Group Psychotherapy Effective For Treating Depression Of Teen Girls Affected By War In Africa

"Over 1.8 million individuals, mainly ethnic Acholi, have been internally displaced during 20 years of conflict between the government of Uganda and the Lord's Resistance Army. The Lord's Resistance Army has been accused of human rights abuses including mass violence, rape, and the abduction of more than 25,000 children.

Local populations have crowded into internally displaced persons camps where they face threats to their health and well being," the authors write. Prior research on children affected by armed conflicts documents increased risk of mental health problems, yet few interventions have been evaluated rigorously in randomized trials or have generated mixed results.

Paul Bolton, M.B.B.S., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues investigated whether a therapy-based intervention (interpersonal psychotherapy for groups, [IPT-G]) and an activity-based intervention (creative play, [CP]) were effective for relieving mental health and psychosocial problems resulting from war and displacement among 314 adolescents (age 14-17 years), living in two camps in northern Uganda. The randomized controlled trial was conducted from May 2005 through December 2005.

Both interventions comprised 16 weekly group meetings, lasting 1.5 to 2 hours each. Locally developed screening tools assessed the effectiveness of the interventions in reducing symptoms of depression and anxiety, improving conduct problems and functioning among those who met study criteria and were randomly allocated to one of three study groups: 105, interpersonal psychotherapy for groups; 105, creative play; and 104, wait-control group (individuals wait listed to receive treatment at study end).

The researchers found that interpersonal psychotherapy was superior to the wait-list control condition in reducing depression symptoms, but statistically significant improvement was limited to the girl participants in the study. Creative play was not superior to the wait-list control condition. Neither interpersonal psychotherapy for groups nor creative play was effective in improving anxiety, conduct problems or functioning among boys or girls.

The failure of both interpersonal psychotherapy for groups and creative play "to significantly assist boys in this study raises the question of whether other interventions may be needed to assist war-affected boys with depression symptoms. Since both group psychotherapy and activity-based interventions were not effective, some form of individual psychotherapy or an entirely different type of intervention may be indicated as the basis for a future trial," the researchers write.

This study suggests that group-based psychological interventions can help adolescents who have been traumatized by war and displacement and who live in poor, rural, and illiterate communities.

Reference: JAMA. 2007;298(5):519-527

Editorial: Children of War and Opportunities for Peace

In an accompanying editorial, Robert J. Ursano, M.D., of Uniformed Services University, Bethesda, Md., and Jon A. Shaw, M.D., of the University of Miami, comment on the issue of children and war.

"No one endures war-related traumatic events unchanged. Little is known about the changes in values and hopes and views of the future that exposure to such trauma engenders. Children who are still learning to regulate mood and aggression are certainly even more vulnerable to these life-changing forces. The researchers reporting the results of their studies in this issue bring much-needed attention to the violence of war and the resulting mental health problems. Deeper appreciation of the effects of exposure to war-related trauma as well as improved understanding of individuals' attitudes toward reconciliation and the means to achieve peace may contribute to development of interventions to address the barriers to recovery not only from disease and illness but from lost futures and visions of life."

Reference for editorial JAMA. 2007;298(5):567-568.