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Randomized Controlled Trial
. 2023 Mar 1;6(3):e236086.
doi: 10.1001/jamanetworkopen.2023.6086.

Effect of the Memory Training for Recovery-Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan: A Randomized Clinical Trial

Sayed Jafar Ahmadi  1 , Laura Jobson  2 , Zeinab Musavi  3 , Sayed Rohullah Rezwani  3 , Farshad Ahmad Amini  3 , Arul Earnest  4 , Nasratullah Samim  3 , Sayed Ali Akbar Sarwary  3 , Sayed Abbas Sarwary  3 , Daniel McAvoy  5
Affiliations
Randomized Controlled Trial

Effect of the Memory Training for Recovery-Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan: A Randomized Clinical Trial

Sayed Jafar Ahmadi et al. JAMA Netw Open. .

Abstract

Importance: Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions.

Objective: To investigate the efficacy of Memory Training for Recovery-Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan.

Design, setting, and participants: This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used.

Interventions: Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks.

Main outcomes and measures: Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment.

Results: The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, -20.38 to -14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, -8.50 to -4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, -6.05 to -0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, -0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P < .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants).

Conclusions and relevance: In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts.

Trial registration: anzctr.org.au Identifier: ACTRN12621001160820.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jobson reported receiving grants from Elrha during the conduct of the study and outside the submitted work. Dr McAvoy reported receiving grants from Elrha during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Participant Recruitment and Assessment
METRA indicates Memory Training for Recovery–Adolescent; TAU, treatment as usual.
Figure 2.
Figure 2.. Marginal Means for Posttraumatic Stress Disorder (PTSD) Symptoms by Treatment Group and Follow-up Period
Whiskers represent 95% CIs. METRA indicates Memory Training for Recovery–Adolescent; TAU, treatment as usual.
Figure 3.
Figure 3.. Marginal Means for Depression Symptoms by Treatment Group and Follow-up Period
Whiskers represent 95% CIs. METRA indicates Memory Training for Recovery–Adolescent; TAU, treatment as usual.
See this image and copyright information in PMC

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