Controlled trial of psychotherapy for congolese survivors of sexual violence

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

Research output: Contribution to journalArticle

173 Citations (Scopus)

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 individual 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 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), 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 individual-support group completed all three assessments. Mean scores for combined depression 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 significantly 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 observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants 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 anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.)

Original languageEnglish (US)
Pages (from-to)2182-2191
Number of pages10
JournalNew England Journal of Medicine
Volume368
Issue number23
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Fingerprint

Sex Offenses
Psychotherapy
Survivors
Post-Traumatic Stress Disorders
Anxiety
Depression
Group Psychotherapy
Self-Help Groups
Therapeutics
Checklist
United States Agency for International Development
Torture
Democratic Republic of the Congo
United Nations
Cognitive Therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bass, J. K., Annan, J., Murray, S. M. I., Kaysen, D., Griffiths, S., Cetinoglu, T., ... Bolton, P. A. (2013). Controlled trial of psychotherapy for congolese survivors of sexual violence. New England Journal of Medicine, 368(23), 2182-2191. https://doi.org/10.1056/NEJMoa1211853

Controlled trial of psychotherapy for congolese survivors of sexual violence. / Bass, Judith K.; Annan, Jeannie; Murray, Sarah Mc Ivor; Kaysen, Debra; Griffiths, Shelly; Cetinoglu, Talita; Wachter, Karin; Murray, Laura K.; Bolton, Paul A.

In: New England Journal of Medicine, Vol. 368, No. 23, 01.01.2013, p. 2182-2191.

Research output: Contribution to journalArticle

Bass, JK, Annan, J, Murray, SMI, Kaysen, D, Griffiths, S, Cetinoglu, T, Wachter, K, Murray, LK & Bolton, PA 2013, 'Controlled trial of psychotherapy for congolese survivors of sexual violence', New England Journal of Medicine, vol. 368, no. 23, pp. 2182-2191. https://doi.org/10.1056/NEJMoa1211853
Bass JK, Annan J, Murray SMI, Kaysen D, Griffiths S, Cetinoglu T et al. Controlled trial of psychotherapy for congolese survivors of sexual violence. New England Journal of Medicine. 2013 Jan 1;368(23):2182-2191. https://doi.org/10.1056/NEJMoa1211853
Bass, Judith K. ; Annan, Jeannie ; Murray, Sarah Mc Ivor ; Kaysen, Debra ; Griffiths, Shelly ; Cetinoglu, Talita ; Wachter, Karin ; Murray, Laura K. ; Bolton, Paul A. / Controlled trial of psychotherapy for congolese survivors of sexual violence. In: New England Journal of Medicine. 2013 ; Vol. 368, No. 23. pp. 2182-2191.
@article{65a906b125aa403ebf01d877a25c8ad3,
title = "Controlled trial of psychotherapy for congolese survivors of sexual violence",
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 individual 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 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), 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 individual-support group completed all three assessments. Mean scores for combined depression 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 significantly 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 observed for PTSD and functional impairment. At 6 months after treatment, 9{\%} of participants 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 anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.)",
author = "Bass, {Judith K.} and Jeannie Annan and Murray, {Sarah Mc Ivor} and Debra Kaysen and Shelly Griffiths and Talita Cetinoglu and Karin Wachter and Murray, {Laura K.} and Bolton, {Paul A.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1056/NEJMoa1211853",
language = "English (US)",
volume = "368",
pages = "2182--2191",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "23",

}

TY - JOUR

T1 - Controlled trial of psychotherapy for congolese survivors of sexual violence

AU - Bass, Judith K.

AU - Annan, Jeannie

AU - Murray, Sarah Mc Ivor

AU - Kaysen, Debra

AU - Griffiths, Shelly

AU - Cetinoglu, Talita

AU - Wachter, Karin

AU - Murray, Laura K.

AU - Bolton, Paul A.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - 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 individual 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 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), 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 individual-support group completed all three assessments. Mean scores for combined depression 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 significantly 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 observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants 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 anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.)

AB - 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 individual 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 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), 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 individual-support group completed all three assessments. Mean scores for combined depression 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 significantly 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 observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants 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 anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.)

UR - http://www.scopus.com/inward/record.url?scp=84878527714&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878527714&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1211853

DO - 10.1056/NEJMoa1211853

M3 - Article

C2 - 23738545

AN - SCOPUS:84878527714

VL - 368

SP - 2182

EP - 2191

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 23

ER -