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

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.

Prevalence of Poor Mental Health Among Adolescents in Kabul, Afghanistan, as of November 2021

This cross-sectional study assesses the mental health of adolescents in Afghanistan and evaluates their risk of having a psychiatric disorder by age and sex.

Investigating the Feasibility, Acceptability and Efficacy of Using Modified-Written Exposure Therapy in the Aftermath of a Terrorist Attack on Symptoms of Posttraumatic Stress Disorder Among Afghan Adolescent Girls

BACKGROUND

The aim of this study was to assess the efficacy, acceptability and feasibility of using modified written exposure therapy (m-WET) to treat symptoms of posttraumatic stress disorder (PTSD) in Afghan adolescent girls in the aftermath of a terrorist attack.

METHODS

120 Afghan (Hazara) adolescent girls who had been exposed to the Sayed al-Shuhada school terrorist attack were randomly assigned to the m-WET (n = 40), trauma-focused cognitive behavior therapy (TF-CBT) (n = 40), or control groups (n = 40). m-WET involved five consecutive daily group sessions where participants simply wrote about the terrorist attack including thoughts and feelings. TF-CBT was an intensive five-session group intervention. The control group had no additional contact. The trial was undertaken at a local non-government organization in Kabul. The primary analysis was comparing PTSD symptoms (Child Revised Impact of Event Scale-13) in the three groups at post-intervention and three-month follow-up.

RESULTS

Overall, participant and facilitator satisfaction with m-WET was high. Acceptability of m-WET was relatively high, with 15% drop-out in the m-WET group and all m-WET sessions were attended. While the groups did not differ significantly in PTSD symptoms at baseline, the m-WET group had significantly lower levels of PTSD symptoms compared to the control group at post-intervention and follow-up. There was no significant difference between the m-WET and TF-CBT groups.

CONCLUSION

The findings suggest m-WET may be promising intervention for the treatment of PTSD among adolescent girls in humanitarian settings. Further research in the area is warranted.