School-Based Mental Health Intervention for Children in War-Affected Burundi

Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of post-traumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim).

We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention.No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators.

• Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on post-traumatic stress disorder and depressive symptoms.
• The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes.

Conclusions: Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for post-traumatic stress disorder and depressive symptoms in conflict-affected children.

• The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables.
• Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings." (Abstract, p. 1).
• Authors also mentioned in their discussion that  "it appears that in settings that are more volatile (for example, Burundi, Sri Lanka), the resilience of children that live in particularly stressful conditions may actually be undermined by the intervention. In these settings, a preliminary intervention recommendation would be to have a clearer separation between intervention aims and to implement interventions in more homogenous groups, so that only the positive preventive effects may be achieved with children in more stable situations, and more intensive treatments may reach those who are more vulnerable. (p. 11).