A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq

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dc.contributor.authorBolton, Paul
dc.contributor.authorK Bass, Judith
dc.contributor.authorZangana, Goran Abdulla Sabir
dc.contributor.authorKamal, Talar
dc.contributor.authorMcIvor Murray, Sarah
dc.contributor.authorKaysen, Debra
dc.contributor.authorLejuez, Carl W
dc.contributor.authorLindgren, Kristen
dc.contributor.authorPagoto, Sherry
dc.contributor.authorMurray, Laura K
dc.contributor.authorVan Wyk, Stephanie Skavenski
dc.contributor.authorAhmed, Ahmed Mohammed Amin
dc.contributor.authorAmin, Nazar M Mohammad
dc.contributor.authorRosenblum, Michael
dc.date.accessioned2021-08-30T17:00:10Z
dc.date.available2021-08-30T17:00:10Z
dc.date.issued2014-12-31
dc.description.abstractExperiencing systematic violence and trauma increases the risk of poor mental health outcomes; few interventions for these types of exposures have been evaluated in low resource contexts. The objective of this randomized controlled trial was to assess the effectiveness of two psychotherapeutic interventions, Behavioral Activation Treatment for Depression (BATD) and Cognitive Processing Therapy (CPT), in reducing depression symptoms using a locally adapted and validated version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale. Secondary outcomes included posttraumatic stress, anxiety, and traumatic grief symptoms. Twenty community mental health workers, working in rural health clinics, were randomly assigned to training in one of the two interventions. The community mental health workers conducted baseline assessments, enrolled survivors of systematic violence based on severity of depression symptoms, and randomly assigned them to treatment or waitlist-control. Blinded community mental health workers conducted post-intervention assessments on average five months later. Adult survivors of systematic violence were screened (N = 732) with 281 enrolled in the trial; 215 randomized to an intervention (114 to BATD; 101 to CPT) and 66 to waitlist-control (33 to BATD; 33 to CPT). Nearly 70% (n = 149) of the intervention participants completed treatment and post-intervention assessments; 53 (80%) waitlist-controls completed post-intervention assessments. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively, comparing BATD participants to all controls and 0.84 and 0.79 respectively, compared to BATD controls only. Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only. Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models, BATD had significant effects on depression (p = .003) and dysfunction (p = .007), while CPT had a significant effect on dysfunction only (p = .004). Both interventions showed moderate to strong effects on most outcomes. This study demonstrates effectiveness of these interventions in low resource environments by mental health workers with limited prior experience.en_US
dc.description.urihttps://doi.org/10.1186/s12888-014-0360-2
dc.identifierhttps://doi.org/10.13016/zdjs-zzgp
dc.identifier.citationBolton, P., Bass, J.K., Zangana, G.A.S. et al. A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq. BMC Psychiatry 14, 360 (2014).en_US
dc.identifier.urihttp://hdl.handle.net/1903/27656
dc.language.isoen_USen_US
dc.publisherSpringer Natureen_US
dc.relation.isAvailableAtCollege of Behavioral & Social Sciencesen_us
dc.relation.isAvailableAtPsychologyen_us
dc.relation.isAvailableAtDigital Repository at the University of Marylanden_us
dc.relation.isAvailableAtUniversity of Maryland (College Park, MD)en_us
dc.subjectTrauma treatmenten_US
dc.subjectIraqen_US
dc.subjectTask sharingen_US
dc.subjectEvidence-based treatmentsen_US
dc.titleA randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraqen_US
dc.typeArticleen_US

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