually Abused Children in Turkey Exhibit More Psychiatric Disorders at Initial Assessment than Two-Years Later

Prior research indicates that children who have been sexually abused are at risk of developing various negative short and long-term psychological sequelae. However, there is little research on the effects of sexual abuse on children living in non-Western contexts. In this study, Ozbaran et al. (2009) aim to explore the emotional and psychological impact of sexual abuse among a sample of children in Turkey at referral and two years after referral. Over 300 parents and their children (ages 5-16) were referred to the Department of Child and Adolescent Psychiatry at Ege University in Turkey, and 20 parents and their children agreed to participate in the research. At referral, the parent-child pairs (N=20) completed the first evaluation, which included a detailed psychiatric examination of each participant, completion of the Child Behavior Checklist by the mother, and an evaluation of the child’s mental capacity by a clinical psychologist. Over a period of two years, the sample participated in a combination of the following interventions, depending on the child and family’s needs: psychopharmacologic medication, parental support groups, family meetings with social workers, school counseling services, sport and art activities, and outpatient occupational therapy. After two years, the parent and child were asked to return for a follow-up evaluation. The study found that children who were sexually abused had more psychiatric disorders during the first assessment (55%) than during the second-stage evaluation (0%). However, the study also found that there was no statistically significant relationships between psychiatric diagnoses, socio-demographic features, duration of abuse, or abuse type.

The study methodology lacked rigor in that it was not clear that there was a systematized method for conducting the first and second-stage evaluations. However, the implementation of blind psychiatric interview during the second-stage evaluation was strength of the study, because it lessens the likelihood that the therapist’s impressions will be biased. The small sample size (N=20) of the study, ensured that no participants were lost to follow-up. However, the small sample size - and therefore the decreased statistical power - also made it difficult to draw any statistically significant conclusions. The lack of a control group in the study design also made it a challenge to directly demonstrate a causal relationship between sexual abuse and development of a psychiatric diagnosis or behavioral problems. The authors’ statement that the condition of the sexually abused children in their sample improved significantly as a result of time is misleading, because the study design doesn’t discern whether this is attributed to time or to the array of intervention services that the children and their families received during the study period. Lastly, sampling bias may pose a threat to the external validity of the study, as the sample reflected less than 7% of the initial referrals (over 300) to the hospital. This small sample may have characteristics that the general population does not exhibit. In light of these limitations, this study still adds to the sparse literature on the topic of children affected by sexual abuse in non-Western settings and represents an obvious precursor to more rigorous studies.

Source:
Ozbaran, B., Erermis, S., Bukusoglu, N., Bildik, T., Tamar, M., Ercan, E.S., Aydin, C., and Cetin, S.K. (2009). Social and emotional outcomes of child sexual abuse: a clinical sample in Turkey. Journal of Interpersonal Violence, 24(9), 1478-1493.

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