Jobson Laura, Malallah Hussain, Ahmadi Sayed Jafar, McAvoy Daniel, Earnest Arul, Vaughan Kelsey, Berzenji Latef S, Mohammad Shkofa, Berzengi Azi
Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.
National Institute for Human Rights, Kirkuk, Iraq.
J Glob Health. 2025 May 5;15:04111. doi: 10.7189/jogh.15.04111.
In this randomised clinical trial, we investigated the efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychiatric symptoms among adolescents in Iraq.
In the study, we included adolescents aged 10-19 years with heightened psychiatric distress living in Kirkuk. It was a parallel-group trial comparing METRA with treatment as usual (TAU), with a three-month follow-up. The study occurred between July 2023 and January 2024. Participants assigned to METRA received a 10-session group-intervention comprised of memory specificity training and writing for recovery. Assessments occurred at baseline, post-intervention, and three months after treatment. Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms post-intervention. Secondary outcomes were measures of anxiety and psychiatric difficulties. We also examined the costs and affordability of METRA in a humanitarian context. The sample size for primary analyses included 67 adolescents in the METRA group and 65 adolescents in TAU.
Following the intention-to-treat principle, linear mixed effects models found at post-intervention the METRA group had a 10.96-point decrease (95% confidence interval (CI) = -13.82, -8.09) in PTSD symptoms and a 3.27-point decrease (95% CI = -4.67, -1.87) in depression symptoms. Improvements were maintained at the three-month follow-up. While the time main effects were significant (P < 0.001), the group × time interactions were not significant (P = 0.61 for PTSD and P = 0.71 for depression); thus, there was no evidence that these improvements were superior to the symptom improvements observed in TAU.
In this study, we found that while METRA was not more effective than TAU, it was less costly, offering an option for replacing current practice. The findings highlight a need for further research in this area of global mental health.
Australian New Zealand Clinical Trials Registry (ACTRN12622001413718).
在这项随机临床试验中，我们调查了青少年记忆训练促进康复（METRA）对改善伊拉克青少年精神症状的疗效。
在该研究中，我们纳入了居住在基尔库克、精神痛苦加剧的10至19岁青少年。这是一项将METRA与常规治疗（TAU）进行比较的平行组试验，随访期为三个月。该研究于2023年7月至2024年1月进行。分配到METRA组的参与者接受了为期10节的小组干预，包括记忆特异性训练和康复写作。评估在基线、干预后和治疗后三个月进行。主要结局指标是干预后自我报告的创伤后应激障碍（PTSD）和抑郁症状。次要结局是焦虑和精神障碍的测量指标。我们还在人道主义背景下研究了METRA的成本和可承受性。主要分析的样本量包括METRA组的67名青少年和TAU组的65名青少年。
遵循意向性分析原则，线性混合效应模型发现，干预后METRA组的PTSD症状减少了10.96分（95%置信区间（CI）=-13.82，-8.09），抑郁症状减少了3.27分（95%CI=-4.67，-1.87）。在三个月的随访中，改善情况得以维持。虽然时间的主效应显著（P<0.001），但组×时间交互作用不显著（PTSD为P=0.61，抑郁为P=0.71）；因此，没有证据表明这些改善优于TAU组观察到的症状改善。
在本研究中，我们发现虽然METRA并不比TAU更有效，但成本更低，为替代当前做法提供了一种选择。研究结果凸显了在全球心理健康这一领域进行进一步研究的必要性。
澳大利亚新西兰临床试验注册中心（ACTRN12622001413718）
