Original article
Moderators of Treatment Effectiveness for War-Affected Youth With Depression in Northern Uganda

https://doi.org/10.1016/j.jadohealth.2012.02.010Get rights and content

Abstract

Purpose

As we build the evidence base of interventions for depression among war-affected youth, it is critical to understand 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, randomized, controlled trial—was conducted with internally displaced war-affected adolescents in northern Uganda. Participants with significant depression symptoms (N = 304; 57% female; 14–17 years of age) were randomly 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 randomized 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.

Section snippets

Participants

The RCT was conducted in two IDP camps near the town of Gulu, northern Uganda. Study inclusion criteria consisted of ability to understand and speak Acholi Luo and having lived in either of the two camps for at least 1 month before the baseline screening interview. Eligible adolescents were aged 14–17 years, scored above a predetermined threshold of depression symptom severity based on the Acholi Psychosocial Assessment Instrument (APAI) Depression Problems Subscale [26], and reported some

Results

The IPT-G, CP, and wait-list control groups had similar mean age and gender distributions (Table 1). The trial arms did not differ significantly in baseline characteristics, including rates of LRA abduction; however, male subjects reported a significantly higher rate of abduction (n = 68, 52%) compared with female subjects (n = 59, 34%) (p < .01). There were no significant differences in baseline depression scores across groups. Further sociodemographic details are provided elsewhere [8].

Discussion

We found that the effect of IPT-G on depression symptoms was different among youth with a history of abduction compared with never abducted youth. Importantly, both male and female former child soldiers benefited from IPT-G. The intervention was most effective among war-affected adolescent girls without a history of abduction by rebel forces; however, in contrast to our hypotheses, those least likely to benefit from IPT-G were male subjects with no history of abduction. These findings are

Conclusions

These findings contribute to a growing, yet nascent, evidence base on mental health interventions for war-affected youth, including former child soldiers [39]. The present study indicates that the effectiveness of IPT-G for war-affected youth may vary according to the joint effects of abduction status and gender. These findings raise the possibility that the effectiveness of other treatments might also vary by similar factors, and that such treatment moderators should be explicitly investigated

Acknowledgments

The authors are grateful to the project staff, local leaders, and the communities for their warm welcome and professional engagement with the study. They thank Ista Zahn and Sidney Atwood for their assistance with data management and analysis. This study was supported by funding from World Vision, War Child Holland, grant 1K01MH077246-01A2 from the National Institute of Mental Health, grant P60 MD002261 from the National Center for Minority Health and Disparities, the American Australian

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