title: Lessons from writing sessions: a school-based randomized trial with adolescent orphans in Rwanda.
abstract: BACKGROUND
  Treatments for adolescents affected by long-term loss in low- and middle-income countries are lacking. As school-based interventions are cost-efficient and easy to disseminate, an evaluation of this treatment setting for adolescents is worthwhile.
  
  
  OBJECTIVE
  Examining the effect of a school-based unstructured emotional writing intervention (sensu Pennebaker, group 1) about the loss of a parent to reduce adaptation problems to loss, compared to writing about a hobby (group 2), and non-writing (group 3).
  
  
  METHODS
  We randomly assigned 14-18-year-old Rwandan orphans to one of the three conditions (n=23 per condition). Before and after the intervention, subjects completed the Prolonged Grief Questionnaire for Adolescents and the Mini International Neuropsychiatric Interview for Children and Adolescents, Part A, on depression as self-report measures of long-term effects of early parental loss.
  
  
  RESULTS
  Repeated measures analyses of variance showed no differential effect for any of the three conditions but revealed a significant effect of time at posttest regarding grief severity. Reduction of grief symptoms was significantly higher in subjects with elevated grief. Depressive symptoms showed no significant change from pre- to posttest in the emotional writing condition, whereas they significantly decreased in the control condition.
  
  
  CONCLUSIONS
  RESULTS imply that unstructured, brief emotional writing might not be indicated in adolescents affected by early parental loss who show severe and long-term distress; a more structured approach seems recommendable.
authors.affiliation: Clinical and Biological Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany; johanna.unterhitzenberger@ku.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Unterhitzenberger
authors.affiliation: Clinical and Biological Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany.
authors.forename: Rita
authors.initials: R
authors.lastname: Rosner
keywords: Bereavement; adolescents; disclosure; orphans; prolonged grief; school-based; writing