Mediators and moderators of a psychosocial intervention for children affected by political violence.
OBJECTIVE
The authors examined moderators and mediators of a school-based psychosocial intervention for children affected by political violence, according to an ecological resilience theoretical framework.


METHODS
The authors examined data from a cluster randomized trial, involving children aged 8-13 in Central Sulawesi, Indonesia (treatment condition n = 182, waitlist control condition n = 221). Mediators (hope, coping, peer/emotional/play social support) and moderators (gender, age, family connectedness, household size, other forms of social support, exposure to political violence, and displacement) of treatment outcome on posttraumatic stress symptoms and function impairment were examined in parallel process latent growth curve models.


RESULTS
Compared with the waitlist group, those receiving treatment showed maintained hope, increased positive coping, maintained peer social support, and increased play social support. Of these putative mediators, only play social support was found to mediate treatment effects, such that increases in play social support were associated with smaller reductions in posttraumatic stress disorder (PTSD) symptoms. Furthermore, the authors identified a number of moderators: Girls showed larger treatment benefits on PTSD symptoms; girls, children in smaller households, and children receiving social support from adults outside the household showed larger treatment benefits on function impairment.


CONCLUSIONS
Findings provide limited evidence for an ecological resilience theoretical framework. On the basis of these findings, the authors recommend a stronger separation between universal prevention (e.g., resilience promotion through play) and selective/indicated prevention (e.g., interventions aimed at decreasing posttraumatic stress symptoms). Play-based interventions should be careful to exclude children with psychological distress. In addition, treatment effects may be augmented by selecting girls and socially vulnerable children.
HealthNet TPO, Amsterdam, the Netherlands and Global Health Initiative, Yale University, USA. wietse.tol@yale.edu
Wietse A
WA
Tol
Ivan H
IH
Komproe
Mark J D
MJ
Jordans
Alden L
AL
Gross
Dessy
D
Susanty
Robert D
RD
Macy
Joop T V M
JT
de Jong
D000223:Adaptation, Psychological; D000293:Adolescent; D000367:Age Factors; D002648:Child; D005190:Family; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D011057:Politics; D011613:Psychotherapy; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014754:Violence / Q000523:psychology*