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Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial

BACKGROUND: Systematic violence is a long-standing problem in Iraq. Research indicates that survivors often experience multiple mental health problems, and that there is a need for more rigorous research that targets symptoms beyond post-traumatic stress (PTS). Our objective was to test the effectiv...

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Autores principales: Weiss, William M., Murray, Laura K., Zangana, Goran Abdulla Sabir, Mahmooth, Zayan, Kaysen, Debra, Dorsey, Shannon, Lindgren, Kristen, Gross, Alden, Murray, Sarah McIvor, Bass, Judith K., Bolton, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605204/
https://www.ncbi.nlm.nih.gov/pubmed/26467303
http://dx.doi.org/10.1186/s12888-015-0622-7
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author Weiss, William M.
Murray, Laura K.
Zangana, Goran Abdulla Sabir
Mahmooth, Zayan
Kaysen, Debra
Dorsey, Shannon
Lindgren, Kristen
Gross, Alden
Murray, Sarah McIvor
Bass, Judith K.
Bolton, Paul
author_facet Weiss, William M.
Murray, Laura K.
Zangana, Goran Abdulla Sabir
Mahmooth, Zayan
Kaysen, Debra
Dorsey, Shannon
Lindgren, Kristen
Gross, Alden
Murray, Sarah McIvor
Bass, Judith K.
Bolton, Paul
author_sort Weiss, William M.
collection PubMed
description BACKGROUND: Systematic violence is a long-standing problem in Iraq. Research indicates that survivors often experience multiple mental health problems, and that there is a need for more rigorous research that targets symptoms beyond post-traumatic stress (PTS). Our objective was to test the effectiveness of two counseling therapies in Southern Iraq in addressing multiple mental health problems among survivors of systematic violence: (1) a transdiagnostic intervention (Common Elements Treatment Approach or CETA); and (2) cognitive processing therapy (CPT). The therapies were provided by non-specialized health workers since few MH professionals are available to provide therapy in Iraq. METHODS: This was a randomized, parallel, two site, two-arm (1:1 allocation), single-blinded, wait-list controlled (WLC) trial of CETA in one site (99 CETA, 50 WLC), and CPT in a second site (129 CPT, 64 WLC). Eligibility criteria were elevated trauma symptoms and experience of systematic violence. The primary and secondary outcomes were trauma symptoms and dysfunction, respectively, with additional assessment of depression and anxiety symptoms. Non-specialized health workers (community mental health worker, CMHW) provided the interventions in government-run primary health centers. Treatment effects were determined using longitudinal, multilevel models with CMHW and client as random effects, and a time by group interaction with robust variance estimation, to test for the net difference in mean score for each outcome between the baseline and follow up interview. Multiple imputation techniques were used to account for missingness at the item level and the participant level. All analyses were conducted using Stata 12. RESULTS: The CETA intervention showed large effect sizes for all outcomes. The CPT intervention showed moderate effects sizes for trauma and depression, with small to no effect for anxiety or dysfunction, respectively. CONCLUSIONS: Both CETA and CPT appear to benefit survivors of systematic violence in Southern Iraq by reducing multiple mental health symptoms, with CETA providing a very large benefit across a range of symptoms. Non-specialized health workers were able to treat comorbid symptoms of trauma, depression and anxiety, and dysfunction among survivors of systematic violence who have limited access to mental health professionals. The trial further supports the use of evidence-based therapies in lower-resource settings. TRIAL REGISTRATION AND PROTOCOL: This trial was registered at ClinicalTrials.gov on 16 July 2010 with an identifier of NCT01177072 as the Study of Effectiveness of Mental Health Interventions among Torture Survivors in Southern Iraq. The study protocol can be downloaded from the following website: http://tinyurl.com/CETA-Iraq-Protocol. In the protocol, the CETA intervention is given a different name: components-based intervention or CBI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-015-0622-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-46052042015-10-15 Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial Weiss, William M. Murray, Laura K. Zangana, Goran Abdulla Sabir Mahmooth, Zayan Kaysen, Debra Dorsey, Shannon Lindgren, Kristen Gross, Alden Murray, Sarah McIvor Bass, Judith K. Bolton, Paul BMC Psychiatry Research Article BACKGROUND: Systematic violence is a long-standing problem in Iraq. Research indicates that survivors often experience multiple mental health problems, and that there is a need for more rigorous research that targets symptoms beyond post-traumatic stress (PTS). Our objective was to test the effectiveness of two counseling therapies in Southern Iraq in addressing multiple mental health problems among survivors of systematic violence: (1) a transdiagnostic intervention (Common Elements Treatment Approach or CETA); and (2) cognitive processing therapy (CPT). The therapies were provided by non-specialized health workers since few MH professionals are available to provide therapy in Iraq. METHODS: This was a randomized, parallel, two site, two-arm (1:1 allocation), single-blinded, wait-list controlled (WLC) trial of CETA in one site (99 CETA, 50 WLC), and CPT in a second site (129 CPT, 64 WLC). Eligibility criteria were elevated trauma symptoms and experience of systematic violence. The primary and secondary outcomes were trauma symptoms and dysfunction, respectively, with additional assessment of depression and anxiety symptoms. Non-specialized health workers (community mental health worker, CMHW) provided the interventions in government-run primary health centers. Treatment effects were determined using longitudinal, multilevel models with CMHW and client as random effects, and a time by group interaction with robust variance estimation, to test for the net difference in mean score for each outcome between the baseline and follow up interview. Multiple imputation techniques were used to account for missingness at the item level and the participant level. All analyses were conducted using Stata 12. RESULTS: The CETA intervention showed large effect sizes for all outcomes. The CPT intervention showed moderate effects sizes for trauma and depression, with small to no effect for anxiety or dysfunction, respectively. CONCLUSIONS: Both CETA and CPT appear to benefit survivors of systematic violence in Southern Iraq by reducing multiple mental health symptoms, with CETA providing a very large benefit across a range of symptoms. Non-specialized health workers were able to treat comorbid symptoms of trauma, depression and anxiety, and dysfunction among survivors of systematic violence who have limited access to mental health professionals. The trial further supports the use of evidence-based therapies in lower-resource settings. TRIAL REGISTRATION AND PROTOCOL: This trial was registered at ClinicalTrials.gov on 16 July 2010 with an identifier of NCT01177072 as the Study of Effectiveness of Mental Health Interventions among Torture Survivors in Southern Iraq. The study protocol can be downloaded from the following website: http://tinyurl.com/CETA-Iraq-Protocol. In the protocol, the CETA intervention is given a different name: components-based intervention or CBI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-015-0622-7) contains supplementary material, which is available to authorized users. BioMed Central 2015-10-14 /pmc/articles/PMC4605204/ /pubmed/26467303 http://dx.doi.org/10.1186/s12888-015-0622-7 Text en © Weiss et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Weiss, William M.
Murray, Laura K.
Zangana, Goran Abdulla Sabir
Mahmooth, Zayan
Kaysen, Debra
Dorsey, Shannon
Lindgren, Kristen
Gross, Alden
Murray, Sarah McIvor
Bass, Judith K.
Bolton, Paul
Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
title Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
title_full Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
title_fullStr Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
title_full_unstemmed Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
title_short Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial
title_sort community-based mental health treatments for survivors of torture and militant attacks in southern iraq: a randomized control trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605204/
https://www.ncbi.nlm.nih.gov/pubmed/26467303
http://dx.doi.org/10.1186/s12888-015-0622-7
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