A Randomized Controlled Trial of a Trauma-Informed Support, Skills, and Psychoeducation Intervention for Survivors of Torture and Related Trauma in Kurdistan, Northern Iraq.
Supportive counseling type interventions are frequently provided to meet the mental health needs of populations in emergency and post-conflicts contexts, but it has seldom been rigorously evaluated. Existing evaluations from low- and middle-income countries provide mixed evidence of effectiveness. While Iraqi Kurdistan experienced relative stability following the fall of Saddam Hussein's government, the population in the northern Dohuk region has continued to experience periodic violence due to conflicts with neighboring Turkey as well as more recent ISIS-associated violence. We evaluated the impact of a trauma-informed support, skills, and psychoeducation intervention provided by community mental health workers (CMHWs) on depressive symptoms and dysfunction (primary outcomes) as well as post-traumatic stress, traumatic grief, and anxiety symptoms (secondary outcomes). Between June 2009 and June 2010, 295 adults were screened; 209 (71%) met eligibility criteria (trauma exposure and a symptom severity score indicating significant distress and functional impairment, among others) and consented to participate. Of these, 159 were randomized to supportive counseling while 50 were randomized to a waitlist control condition. Comparing average symptom severity scores post-treatment among those in the intervention group with those in the waitlist control group, the supportive counseling program had statistically and clinically significant impacts on the primary outcomes of depression (Cohen's d, 0.57; P = .02) and dysfunction (Cohen's d, 0.53; P = .03) and significant but smaller impacts on anxiety. Although studies by the same research team of psychotherapeutic interventions in other parts of Kurdistan and in southern Iraq found larger effects, this study adds to the global research literature on mental health and psychosocial support and shows that a well-trained and supervised program of trauma-informed support, skills, and psychoeducation that emphasizes the therapeutic relationship can also be effective.
Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA jbass1@jhu.edu.
Judith
J
Bass
Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.
Sarah McIvor
SM
Murray
Heartland Alliance International, Chicago, IL, USA.
Thikra Ahmed
TA
Mohammed
Heartland Alliance International, Chicago, IL, USA University of Chicago, School of Social Service Administration, Chicago, IL, USA.
Mary
M
Bunn
Heartland Alliance International, Chicago, IL, USA.
William
W
Gorman
Trauma Rehabilitation and Training Center; Iraq-Kurdistan Region-Sulaimani and Department of Community Health, Sulaimani Polytechnic University, Technical College of Health, Qirga, Iraq.
Ahmed Mohammed Amin
AM
Ahmed
Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.
Laura
L
Murray
Johns Hopkins Bloomberg School of Public Health, Center for Refugee and Disaster Response and Department of International Health, Baltimore, MD, USA.
Paul
P
Bolton
D000328:Adult; D001007:Anxiety / Q000628:therapy*; D000068337:Armed Conflicts; D003150:Community Health Workers / Q000193:education; D003376:Counseling; D003863:Depression / Q000628:therapy*; D004630:Emergencies; D005006:Ethnicity; D005260:Female; D006801:Humans; D007318:Inservice Training; D007493:Iraq; D008297:Male; D008603:Mental Health / Q000193:education; D008875:Middle Aged; D015397:Program Evaluation; D000067073:Psychological Trauma / Q000628:therapy*; D011613:Psychotherapy; D012720:Severity of Illness Index; D012944:Social Support; D017741:Survivors; D023481:Terrorism; D014104:Torture / Q000523:psychology*