Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants

Marianna Purgato^{1

2}, Federico Tedeschi¹, Theresa S Betancourt³, Paul Bolton⁴, Chiara Bonetto¹, Chiara Gastaldon^{1

2}, James Gordon⁵, Paul O'Callaghan⁶, Davide Papola¹, Kirsi Peltonen⁷, Raija-Leena Punamaki⁷, Justin Richards^{8

9}, Julie K Staples⁵, Johanna Unterhitzenberger¹⁰, Joop de Jong¹¹, Mark J D Jordans^{12

11}, Alden L Gross¹³, Wietse A Tol^{14

15}, Corrado Barbui^{1

2}

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.
² Cochrane Global Mental Health, University of Verona, Verona, Italy.
³ Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA.
⁴ Center for Humanitarian Health, Department of International Health and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ The Center for Mind-Body Medicine, Washington, D.C, USA.
⁶ School of Psychology, Queen's University Belfast, Belfast, UK.
⁷ Department of Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland.
⁸ School of Public Health & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
⁹ Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
¹⁰ Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Bavaria, Germany.
¹¹ Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
¹² Center for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁴ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁵ HealthRight International, New York, NY, USA.

PMID: 31701533
DOI: 10.1111/jcpp.13151

Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants

Marianna Purgato et al. J Child Psychol Psychiatry. 2020 May.

. 2020 May;61(5):584-593.

doi: 10.1111/jcpp.13151. Epub 2019 Nov 7.

Authors

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.
² Cochrane Global Mental Health, University of Verona, Verona, Italy.
³ Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA.
⁴ Center for Humanitarian Health, Department of International Health and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ The Center for Mind-Body Medicine, Washington, D.C, USA.
⁶ School of Psychology, Queen's University Belfast, Belfast, UK.
⁷ Department of Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland.
⁸ School of Public Health & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
⁹ Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
¹⁰ Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Bavaria, Germany.
¹¹ Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
¹² Center for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁴ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁵ HealthRight International, New York, NY, USA.

PMID: 31701533
DOI: 10.1111/jcpp.13151

Abstract

Background: Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways.

Methods: We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review.

Results: We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%.

Conclusions: Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency.

Keywords: Mediation analysis; children; humanitarian setting; individual participant data; trauma.

PubMed Disclaimer

References

1. Baron, R.M., & Kenny, D.A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.
1. Betancourt, T.S., & Khan, K.T. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20, 317-328.
1. Betancourt, T.S., McBain, R., Newnham, E.A., Akinsulure-Smith, A.M., Brennan, R.T., Weisz, J.R., & Hansen, N.B. (2014). A behavioral intervention for war-affected youth in Sierra Leone: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 1288-1297.
1. Betancourt, T.S., Meyers-Ohki, S.E., Charrow, A.P., & Tol, W.A. (2013). Interventions for children affected by war: An ecological perspective on psychosocial support and mental health care. Harvard Review of Psychiatry, 21, 70-91.
1. Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K.F., … & Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: A randomized controlled trial. Journal of the American Medical Association, 298, 519-527.

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

626466/MCCC_/Marie Curie/United Kingdom

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants

Affiliations

Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources