title: Improving outcomes for caregivers through treatment of young people affected by war: a randomized controlled trial in Sierra Leone.
abstract: OBJECTIVE
  To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living in a war-affected area.
  
  
  METHODS
  Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention--a cognitive-behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems--in Freetown, Sierra Leone. Overall, 436 participants aged 15-24 years were randomized to receive the intervention (n = 222) or care as usual (n = 214). Household caregivers for the participants in the intervention arm (n = 101) or control arm (n = 103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later in a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional impairment. The caregivers' mental health--i.e. internalizing, externalizing and prosocial behaviour--was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects.
  
  
  RESULTS
  Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions in emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026-0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012-0.486) between the two surveys.
  
  
  CONCLUSIONS
  A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, 7th Floor, Boston, 02115, MA, United States of America (USA).
authors.forename: Ryan K
authors.initials: RK
authors.lastname: McBain
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, 7th Floor, Boston, 02115, MA, United States of America (USA).
authors.forename: Carmel
authors.initials: C
authors.lastname: Salhi
authors.affiliation: FXB Center for Health and Human Rights, Harvard University, Boston, USA .
authors.forename: Katrina
authors.initials: K
authors.lastname: Hann
authors.affiliation: CARITAS Freetown, Freetown, Sierra Leone .
authors.forename: Jim
authors.initials: J
authors.lastname: Kellie
authors.affiliation: CARITAS Freetown, Freetown, Sierra Leone .
authors.forename: Alimamy
authors.initials: A
authors.lastname: Kamara
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, 7th Floor, Boston, 02115, MA, United States of America (USA).
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, USA .
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, 7th Floor, Boston, 02115, MA, United States of America (USA).
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019955:Conduct Disorder / Q000628:therapy; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012807:Sierra Leone; D013315:Stress, Psychological / Q000523:psychology*; D016896:Treatment Outcome; D014857:Warfare; D055815:Young Adult