Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence

Citation:

Bass, Judith K., Jeannie Annan, Sarah McIvor Murray, Debra Kaysen, Shelly Griffiths, Talita Cetinoglu, Karin Wachter, Laura K. Murray, and Paul A. Bolton. 2013. “Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence.” New England Journal of Medicine 368 (23): 2182–91. doi:10.1056/NEJMoa1211853.

Authors: Judith K. Bass, Jeannie Annan, Sarah McIvor Murray, Debra Kaysen, Shelly Griffiths, Talita Cetinoglu, Karin Wachter, Laura K. Murray, Paul A. Bolton

Abstract:

Background Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries.

Methods In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or in- dividual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 wom- en). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symp- toms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended.

Results A total of 65% of participants in the therapy group and 52% of participants in the indi- vidual-support group completed all three assessments. Mean scores for combined de- pression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were signifi- cantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were ob- served for PTSD and functional impairment. At 6 months after treatment, 9% of par- ticipants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD.

Conclusions In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxi- ety symptoms and improved functioning. 

 

Topics: Armed Conflict, Gender, Women, Health, Mental Health, PTSD, Sexual Violence, SV against women Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2013

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