Instituto CISALVA, Universidad del Valle, Cali, Colombia.
Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, United States of America.
PLoS One. 2018 Dec 10;13(12):e0208483. doi: 10.1371/journal.pone.0208483. eCollection 2018.
Exposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors.
A referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d = 0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city.
This trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors.
ClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).
暴露于暴力会对心理健康产生负面影响。哥伦比亚的武装冲突广泛影响了太平洋地区的非裔哥伦比亚人。在低收入环境中，特别是在活跃冲突地区，缺乏关于心理健康干预措施有效性的证据。本研究的目的是评估个体化的常见要素治疗方法（CETA），这是一种基于认知行为疗法的跨诊断心理治疗模式，用于治疗成年创伤幸存者。
从哥伦比亚布埃纳文图拉和基布多招募了一个有创伤经历且相关功能受损的、经历过重大悲伤、痛苦或恐惧（总心理健康症状得分>0.77）的 521 名非裔成年被试，他们被随机分配到 CETA 干预组、无干预的候补组（但每月监测）或叙事社区为基础的团体治疗组。CETA 由经过培训的、没有心理健康经验的基层心理社会社区工作者提供，由心理学家监督，每周进行 12-14 次、每次 1.5 小时的治疗。使用当地验证的调查问卷评估症状，该问卷基于 Hopkins 症状清单、哈佛创伤问卷、创伤后应激障碍检查表-平民版、一项用于评估其他一般症状的定性研究以及性别特异性功能障碍量表构建。将 CETA 与对照组进行比较，并使用意向治疗分析的混合模型计算干预效果。参与者的随访完成率为 75.1%，13.2%的参与者自愿退出。在布埃纳文图拉和基布多两个城市，与对照组相比，创伤后应激症状均显著减少（平均差异），布埃纳文图拉的效果中等（Cohen's d = 0.70），基布多的效果较小（d = 0.31）。在布埃纳文图拉，干预对抑郁（大效应量 d = 1.03）、焦虑（大效应量 d = 0.80）和功能障碍（中效应量 d = 0.70）也有显著影响。在基布多，它对这些结果没有显著影响。在这两个城市，总心理健康症状的变化都不显著。
本试验表明，在低收入和活跃冲突环境中，CETA 可有效改善有组织暴力受害者的抑郁、焦虑、创伤后应激和功能。然而，干预两个城市之间的有效性差异可能表明，我们不能假设在一个已知有效的环境中有效的心理健康干预措施在另一个环境中也会有效，即使在类似的情况下和人群中也是如此。当在非受控环境中实施和复制这些类型的干预措施时，这可能具有特殊意义。应进一步研究这些问题。研究结果可供政府决策者在为幸存者制定心理健康计划时参考。
ClinicalTrials.gov NCT01856673（https://clinicaltrials.gov/ct2/show/NCT01856673）。
