Academic journal article Bulletin of the World Health Organization

Improving Outcomes for Caregivers through Treatment of Young People Affected by War: A Randomized Controlled Trial in Sierra Leone/ Ameliorer L'etat De Sante Des Aidants Familiaux Par la Prise En Charge Des Jeunes Touches Par la Guerre: Essai Controle Randomise En Sierra Leone/ Mejorar Los Resultados De Ios Cuidadores Mediante El Tratamieto De Los Jovenes Afectados Por la Guerra: Un Ensayo Controlado Aleatorizado En Sierra Leona

Academic journal article Bulletin of the World Health Organization

Improving Outcomes for Caregivers through Treatment of Young People Affected by War: A Randomized Controlled Trial in Sierra Leone/ Ameliorer L'etat De Sante Des Aidants Familiaux Par la Prise En Charge Des Jeunes Touches Par la Guerre: Essai Controle Randomise En Sierra Leone/ Mejorar Los Resultados De Ios Cuidadores Mediante El Tratamieto De Los Jovenes Afectados Por la Guerra: Un Ensayo Controlado Aleatorizado En Sierra Leona

Article excerpt

Introduction

Although, globally, psychiatric disorders account for a larger disease burden than human immunodeficiency virus and malaria combined, (1) more than three-quarters of individuals living in low- and middle-income countries who have such disorders receive no clinical treatment. (2) Treatment coverage is particularly poor among children and adolescents with psychiatric disorders (3)--especially in war-affected countries

where displacement, bereavement, the witnessing of violence and limited educational and economic opportunities all contribute to a high prevalence of psychiatric conditions. (4-7)

There have been few attempts to evaluate the effectiveness of psychotherapeutic interventions among young people affected by war but such interventions appear to have a favourable impact on depressive symptoms* and post-traumatic stress reactions. (9) It remains unclear if such interventions also lead to indirect benefits among the household caregivers or other household members of the young people. If such side-benefits do exist, the effectiveness of psychotherapeutic interventions for young people may have been underestimated.

Many interventions once thought to have only a focused impact have subsequently been found to have a wider social benefit. Examples include the herd immunity associated with vaccination campaigns (10) and the spread of healthy behaviour through social networks. (11) In the context of interventions to improve the lives of war-affected young people, it is possible that improvements in the mental health of the participants translate into enriched household relations and fewer caregiver responsibilities.

There is growing evidence of the transmission of mental health problems, through social networks, from parents to children (12,13) and between intimate partners (14,15) or siblings. (16,17) In France, psychiatric illness has been found to have detrimental effects on employment and overall quality of life of members of the affected person's household. (18) Similar qualitative observations have been made in Botswana, (19) Nigeria (20) and South Africa. (21)

Here we investigated whether a similar household-level burden of care exists in post-conflict Sierra Leone and whether this burden could be reduced via a cognitive-behavioural intervention for war-affected young people.

Methods

We did a randomized controlled trial of the Youth Readiness Intervention in young residents of Freetown, Sierra Leone, who had psychological distress and functional impairments. We interviewed caregivers of the young people enrolled in the trial to assess if there was a spill-over effect.

Intervention

The Youth Readiness Intervention has been described elsewhere. (22) Briefly, the intervention is a group-based cognitive-behavioural intervention for war-affected young people who show psychological distress and functional impairments as the result of behavioural and emotional problems. To accommodate for multiple problems previously documented among young people in our study area, (23,24) we used practice elements of cognitive-behavioural therapy shown to have efficacy across a range of diagnostic categories. Content modules included psychoeducation about trauma, self-regulation and relaxation skills, cognitive restructuring, behavioural activation, communication and interpersonal skills and sequential problem solving. (25-27) Given concerns about the safety of addressing complex trauma in a group context (28) and the limited time we had available to provide specialized training on trauma processing, the intervention did not focus directly on the processing of traumatic memories.

We trained four counsellors for two weeks. (22) The trained counsellors then led supervised training workshops for other potential counsellors. We employed the eight individuals--four women and four men with bachelor degrees--who completed the training and achieved a high level of competency. …

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