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Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled
Mark J D Jordans1, Ivan H Komproe, Wietse A Tol
1HealthNet TPO, Department of Research and Development, Amsterdam, The Netherlands. mjordans@healthnettpo.org
Insights
A school-based psychosocial intervention in Nepal showed moderate short-term benefits for children affected by conflict, improving social behaviors and resilience in specific subgroups. Psychiatric symptoms were not reduced.
Area of Science:
- Child and Adolescent Psychiatry
- Global Mental Health
- Trauma Psychology
Background:
- Childhood psychosocial and mental health issues are prevalent in ongoing violence situations.
- Intervention resources and evidence are limited for children in low- and middle-income countries.
- This study assessed a school-based psychosocial intervention in rural, conflict-affected Nepal.
Purpose of the Study:
- To evaluate the effectiveness of a school-based psychosocial intervention for children in a conflict-affected region.
- To assess changes in psychiatric symptoms, psychological difficulties, resilience, and functional impairment.
Main Methods:
- A cluster randomized controlled trial design was employed.
- Participants included 325 children (mean age 12.7 years) with elevated psychosocial distress.
- Outcomes measured included depression, anxiety, PTSD, psychological difficulties, hope, prosocial behavior, and function impairment.
Main Results:
- Initial analyses showed significant between-group differences with moderate effect sizes.
- After accounting for school-based clustering, no overall treatment effects were found for psychiatric symptoms.
- Subgroup analyses revealed gender-specific effects on prosocial behavior, psychological difficulties, and aggression, and age-specific effects on hope.
Conclusions:
- The intervention demonstrated moderate short-term benefits for social-behavioral and resilience indicators in specific subgroups of children exposed to armed conflict.
- Boys experienced reduced psychological difficulties and aggression; girls showed increased prosocial behavior; older children reported increased hope.
- The intervention did not lead to a reduction in psychiatric symptoms.
Background:
In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal.
Methods:
A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, posttraumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children (n = 325) (mean age = 12.7, SD = 1.04, range 11-14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group.
Results:
Comparisons of crude change scores showed significant between-group differences on several outcome indicators, with moderate effect sizes (Cohen d = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on prosocial behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (-2.19; 95% CI, -3.82 to -.56), and aggression (-4.42; 95% CI, -6.16 to -2.67). An age effect for treatment was found for hope (.90; 95% CI, -1.54 to -.26).
Conclusions:
A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased prosocial behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms.
