81222 enGender Impact: The World Bank’s Gender Impact Evaluation Database Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence Judith Bass, Neannie Annan, Sarah McIvor Murray, Debra Kaysen, Shelly Griffiths, Talita Author(s) Cetinoglu, Karin Wachter, Laura Murray, Paul Bolton Contact jbass@jhsph.edu Country Democratic Republic of Congo Organizing Theme Gender Based Violence, Voice and Agency Status Completed Intervention Category Psychological Treatment Sector Social Development 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]), Abstract 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 Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database 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.) Gender Connection Gender Focused Intervention Gender Outcomes Mental or physical consequences of GBV, psychological agency IE Design Clustered Randomized Control Trial (Clustered at village level) 16 study villages were each assigned psychosocial assistants (One study was dropped due to incompetence of the assistant). Villages were randomly assigned to receive cognitive processing therapy or individual support. The assistants reviewed their files to identify women with clinically significant psychological problems. For the individual support Intervention treatment arm, psychosocial assistants were available throughout the treatment period for women who sought their services. For the therapy treatment arm, Cognitive Processing Therapy was administered. The treatment included 1 individual 1 hour session and 11 2- hour group sessions. Intervention Period April to July 2011 494 women were screened for eligibility and 434 met the inclusion criteria. 231 women completed all three assessments. 141 therapy participants completed at least 9 sessions and Sample population 182 individual-support participants attended at least 1 session with the psycho-social assistant. Individuals receiving cognitive process therapy are compared to individuals receiving Comparison conditions Individual psycho-social support Unit of analysis Individual Level Follow up data was collected 1 month after treatment and then 6 months after the first Evaluation Period follow-up Both the individual-support and therapy groups had significant improvements during treatment, with effects maintained at 6 months For PTSD symptoms and combined depression and anxiety symptoms, participants in the therapy group had significantly greater improvements than those in the individual-support group both follow-up assessments, with all treatment-effect sizes greater than 1.0. Approximately 70% of participants in the therapy group met our criteria for probable Results depression or anxiety at baseline, with 10% or less meeting the criteria at either follow-up assessment. In the individual-support group, the proportions of participants who met the criteria were as follows: 83% at baseline, 53% at the end of treatment, and 42% at 6 months after treatment. The relative risks of meeting the criteria for depression or anxiety and PTSD were significantly greater with individual support than with therapy at the end of treatment and 6 months after treatment. Primary study limitations Funding Source USAID Victims of Torture Fund and the World Bank Last updated: 14 August 2013 2 enGender Impact: The World Bank’s Gender Impact Evaluation Database Bass, J. K., Annan, J., McIvor Murray, S., Kaysen, D., Griffiths, S., Cetinoglu, T., ... & Reference(s) Bolton, P. A. (2013). Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence. New England Journal of Medicine, 368(23), 2182-2191. Link to Studies http://www.nejm.org/doi/full/10.1056/NEJMoa1211853 Microdata Last updated: 14 August 2013 3