Highly Vulnerable Children Research Center, Tulane University School of Social Work, New Orleans, LA, USA; Tulane International LLC, Cape Town, South Africa.
Highly Vulnerable Children Research Center, Tulane University School of Social Work, New Orleans, LA, USA.
Lancet Glob Health. 2017 Jun;5(6):e604-e614. doi: 10.1016/S2214-109X(17)30146-8. Epub 2017 Apr 24.
Bereavement increases children's risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in South Africa.
This randomised controlled trial enrolled female adolescents at 11 schools in three peri-urban towns of Free State province, South Africa. 453 bereaved ninth-grade students aged 13-17 years who had expressed interest in taking part in the group were randomly assigned (1:1) to receive the intervention or to be waitlisted for programme enrolment after the study period and serve as the control group. The intervention, Abangane ("friends" in isiZulu), is a locally derived, curriculum-based support group focused on coping with loss incorporating indigenous stories and cognitive behavioural therapy components. Weekly group sessions were facilitated by trained social workers or social auxiliary workers from a local non-profit organisation. The primary outcomes included indicators of grief and depression as reported by adolescents and behavioural problems reported by their caregivers. Grief was measured with three scales: the grief subscale of the Core Bereavement Items to assess normative grief; and the Intrusive Grief Thoughts Scale and the Inventory of Complicated Grief-Revised for Children to assess maladaptive grief symptoms in the past 4 weeks. Depression symptoms in the past 7 days were measured with the Center for Epidemiological Studies-Depression Scale for Children. Caregivers completed the Brief Problem Monitor-Parent Form to report on adolescent's behaviour in the previous 4 weeks. Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT02368808.
Between Sept 30, 2014, and Feb 5, 2015, eligible female participants were identified, of whom 226 were assigned to the intervention, Abangane, and 227 were assigned to the waitlisted control group. Analysis included 382 adolescents who completed both surveys (193 participants assigned to Abangane and 189 assigned to waitlist). At follow up, the intervention group had significantly lower scores for primary outcomes, including intrusive grief (p=0·000, Cohen's d=-0·21), complicated grief (p=0·015, d=-0·14), and depression (p=0·009, d=-0·21) relative to the waitlisted group, while core bereavement scores were similar between groups (p=0·269). Caregivers in the intervention group reported lower levels of behavioural problems among adolescents (p=0·017, d=-0·31).
Short-term, structured, theory-based support groups with contextually relevant content show promise in mitigating psychological and behavioural problems among bereaved adolescents. Abangane is replicable in resource limited settings, using freely available curriculum materials, existing programme structures, and appropriately trained personnel to implement it.
US Agency for International Development Southern Africa.
丧亲会增加儿童出现心理障碍的风险，这凸显了实施有效干预措施的必要性，尤其是在孤儿现象普遍的地区。我们旨在评估一个为期 8 节的支持小组干预措施对南非丧亲的女性青少年心理健康的影响。
本随机对照试验招募了南非自由州省三个城郊镇 11 所学校的 13-17 岁的 9 年级丧亲女性青少年。453 名对参加小组有兴趣的丧亲女性青少年有意愿参与研究，按 1:1 比例随机分配（1:1）至干预组或等待名单组，在研究期间后注册参与项目并作为对照组。干预措施是 Abangane（祖鲁语中“朋友”的意思），是一种基于课程的、由当地开发的支持小组，侧重于通过融入本土故事和认知行为疗法元素来应对丧失。每周一次的小组活动由当地非营利组织的经过培训的社工或社工助理来开展。主要结局指标包括青少年报告的悲伤和抑郁程度以及其照顾者报告的行为问题。悲伤通过三个量表进行测量：核心丧亲项目的悲伤分量表，用于评估正常的悲伤；创伤性悲伤思维量表和儿童复杂悲伤修订量表，用于评估过去 4 周的适应不良悲伤症状。过去 7 天的抑郁症状通过儿童流行病学研究中心抑郁量表进行测量。照顾者通过简短问题监测-父母形式报告过去 4 周青少年的行为。分析采用意向治疗。该研究在 ClinicalTrials.gov 注册，编号为 NCT02368808。
2014 年 9 月 30 日至 2015 年 2 月 5 日期间，确定了符合条件的女性参与者，其中 226 名被分配到干预组 Abangane，227 名被分配到等待名单对照组。分析纳入了完成两次调查的 382 名青少年（193 名参与者被分配到 Abangane，189 名参与者被分配到等待名单）。随访时，干预组在主要结局指标上的评分显著较低，包括创伤性悲伤（p=0·000，Cohen's d=-0·21）、复杂悲伤（p=0·015，d=-0·14）和抑郁（p=0·009，d=-0·21），而等待名单组的核心丧亲评分相似（p=0·269）。干预组的青少年照顾者报告的行为问题较少（p=0·017，d=-0·31）。
短期、结构化、基于理论的支持小组，内容具有相关性，显示出在减轻丧亲青少年的心理和行为问题方面的潜力。Abangane 可以在资源有限的环境中复制，使用免费的课程材料、现有的项目结构和经过适当培训的人员来实施。
美国国际开发署南部非洲局。
