TY - JOUR

T1 - Improving mental health in low-resource settings

T2 - A feasibility randomized controlled trial of a transdiagnostic psychological intervention among Burundian refugee adolescents and their caregivers

AU - Fine, Shoshanna L.

AU - Malik, Aiysha

AU - Guimond, Marie-France

AU - Nemiro, Ashley

AU - Temu, Getruda

AU - Likindikoki, Samuel

AU - Annan, Jeannie

AU - Tol, Wietse A.

PY - 2021

Y1 - 2021

N2 - There is a paucity of evidence regarding interventions that can improve the mental health of adversity-affected young adolescents living in low-resource settings. We evaluated the feasibility, acceptability, relevance, and safety of the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention among Burundian refugee adolescents and their caregivers in Tanzania. This study consisted of a feasibility cluster randomized controlled trial (cRCT) and a process evaluation. The feasibility cRCT included 82 young adolescents and their 64 caregivers, with two clusters randomized to EASE and two to an enhanced control condition. EASE was delivered by adult refugees without prior training in mental health. The process evaluation consisted of 36 semi-structured qualitative interviews with key stakeholders, including adolescents, caregivers, and facilitators. EASE participants and facilitators gave positive feedback about its format, accessibility, and content. Trained non-specialist refugee facilitators were able to deliver EASE with high fidelity. The research protocol functioned well in terms of balanced randomization, limited loss to follow-up, and psychometrically promising measures, but discordance was observed between the short screener and psychological distress symptom checklist. This formative study suggests the potential of EASE in targeting psychological distress among displaced young adolescents and lays the groundwork for a future definitive trial.

AB - There is a paucity of evidence regarding interventions that can improve the mental health of adversity-affected young adolescents living in low-resource settings. We evaluated the feasibility, acceptability, relevance, and safety of the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention among Burundian refugee adolescents and their caregivers in Tanzania. This study consisted of a feasibility cluster randomized controlled trial (cRCT) and a process evaluation. The feasibility cRCT included 82 young adolescents and their 64 caregivers, with two clusters randomized to EASE and two to an enhanced control condition. EASE was delivered by adult refugees without prior training in mental health. The process evaluation consisted of 36 semi-structured qualitative interviews with key stakeholders, including adolescents, caregivers, and facilitators. EASE participants and facilitators gave positive feedback about its format, accessibility, and content. Trained non-specialist refugee facilitators were able to deliver EASE with high fidelity. The research protocol functioned well in terms of balanced randomization, limited loss to follow-up, and psychometrically promising measures, but discordance was observed between the short screener and psychological distress symptom checklist. This formative study suggests the potential of EASE in targeting psychological distress among displaced young adolescents and lays the groundwork for a future definitive trial.

KW - Psychological intervention

KW - Feasibility cluster randomized controlled trial

KW - Low-resource settings

KW - Humanitarian emergencies

KW - Refugees

KW - Adolescents

KW - MIDDLE-INCOME COUNTRIES

KW - CHILDHOOD TRAUMA QUESTIONNAIRE

KW - COGNITIVE-BEHAVIORAL THERAPY

KW - CULTURAL CONSTRUCT-VALIDITY

KW - GUIDED SELF-HELP

KW - PSYCHOSOCIAL INTERVENTION

KW - PSYCHOMETRIC PROPERTIES

KW - CHILDREN

KW - WAR

KW - DISTRESS

U2 - 10.1016/j.brat.2021.103944

DO - 10.1016/j.brat.2021.103944

M3 - Journal article

C2 - 34392115

VL - 145

JO - Behaviour Research and Therapy

JF - Behaviour Research and Therapy

SN - 0005-7967

M1 - 103944

ER -