Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, PO Box 100131, 33501 Bielefeld, Germany.
JAMA. 2011 Aug 3;306(5):503-12. doi: 10.1001/jama.2011.1060.
The psychological rehabilitation of former child soldiers and their successful reintegration into postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers.
To assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals.
DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization. Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention.
Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities.
Change in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation, feelings of guilt, and perceived stigmatization.
PTSD symptom severity (range, 0-148) was significantly more improved in the narrative exposure therapy group than in the academic catch-up (mean change difference, -14.06 [95% confidence interval, -27.19 to -0.92]) and waiting-list (mean change difference, -13.04 [95% confidence interval, -26.79 to 0.72]) groups. Contrast analyses of the time × treatment interaction of the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F(1,234.1) = 5.21, P = .02) and wait-listing (F(1,228.3) = 5.28, P = .02). Narrative exposure therapy produced a larger within-treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81).
Among former Ugandan child soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing resulted in greater reduction of PTSD symptoms.
clinicaltrials.gov Identifier: NCT00552006.
前儿童兵的心理康复和成功重返冲突后社会面临挑战。尽管存在高比例的损伤，但尚无随机对照试验研究针对前儿童兵的心理健康干预措施的可行性和疗效。
评估针对以前被绑架者的创伤后应激障碍（PTSD）症状的基于社区的干预措施的功效。
设计、地点和参与者：这是一项随机对照试验，招募了 85 名来自北乌干达的 PTSD 前儿童兵，他们是对 1113 名 12 至 25 岁的境内流离失所者进行的基于人群的调查的一部分，该调查于 2007 年 11 月至 2009 年 10 月在境内流离失所者营地进行。参与者被随机分配到 3 个组之一：叙事暴露疗法（n = 29），包括支持性咨询的学术补课计划（n = 28），或候补名单（n = 28）。使用临床医生管理的 PTSD 量表来衡量 PTSD 和创伤相关的内疚感的症状。使用《国际神经精神访谈手册》的各自部分来评估抑郁和自杀风险，并且使用当地改编的量表来衡量感知耻辱感。在治疗前和治疗后 3 个月，6 个月和 12 个月时评估 PTSD 严重程度，抑郁和相关损伤的症状。
受过培训的当地非专业人员在社区中直接进行了 8 次治疗。
治疗后 1 年内 PTSD 严重程度的变化。次要结局测量是抑郁症状，自杀意念的严重程度，内疚感和感知耻辱感。
叙事暴露疗法组的 PTSD 严重程度（范围为 0-148）明显优于学术补课（平均变化差异，-14.06 [95％置信区间，-27.19 至-0.92]）和候补名单（平均变化差异，-13.04 [95％置信区间，-26.79 至 0.72]）组。混合效应模型的时间×治疗相互作用的对比分析表明，叙事暴露疗法与学术补课（F（1,234.1）= 5.21，P =.02）和候补名单（F（1,228.3）= 5.28，P =.02）相比具有优越性。叙事暴露疗法产生的治疗内效应量（Cohen d = 1.80）大于学术补课（d = 0.83）和候补名单（d = 0.81）。
在前乌干达儿童兵中，与学术补课计划（包括支持性咨询）或候补名单相比，短期以创伤为重点的治疗可更大程度地减轻 PTSD 症状。
clinicaltrials.gov 标识符：NCT00552006。
