***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The North-Eastern part of Sri Lanka had already been affected by civil war when the 2004 Tsunami wave hit the region , leading to high rates of posttraumatic stress disorder ( PTSD ) in children . In the acute aftermath of the Tsunami we tested the efficacy of two pragmatic short-term interventions when applied by trained local counselors . Methods A r and omized treatment comparison was implemented in a refugee camp in a severely affected community . 31 children who presented with a preliminary diagnosis of PTSD were r and omly assigned either to six sessions Narrative Exposure Therapy for children ( KIDNET ) or six sessions of meditation-relaxation ( MED-RELAX ) . Outcome measures included severity of PTSD symptoms , level of functioning and physical health . Results In both treatment conditions , PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time . At 6 months follow-up , recovery rates were 81 % for the children in the KIDNET group and 71 % for those in the MED-RELAX group . There was no significant difference between the two therapy groups in any outcome measure . Conclusion As recovery rates in the treatment groups exceeded the expected rates of natural recovery , the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters . Trial registration Clinical Trials.gov Identifier : BACKGROUND There are no psychosocial interventions to address both educational needs and psychological distress among displaced children in post-conflict setting s. AIMS To assess the psychosocial status of displaced children enrolled in the Rapid-Ed intervention ;  and to determine whether the Rapid-Ed intervention alleviated traumatic stress symptoms that interfere with learning among war-affected children in Sierra Leone . METHOD A r and omly selected sample of 315 children aged 8 - 18 years who were displaced by war were interviewed about their war experiences and reactions to the violence before and after participating in the 4-week Rapid-Ed intervention combining basic education with trauma healing activities . RESULTS High levels of intrusion , arousal and avoidance symptoms were reported at the pre-test interviews conducted 9 - 12 months after the war . Post-test findings showed statistically significant decreases in intrusion and arousal symptoms ( P<0.0001 ) , a slight increase in avoidance reactions ( P<0.0001 ) and greater optimism about the future . CONCLUSIONS The findings suggest potential for combining basic education with trauma healing activities for children in post-conflict setting s , but confirmatory studies using a control group are needed . Conducting research in post-conflict setting s presents unique challenges Cognitive theories point to reduction in dysfunctional posttraumatic cognitions ( PTCs ) as one mechanism involved in recovery from posttraumatic stress symptoms ( PTSS ) , yet research findings have shown individual differences in the recovery process . We tested the cognitive mediation hypothesis above in a previously published psychosocial group intervention among war-affected children . We also examined heterogeneity in children 's PTCs during the intervention . We used a cluster r and omized trial of Smith et al. 's ( 2002 ) teaching recovery techniques ( TRT ) intervention among 482 Palestinians 10 - 13 years of age ( n = 242 for intervention group , n = 240 for control group ) . Children reported PTSS , PTCs , and depressive symptoms at baseline , midpoint , postintervention , and at 6-month follow-up . Path analysis results showed that TRT was not effective in reducing dysfunctional PTCs , and the reductions did not mediate intervention effects on PTSS . Using latent class growth analysis , we chose the model with 3 differing trajectories in the intervention group : high , decreasing , moderate , downward trending , and severe , stable levels of PTCs . Higher PTSS and depressive symptoms at baseline were associated with membership in the severe , stable trajectory . The intervention did not produce the kind of beneficial cognitive change needed in the cognitive mediation conceptualization . Nevertheless , cognitive changes differed substantially across children during the intervention , and were associated with their preintervention mental health status . These findings call for more detailed examination of the process of cognitive mediation Effective evidence -based intervention for traumatic bereavement is one of the current major research issues in the field of Post Traumatic Stress Disorder ( PTSD ) in children and adolescents . The “ Writing for Recovery ” group intervention is a new treatment approach developed by the Children and War Foundation for traumatized and bereaved children and adolescents after disasters . The purpose of this project was an empirical examination of this intervention with 12- to 18-year-old war bereaved Afghani refugees . Eighty-eight war bereaved Afghani refugees were screened using the Traumatic Grief Inventory for Children ( TGIC ) . From those with the highest total score , 61 were r and omly assigned to either an experimental ( n = 29 ) or control group ( n = 32 ) . The experimental group received six sessions of group training on 3 consecutive days in their school . The difference of TGIC scores between the experimental group in pretest and posttest was significant ( p = 0.001 ) . Results of analysis of covariance also showed a significant effect of Writing for Recovery on the experimental group ( p < 0.001 ) . It is concluded that “ Writing for Recovery ” is an effective group intervention for bereaved children and adolescents after disasters Background : Preventative and treatment programs for people at risk of developing psychological problems after exposure to war trauma have mushroomed in the last decade . However , there is still much contention about evidence -based and culturally sensitive interventions for children . The aim of this study was to examine the efficacy of the Teaching Recovery Techniques in improving the emotional and behavioral outcomes of war-affected children resettled in Australia . Methods and Findings : A cluster r and omized controlled trial with pre-test , post-test , and 3-month follow-up design was employed . A total of 82 participants ( aged 10–17 years ) were r and omized by school into the 8-week intervention ( n = 45 ) or the waiting list ( WL ) control condition ( n = 37 ) . Study outcomes included symptoms of post-traumatic stress disorder , depression , internalizing and externalizing problems , as well as psychosocial functioning . A medium intervention effect was found for depression symptoms . Participants in the intervention condition experienced a greater symptom reduction than participants in the WL control condition , F(1 , 155 ) = 5.20 , p = 0.024 , partial η2 = 0.07 . This improvement was maintained at the 3-month follow-up , F(2 , 122 ) = 7.24 , p = 0.001 , partial η2 = 0.20 . Conclusions : These findings suggest the potential benefit of the school and group-based intervention on depression symptoms but not on other outcomes , when compared to a waiting list control group . Trial Registration : Australian New Zeal and Clinical Trials Registry ACTRN12611000 948998 CONTEXT Prior qualitative work with internally displaced persons in war-affected northern Ug and a showed significant mental health and psychosocial problems . OBJECTIVE To assess effect of locally feasible interventions on depression , anxiety , and conduct problem symptoms among adolescent survivors of war and displacement in northern Ug and a. DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial from May 2005 through December 2005 of 314 adolescents ( aged 14 - 17 years ) in 2 camps for internally displaced persons in northern Ug and a. INTERVENTIONS Locally developed screening tools assessed the effectiveness of interventions in reducing symptoms of depression and anxiety , ameliorating conduct problems , and improving function among those who met study criteria and were r and omly allocated ( 105 , psychotherapy-based intervention [ group interpersonal psychotherapy ] ; 105 , activity-based intervention [ creative play ] ; 104 , wait-control group [ individuals wait listed to receive treatment at study end ] ) . Intervention groups met weekly for 16 weeks . Participants and controls were reassessed at end of study . MAIN OUTCOME MEASURES Primary measure was a decrease in score ( denoting improvement ) on a depression symptom scale . Secondary measures were improvements in scores on anxiety , conduct problem symptoms , and function scales . Depression , anxiety , and conduct problems were assessed using the Acholi Psychosocial Assessment Instrument with a minimum score of 32 as the lower limit for clinical ly significant symptoms ( maximum scale score , 105 ) . RESULTS Difference in change in adjusted mean score for depression symptoms between group interpersonal psychotherapy and control groups was 9.79 points ( 95 % confidence interval [ CI ] , 1.66 - 17.93 ) . Girls receiving group interpersonal psychotherapy showed substantial and significant improvement in depression symptoms compared with controls ( 12.61 points ; 95 % CI , 2.09 - 23.14 ) . Improvement among boys was not statistically significant ( 5.72 points ; 95 % CI , -1.86 to 13.30 ) . Creative play showed no effect on depression severity ( -2.51 points ; 95 % CI , -11.42 to 6.39 ) . There were no statistically different improvements in anxiety in either intervention group . Neither intervention improved conduct problem or function scores . CONCLUSIONS Both interventions were locally feasible . Group interpersonal psychotherapy was effective for depression symptoms among adolescent girls affected by war and displacement . Other interventions should be investigated to assist adolescent boys in this population who have symptoms of depression . