title: Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial.
abstract: BACKGROUND
  The psychological rehabilitation of former child soldiers and their successful reintegration into postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers.
  
  
  OBJECTIVE
  To assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals.
  
  
  METHODS
  Randomized controlled trial recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization. Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention.
  
  
  METHODS
  Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities.
  
  
  METHODS
  Change in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation, feelings of guilt, and perceived stigmatization.
  
  
  RESULTS
  PTSD symptom severity (range, 0-148) was significantly more improved in the narrative exposure therapy group than in the academic catch-up (mean change difference, -14.06 [95% confidence interval, -27.19 to -0.92]) and waiting-list (mean change difference, -13.04 [95% confidence interval, -26.79 to 0.72]) groups. Contrast analyses of the time × treatment interaction of the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F(1,234.1) = 5.21, P = .02) and wait-listing (F(1,228.3) = 5.28, P = .02). Narrative exposure therapy produced a larger within-treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81).
  
  
  CONCLUSIONS
  Among former Ugandan child soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing resulted in greater reduction of PTSD symptoms.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00552006.
authors.affiliation: Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, PO Box 100131, 33501 Bielefeld, Germany. verena.ertl@uni-bielefeld.de
authors.forename: Verena
authors.initials: V
authors.lastname: Ertl
authors.forename: Anett
authors.initials: A
authors.lastname: Pfeiffer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
authors.forename: Frank
authors.initials: F
authors.lastname: Neuner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003156:Community Mental Health Services; D003376:Counseling; D003863:Depression / Q000209:etiology / Q000628:therapy; D004493:Education; D006801:Humans; D007171:Implosive Therapy; D008889:Military Personnel / Q000523:psychology*; D012720:Severity of Illness Index; D012924:Social Conditions; D013240:Stereotyping; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D014454:Uganda; D014850:Waiting Lists; D014857:Warfare; D055815:Young Adult