School of Psychology, University of New South Wales, Sydney, Australia.
Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, Australia.
PLoS Med. 2022 Aug 12;19(8):e1004046. doi: 10.1371/journal.pmed.1004046. eCollection 2022 Aug.
Millions of young adolescents in low- and middle-income countries (LMICs) affected by humanitarian crises experience elevated rates of poor mental health. There is a need for scalable programs that can improve the mental health of young adolescents. This study evaluated the effectiveness of a nonspecialist delivered group-based intervention (Early Adolescent Skills for Emotions (EASE)) to improve young adolescents' mental health.
In this single-blind, parallel, controlled trial, Syrian refugees aged 10 to 14 years in Jordan were identified through screening of psychological distress as defined by scores ≥15 on the Paediatric Symptom Scale. Participants were randomised to either EASE or enhanced usual care (EUC) involving referral to local psychosocial services (on a 1:1.6 ratio). Participants were aware of treatment allocation but assessors were blinded. Primary outcomes were scores on the Paediatric Symptom Checklist (PSC; internalising, externalising, and attentional difficulty scales) assessed at week 0, 9 weeks, and 3 months after treatment (primary outcome time point). It was hypothesised that EASE would result in greater reductions on internalising symptoms than EUC. Secondary outcomes were depression, posttraumatic stress, well-being, functioning, school belongingness, and caregivers' parenting and mental health. Between June 2019 and January 2020, 1,842 young adolescent refugees were screened for eligibility on the basis of psychological distress. There were 520 adolescents (28.2%) who screened positive, of whom 471 (90.6%) agreed to enter the trial. Overall, 185 were assigned to EASE and 286 to EUC, and 169 and 254 were retained at 3 months for EASE and EUC, respectively. Intent-to-treat analyses indicated that at 3 months, EASE resulted in greater reduction on the PSC-internalising scale than EUC (estimated mean difference 0.69, 95% CI 0.19 to 1.19; p = 0.007; effect size, 0.38) but there were no differences for PSC-externalising (estimated mean difference 0.24, 95% CI -0.43 to 0.91; p = 0.49; effect size, -0.10), PSC-attentional problem (estimated mean difference -0.01, 95% CI -0.51 to 0.54; p = 0.97; effect size, -0.01) scores, or on depression, posttraumatic stress, well-being, functioning, or school belongingness. Relative to EUC, caregivers in EASE had less psychological distress (estimated mean difference 1.95, 95% CI 0.71 to 3.19; p = 0.002) and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < 0.001). Secondary analyses that (a) focused on adolescents with probable internalising disorders; (b) completed the 3-month assessment; and (c) controlled for trauma exposure did not alter the primary results. Mediation analysis indicated that for caregivers in the EASE condition, reduction in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) and internalising (β = 0.11, SE 0.07; 95% CI 0.003, 0.274) problems in their children. No adverse events were attributable to the intervention. A limitation was that EUC was not matched to EASE in terms of facilitator attention or group involvement.
EASE led to reduced internalising problems in young refugee adolescents and was associated with reduced distress and less inconsistent disciplinary parenting in caregivers. This intervention has the potential as a scalable intervention to mitigate young adolescents' emotional difficulties in LMIC.
Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619000341123.
受人道主义危机影响，数以百万计的中低收入国家（LMIC）的青少年经历着心理健康水平下降的困扰。因此，我们需要可推广的项目来改善青少年的心理健康。本研究评估了一种非专业人士提供的团体干预措施（早期青少年情绪技能（EASE））改善青少年心理健康的效果。
在这项单盲、平行、对照试验中，在约旦的叙利亚难民青少年（年龄在 10 至 14 岁之间）通过得分≥15 的儿童症状量表（Paediatric Symptom Scale）筛查出心理困扰。参与者被随机分配到 EASE 或增强的常规护理（EUC）组，EUC 组包括将参与者转介到当地的心理社会服务机构（比例为 1:1.6）。参与者了解治疗分配情况，但评估人员对此不知情。主要结果是在治疗后 0 周、9 周和 3 个月时使用儿童症状清单（PSC；内部化、外化和注意力困难量表）评估的得分，这是主要的结果时间点。研究假设 EASE 会导致内部化症状的减少程度大于 EUC。次要结果是抑郁、创伤后应激、幸福感、功能、学校归属感以及照顾者的养育和心理健康。在 2019 年 6 月至 2020 年 1 月期间，根据心理困扰情况，对 1842 名青少年难民进行了筛查，以确定其是否符合条件。共有 520 名青少年（28.2%）筛查呈阳性，其中 471 名（90.6%）同意参加试验。总体而言，185 名参与者被分配到 EASE 组，286 名参与者被分配到 EUC 组，分别有 169 名和 254 名参与者在 3 个月时分别保留在 EASE 和 EUC 组。意向性治疗分析表明，在 3 个月时，EASE 组在 PSC 内部化量表上的减分大于 EUC 组（估计平均差异为 0.69，95%置信区间为 0.19 至 1.19；p=0.007；效应大小为 0.38），但在 PSC 外化量表（估计平均差异为 0.24，95%置信区间为 -0.43 至 0.91；p=0.49；效应大小为 -0.10）、PSC 注意力问题量表（估计平均差异为 -0.01，95%置信区间为 -0.51 至 0.54；p=0.97；效应大小为 -0.01）上的差异或在抑郁、创伤后应激、幸福感、功能或学校归属感上没有差异。与 EUC 组相比，EASE 组的照顾者心理困扰较少（估计平均差异为 1.95，95%置信区间为 0.71 至 3.19；p=0.002），不一致的纪律性育儿方式也较少（平均差异为 1.54，95%置信区间为 1.03 至 2.05；p<0.001）。二次分析结果如下：（a）关注有潜在内部化障碍的青少年；（b）完成了 3 个月的评估；（c）控制了创伤暴露情况。这些二次分析没有改变主要结果。中介分析表明，对于 EASE 组的照顾者，不一致的纪律性育儿方式的减少与他们孩子注意力（β=0.11，SE=0.07；95%置信区间为 0.003，0.274）和内部化（β=0.11，SE=0.07；95%置信区间为 0.003，0.274）问题的减少有关。没有观察到与干预相关的不良事件。但存在的局限性是，EUC 在关注程度或小组参与程度方面与 EASE 并不匹配。
EASE 导致难民青少年的内化问题减少，与照顾者的痛苦减轻和不那么一致的纪律性育儿方式有关。这种干预措施有可能成为一种可推广的干预措施，以减轻中低收入国家青少年的情绪困难。
澳大利亚和新西兰临床试验注册中心前瞻性注册：ACTRN12619000341123。
