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A Randomized Controlled Trial

Paul Bolton, MBBS; Judith Bass, PhD; Theresa Betancourt, ScD; Liesbeth Speelman, MA; Grace Onyango, MA; Kathleen F. Clougherty, MSW; Richard Neugebauer, PhD; Laura Murray, PhD; Helen Verdeli, PhD

JAMA. 2007;298:519-527.

Context  Prior qualitative work with internally displaced persons in war-affected northern Uganda 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 Uganda.

Design, Setting, and Participants  A randomized controlled trial from May 2005 through December 2005 of 314 adolescents (aged 14-17 years) in 2 camps for internally displaced persons in northern Uganda.

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 randomly 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 clinically 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  clinicaltrials.gov Identifier: NCT00280319

Author Affiliations: Applied Mental Health Research Group, Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts (Drs Bolton, Bass, and Murray); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Bass); Department of Population and International Health, Franois-Xavier Bagnoud Center for Health and Human Rights, Harvard University School of Public Health, Boston, Massachusetts (Dr Betancourt); War Child Holland, Gulu, Uganda, (Ms Speelman); World Vision Uganda, Kampla, Uganda (Ms Onyango); New York State Psychiatric Institute, Columbia University, New York, New York (Ms Clougherty and Dr Verdeli); Division of Epidemiology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, and Gertrude H. Sergievsky Center, Faculty of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York (Dr Neugebauer); Teachers College, Columbia University (Dr Verdeli); Dr Bolton is now with the Center for Refugee and Disaster Response, and Dr Bass is now with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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