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A Mental Health Intervention for Schoolchildren Exposed to Violence
A Randomized Controlled Trial
Bradley D. Stein, MD, PhD;
Lisa H. Jaycox, PhD;
Sheryl H. Kataoka, MD, MSHS;
Marleen Wong, MSW;
Wenli Tu, MS;
Marc N. Elliott, PhD;
Arlene Fink, PhD
JAMA. 2003;290:603-611.
Context No randomized controlled studies have been conducted to date on the effectiveness of psychological interventions for children with symptoms of posttraumatic stress disorder (PTSD) that has resulted from personally witnessing or being personally exposed to violence.
Objective To evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children's symptoms of PTSD and depression that has resulted from exposure to violence.
Design A randomized controlled trial conducted during the 2001-2002 academic year.
Setting and Participants Sixth-grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had clinical levels of symptoms of PTSD.
Intervention Students were randomly assigned to a 10-session standardized cognitive-behavioral therapy (the Cognitive-Behavioral Intervention for Trauma in Schools) early intervention group (n = 61) or to a wait-list delayed intervention comparison group (n = 65) conducted by trained school mental health clinicians.
Main Outcome Measures Students were assessed before the intervention and 3 months after the intervention on measures assessing child-reported symptoms of PTSD (Child PTSD Symptom Scale; range, 0-51 points) and depression (Child Depression Inventory; range, 0-52 points), parent-reported psychosocial dysfunction (Pediatric Symptom Checklist; range, 0-70 points), and teacher-reported classroom problems using the Teacher-Child Rating Scale (acting out, shyness/anxiousness, and learning problems; range of subscales, 6-30 points).
Results Compared with the wait-list delayed intervention group (no intervention), after 3 months of intervention students who were randomly assigned to the early intervention group had significantly lower scores on symptoms of PTSD (8.9 vs 15.5, adjusted mean difference, - 7.0; 95% confidence interval [CI], - 10.8 to - 3.2), depression (9.4 vs 12.7, adjusted mean difference, - 3.4; 95% CI, - 6.5 to - 0.4), and psychosocial dysfunction (12.5 vs 16.5, adjusted mean difference, - 6.4; 95% CI, –10.4 to –2.3). Adjusted mean differences between the 2 groups at 3 months did not show significant differences for teacher-reported classroom problems in acting out (-1.0; 95% CI, –2.5 to 0.5), shyness/anxiousness (0.1; 95% CI, –1.5 to 1.7), and learning (-1.1, 95% CI, –2.9 to 0.8). At 6 months, after both groups had received the intervention, the differences between the 2 groups were not significantly different for symptoms of PTSD and depression; showed similar ratings for psychosocial function; and teachers did not report significant differences in classroom behaviors.
Conclusion A standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence and can be effectively delivered on school campuses by trained school-based mental health clinicians.
Author Affiliations: RAND, Santa Monica, Calif (Drs Stein and Elliott and Ms Tu); RAND, Arlington, VA (Dr Jaycox); Department of Psychiatry and Biobehavioral Sciences (Dr Kataoka), and Schools of Medicine and Public Health (Dr Fink), University of California, Los Angeles; and the Los Angeles Unified School District, Los Angeles (Ms Wong).
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