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00280319 PURPOSE As we build the evidence base of interventions for depression among war-affected youth , it is critical to underst and factors moderating treatment outcomes . The current study investigated how gender and history of abduction by Lord 's Resistance Army rebels moderated treatment outcomes for war-affected youth . METHODS The study -a three-armed , r and omized , controlled trial-was conducted with internally displaced war-affected adolescents in northern Ug and a. Participants with significant depression symptoms ( N = 304 ; 57 % female ; 14 - 17 years of age ) were r and omly assigned to an interpersonal psychotherapy group ( IPT-G ) , a creative play/recreation group , or a wait-list control condition . Secondary analyses were conducted on data from this r and omized controlled trial . RESULTS A history of abduction by Lord 's Resistance Army rebels was reported by 42 % of the sample . Gender and abduction history interacted to moderate the effectiveness of IPT-G  for the treatment of depression . In the IPT-G intervention arm , treatment effectiveness was greatest among female subjects without an abduction history , with effect size = 1.06 . IPT-G was effective for the treatment of depression for both male and female subjects with a history of abduction ( effect size = .92 and .50 , respectively ) . Male subjects with no abduction history in IPT-G showed no significant improvement compared with those in the control conditions . CONCLUSIONS Abduction history and gender are potentially important moderators of treatment effects , suggesting that these factors need to be considered when providing interventions for war-affected youth . IPT-G may be an effective intervention for female subjects without an abduction history , as well as for both male and female former child soldiers , but less so for male subjects without an abduction history CONTEXT Little is known about the efficacy of mental health interventions for children exposed to armed conflicts in low- and middle-income setting s. Childhood mental health problems are difficult to address in situations of ongoing poverty and political instability . OBJECTIVE To assess the efficacy of a school-based intervention design ed for conflict-exposed children , implemented in a low-income setting . DESIGN , SETTING , AND PARTICIPANTS A cluster r and omized trial involving 495 children ( 81.4 % inclusion rate ) who were a mean ( SD ) age of 9.9 ( 1.3 ) years , were attending r and omly selected schools in political violence-affected communities in Poso , Indonesia , and were screened for exposure ( > or = 1 events ) , posttraumatic stress disorder , and anxiety symptoms compared with a wait-listed control group . Nonblinded assessment took place before , 1 week after , and 6 months after treatment between March and December 2006 . INTERVENTION Fifteen sessions , over 5 weeks , of a manualized , school-based group intervention , including trauma-processing activities , cooperative play , and creative-expressive elements , implemented by locally trained paraprofessionals . MAIN OUTCOME MEASURES We assessed psychiatric symptoms using the Child Posttraumatic Stress Scale , Depression Self-Rating Scale , the Self-Report for Anxiety Related Disorders 5-item version , and the Children 's Hope Scale , and assessed function impairment as treatment outcomes using st and ardized symptom checklists and locally developed rating scales . RESULTS Correcting for clustering of participants within schools , we found significantly more improvement in posttraumatic stress disorder symptoms ( mean change difference , 2.78 ; 95 % confidence interval [ CI ] , 1.02 to 4.53 ) and maintained hope ( mean change difference , -2.21 ; 95 % CI , -3.52 to -0.91 ) in the treatment group than in the wait-listed group . Changes in traumatic idioms ( stress-related physical symptoms ) ( mean change difference , 0.50 ; 95 % CI , -0.12 to 1 
    Output:
    
The effect sizes lagged behind the effects observed in traumatized minors in general , and often were small or non-significant .