Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study.

BACKGROUND: War-affected youth often suffer from multiple co-occurring mental health problems. These youth often live in low-resource settings where it may be infeasible to provide mental health services that simultaneously address all of these co-occurring mental health issues. It is therefore important to identify the areas where targeted interventions would do the most good. METHODS: This analysis uses observational data from 3 waves of a longitudinal study on mental health in a sample of 529 war-affected youth (24.2% female; ages 10-17 at T1, 2002) in Sierra Leone. We regressed 4 mental health outcomes at T3 (2008) on internalizing (depression/anxiety) and externalizing (hostility/aggression) problems and prosocial attitudes/behaviors and community variables at T2 (2004) controlling for demographics, war exposures, and previous mental health scores at T1, allowing us to assess the relative impact of potential mental health intervention targets in shaping mental health outcomes over time. RESULTS: Controlling for baseline covariates at T1 and all other exposures/potential intervention targets at T2, we observed a significant association between internalizing problems at T2 and 3 of the 4 outcomes at T3: internalizing (ß = 0.27, 95% confidence interval [CI]: 0.11-0.42), prosocial attitudes (ß = -0.20, 95% CI: -0.33 to -0.07) and posttraumatic stress symptoms (ß = 0.22, 95% CI: 0.02-0.43). No other potential intervention target had similar substantial effects. CONCLUSIONS: Reductions in internalizing may have multiple benefits for other mental health outcomes at a later point in time, even after controlling for confounding variables.

Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial.

OBJECTIVE: The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda. DESIGN: Pre-post design, including 6-month follow-up. METHODS: The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child-caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N = 39 children) with at least one HIV-positive caregiver and one child 7-17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI. RESULTS: Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P < 0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P < .05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P < 0.05). CONCLUSION: The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.

Unpriming or strategizing? A critique of Sparrow and Wegner.

When asked to randomly select answer choices on easy multiple choice questions, people select more correct answers than expected by chance. Sparrow and Wegner showed that this tendency was eliminated if participants answered questions correctly before answering randomly. They argued that answering a question correctly unprimes the tendency to choose the correct answer, thereby reducing the correct response rate close to the chance level of.5. An alternative explanation, consistent with these results, is that answering questions correctly provides a baseline, which allows participants to strategize, i.e., to match and mismatch equal numbers of their purportedly random responses to the baseline response. Three studies showed that the presence of a baseline, even when unpriming is not feasible, led to lower correct response rates than those obtained in a condition in which no baseline was available. Furthermore, the presence of a baseline led to more nonrandom sequences of correct and incorrect responses. One specific sequence-alternating correct and incorrect answers-mediated the relation between the presence of a baseline and lower correct response rate. These findings suggest that strategizing, not unpriming, accounts for Sparrow and Wegner's results.