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July 31, 2007

Displaced Adolescent Girls Benefit from Group Therapy

Depression Symptoms Decreased for Both Sexes; Same Treatment Not As Effective for Boys

Group interpersonal psychotherapy is effective in reducing depressive symptoms among adolescent girls affected by war and displacement, according to researchers at the Johns Hopkins Bloomberg School of Public Health and other institutions. However, the same treatment was not as effective in boys. The researchers also report no statistical improvement in decreasing conduct problems in either sex. The study is published in the August 1, 2007, issue of the Journal of the American Medical Association (JAMA), a theme issue on violence and human rights.

“Rigorous evaluations of intervention programs provided by local and international organizations can and should be done to best utilize resources and identify what actually succeeds in helping the neediest populations,” said Judith K. Bass, PhD, MPH, co-author of the study and an assistant professor in the Bloomberg School of Public Health’s Department of Mental Health. “Our study shows that scientific rigor can be maintained even in very low-resource contexts. For example, one nongovernmental organization [NGO] we studied is already adapting their creative play intervention program.”

From May to December 2005, the study authors conducted a randomized, controlled trial of 314 adolescents (aged 14 to 17 years) in camps for displaced persons in northern Uganda. The study participants were divided among three groups—group interpersonal psychotherapy intervention, creative play intervention or a wait-control group that received treatment at the end of the study. Both intervention groups met weekly for 16 weeks. The researchers assessed the effectiveness of local NGO interventions to reduce depression symptoms using a locally validated psychosocial assessment questionnaire to rate the severity of depression.

The researchers report that interpersonal psychotherapy interventions reduced depression symptoms. Creative play was not statistically significant in its impact on the adolescents. Recovery was defined as a reduction of 50 percent or more of an individual’s baseline depression symptom severity score; remission was defined as being at or less than a predetermined cutoff score. Among the interpersonal psychotherapy intervention group, 42 percent of the girls and 31 percent of the boys recovered; 33.9 percent of girls and 22.7 percent of boys met remission criteria.

The failure of both intervention groups to significantly assist boys raises the question of whether other interventions are needed, according to Paul A. Bolton, MBBS, lead author of the study and an associate in the Bloomberg School’s Department of International Health. In addition, the authors report that further research is necessary to examine the specific impact of psychotherapy on both boys and girls.

The study authors note that the creative play intervention was not effective in addressing the specific problems of depression and anxiety. “It’s important, when considering future practices and research, to highlight strategies that don’t work, as well as those that do—especially when the creative play program is very similar to what many NGOs currently provide in the field,” said Bass.

Paul A. Bolton and Judith K. Bass, both of the Johns Hopkins Bloomberg School of Public Health, co-authored the study. Additional co-authors are Theresa Betancourt, Liesbeth Speelman, Grace Onyango, Kathleen F. Clougherty, Richard Neugebauer, Laura Murray and Helen Verdeli.

“Interventions for Depression Symptoms Among Adolescent Survivors of War and Displacement in Northern Uganda: A Randomized Controlled Trial” was supported solely by grants from World Vision and War Child Holland. Dr. Neugebauer was supported by grants from the Ruth and David Levine Foundation.

Public Affairs media contact for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons at 410-955-6878 or paffairs@jhsph.edu.