Paul Bolton|Judith K. Bass|Goran Abdulla Sabir Zangana|Talar Kamal|Sarah M. Murray|Debra Kaysen|Carl W. Lejuez|Kristen P. Lindgren|Sherry L. Pagoto|Laura Murray|Stephanie Skavenski|Ahmed Mohammed Amin Ahmed|Nazar M. Mohammad Amin|Michael Rosenblum
A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq
Johns Hopkins University|Johns Hopkins University|Heartland Alliance|University of Sulaymaniyah|Johns Hopkins University|University of Washington|University of Maryland, College Park|University of Washington|University of Massachusetts Chan Medical School|Johns Hopkins University|Johns Hopkins University|Sulaimani Polytechnic University|University of Sulaymaniyah|Johns Hopkins University
experiencing systematic violence trauma increases risk poor mental health outcomes interventions types exposures evaluated low resource contexts objective randomized controlled trial assess effectiveness two psychotherapeutic interventions behavioral activation treatment depression batd cognitive processing therapy cpt reducing depression symptoms using locally adapted validated version hopkins symptom checklist dysfunction measured locally developed scale secondary outcomes included posttraumatic stress anxiety traumatic grief symptomstwenty community mental health workers working rural health clinics randomly assigned training one two interventions community mental health workers conducted baseline assessments enrolled survivors systematic violence based severity depression symptoms randomly assigned treatment waitlistcontrol blinded community mental health workers conducted postintervention assessments average five months lateradult survivors systematic violence screened n 732 281 enrolled trial 215 randomized intervention 114 batd 101 cpt 66 waitlistcontrol 33 batd 33 cpt nearly 70 n 149 intervention participants completed treatment postintervention assessments 53 80 waitlistcontrols completed postintervention assessments estimated effect sizes depression dysfunction 060 055 respectively comparing batd participants controls 084 079 respectively compared batd controls estimated effect sizes depression dysfunction 070 090 respectively comparing cpt participants controls 044 063 respectively compared cpt controls using permutationbased hypothesis test robust model assumptions implicit regression models batd significant effects depression p 003 dysfunction p 007 cpt significant effect dysfunction p 004both interventions showed moderate strong effects outcomes study demonstrates effectiveness interventions low resource environments mental health workers limited prior experienceclinicaltrialsgov nct00925262 registered june 3 2009