A controlled trial of problem-solving counseling for war-affected adults in Aceh, Indonesia.
OBJECTIVE
War and conflict have consequences on the mental health of individuals and entire communities and the communities in Aceh, Indonesia, having experienced more than 30 years of armed conflict, are no exception. This study presents results from an evaluation of a non-specific mental health group counseling program among adults affected by conflict. Interventions such as these need to be evaluated to further the limited empirical evidence base for efficacious community-based treatments for improving the mental health and psychosocial problems in humanitarian settings.


METHODS
A total of 589 adults were screened using a locally validated measure of mental health and functioning. Of all, 420 (71%) met the study inclusion criteria of elevated symptom levels and functional impairment: 214 and 206 in three intervention and three control villages, respectively. Intervention participants met weekly for eight sessions in groups of eight to ten adults. Following completion of treatment, 175 (85%) controls and 158 (74%) intervention participants were re-assessed. Regression analyses compared pre- and post-intervention scale scores.


RESULTS
We did not find an intervention effect for reducing the burden of depression and anxiety symptoms when compared with the control sample. Impact on functioning was mixed and there was an increase in use of positive coping strategies.


CONCLUSIONS
The lack of mental health impact may be because the mental health problems and dysfunction were not due to disorder, but were normal responses to struggles of daily living experienced by this community and not addressed by the intervention.
Department of Mental Health and Applied Mental Health Research Group, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 861, Baltimore, MD 21205, USA. jbass@jhsph.edu
Judith
J
Bass
Bhava
B
Poudyal
Wietse
W
Tol
Laura
L
Murray
Maya
M
Nadison
Paul
P
Bolton
D000223:Adaptation, Psychological / Q000145:classification; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales / Q000592:standards; D011615:Psychotherapy, Group / Q000379:methods*; D012044:Regression Analysis; D015203:Reproducibility of Results; D017741:Survivors / Q000523:psychology*; D014104:Torture / Q000523:psychology; D016896:Treatment Outcome; D014857:Warfare
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