Annual Research Review: Resilience and mental health in children and adolescents living in areas of armed conflict – a systematic review of findings in low- and middle-income countries / Wietse A. TOL in Journal of Child Psychology and Psychiatry, 54-4 (April 2013)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 54-4 (April 2013) . - p.445-460 Titre : Annual Research Review: Resilience and mental health in children and adolescents living in areas of armed conflict – a systematic review of findings in low- and middle-income countries Type de document : texte imprimé Auteurs : Wietse A. TOL, Auteur ; Suzan SONG, Auteur ; Mark J.D. JORDANS, Auteur Article en page(s) : p.445-460 Mots-clés : Armed conflict  war  resilience  psychological resilience  developing countries Index. décimale : PER Périodiques Résumé : Background Researchers focused on mental health of conflict-affected children are increasingly interested in the concept of resilience. Knowledge on resilience may assist in developing interventions aimed at improving positive outcomes or reducing negative outcomes, termed promotive or protective interventions. Methods We performed a systematic review of peer-reviewed qualitative and quantitative studies focused on resilience and mental health in children and adolescents affected by armed conflict in low- and middle-income countries. Results Altogether 53 studies were identified: 15 qualitative and mixed methods studies and 38 quantitative, mostly cross-sectional studies focused on school-aged children and adolescents. Qualitative studies identified variation across socio-cultural settings of relevant resilience outcomes, and report contextually unique processes contributing to such outcomes. Quantitative studies focused on promotive and protective factors at different socio-ecological levels (individual, family-, peer-, school-, and community-levels). Generally, promotive and protective factors showed gender-, symptom-, and phase of conflict-specific effects on mental health outcomes. Conclusions Although limited by its predominantly cross-sectional nature and focus on protective outcomes, this body of knowledge supports a perspective of resilience as a complex dynamic process driven by time- and context-dependent variables, rather than the balance between risk- and protective factors with known impacts on mental health. Given the complexity of findings in this population, we conclude that resilience-focused interventions will need to be highly tailored to specific contexts, rather than the application of a universal model that may be expected to have similar effects on mental health across contexts. En ligne : http://dx.doi.org/10.1111/jcpp.12053 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=194 [article] Annual Research Review: Resilience and mental health in children and adolescents living in areas of armed conflict – a systematic review of findings in low- and middle-income countries [texte imprimé] / Wietse A. TOL, Auteur ; Suzan SONG, Auteur ; Mark J.D. JORDANS, Auteur . - p.445-460. in Journal of Child Psychology and Psychiatry > 54-4 (April 2013) . - p.445-460 Mots-clés : Armed conflict  war  resilience  psychological resilience  developing countries Index. décimale : PER Périodiques Résumé : Background Researchers focused on mental health of conflict-affected children are increasingly interested in the concept of resilience. Knowledge on resilience may assist in developing interventions aimed at improving positive outcomes or reducing negative outcomes, termed promotive or protective interventions. Methods We performed a systematic review of peer-reviewed qualitative and quantitative studies focused on resilience and mental health in children and adolescents affected by armed conflict in low- and middle-income countries. Results Altogether 53 studies were identified: 15 qualitative and mixed methods studies and 38 quantitative, mostly cross-sectional studies focused on school-aged children and adolescents. Qualitative studies identified variation across socio-cultural settings of relevant resilience outcomes, and report contextually unique processes contributing to such outcomes. Quantitative studies focused on promotive and protective factors at different socio-ecological levels (individual, family-, peer-, school-, and community-levels). Generally, promotive and protective factors showed gender-, symptom-, and phase of conflict-specific effects on mental health outcomes. Conclusions Although limited by its predominantly cross-sectional nature and focus on protective outcomes, this body of knowledge supports a perspective of resilience as a complex dynamic process driven by time- and context-dependent variables, rather than the balance between risk- and protective factors with known impacts on mental health. Given the complexity of findings in this population, we conclude that resilience-focused interventions will need to be highly tailored to specific contexts, rather than the application of a universal model that may be expected to have similar effects on mental health across contexts. En ligne : http://dx.doi.org/10.1111/jcpp.12053 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=194

Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial / Mark J.D. JORDANS in Journal of Child Psychology and Psychiatry, 51-7 (July 2010)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 51-7 (July 2010) . - p.818-826 Titre : Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial Type de document : texte imprimé Auteurs : Mark J.D. JORDANS, Auteur ; Ivan H. KOMPROE, Auteur ; Wietse A. TOL, Auteur ; Joop T.V.M. DE JONG, Auteur ; Brandon A. KOHRT, Auteur ; Nagendra P. LUITEL, Auteur ; Robert D. MACY, Auteur Année de publication : 2010 Article en page(s) : p.818-826 Langues : Anglais (eng) Mots-clés : Psychosocial war children efficacy Index. décimale : PER Périodiques Résumé : Background: In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal. Methods: A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, posttraumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children (n = 325) (mean age = 12.7, SD = 1.04, range 11–14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group. Results: Comparisons of crude change scores showed significant between-group differences on several outcome indicators, with moderate effect sizes (Cohen d = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on prosocial behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (−2.19; 95% CI, −3.82 to −.56), and aggression (−4.42; 95% CI, −6.16 to −2.67). An age effect for treatment was found for hope (.90; 95% CI, −1.54 to −.26). Conclusions: A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased prosocial behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms. En ligne : http://dx.doi.org/10.1111/j.1469-7610.2010.02209.x Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=101 [article] Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial [texte imprimé] / Mark J.D. JORDANS, Auteur ; Ivan H. KOMPROE, Auteur ; Wietse A. TOL, Auteur ; Joop T.V.M. DE JONG, Auteur ; Brandon A. KOHRT, Auteur ; Nagendra P. LUITEL, Auteur ; Robert D. MACY, Auteur . - 2010 . - p.818-826. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 51-7 (July 2010) . - p.818-826 Mots-clés : Psychosocial war children efficacy Index. décimale : PER Périodiques Résumé : Background: In situations of ongoing violence, childhood psychosocial and mental health problems require care. However, resources and evidence for adequate interventions are scarce for children in low- and middle-income countries. This study evaluated a school-based psychosocial intervention in conflict-affected, rural Nepal. Methods: A cluster randomized controlled trial was used to evaluate changes on a range of indicators, including psychiatric symptoms (depression, anxiety, posttraumatic stress disorder), psychological difficulties, resilience indicators (hope, prosocial behavior) and function impairment. Children (n = 325) (mean age = 12.7, SD = 1.04, range 11–14 years) with elevated psychosocial distress were allocated to a treatment or waitlist group. Results: Comparisons of crude change scores showed significant between-group differences on several outcome indicators, with moderate effect sizes (Cohen d = .41 to .58). After correcting for nested variance within schools, no evidence for treatment effects was found on any outcome variable. Additional analyses showed gender effects for treatment on prosocial behavior (mean change difference: 2.70; 95% CI, .97 to 4.44), psychological difficulties (−2.19; 95% CI, −3.82 to −.56), and aggression (−4.42; 95% CI, −6.16 to −2.67). An age effect for treatment was found for hope (.90; 95% CI, −1.54 to −.26). Conclusions: A school-based psychosocial intervention demonstrated moderate short-term beneficial effects for improving social-behavioral and resilience indicators among subgroups of children exposed to armed conflict. The intervention reduced psychological difficulties and aggression among boys, increased prosocial behavior among girls, and increased hope for older children. The intervention did not result in reduction of psychiatric symptoms. En ligne : http://dx.doi.org/10.1111/j.1469-7610.2010.02209.x Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=101

Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants / Marianna PURGATO in Journal of Child Psychology and Psychiatry, 61-5 (May 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.584-593 Titre : Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants Type de document : texte imprimé Auteurs : Marianna PURGATO, Auteur ; Federico TEDESCHI, Auteur ; Theresa S. BETANCOURT, Auteur ; Paul BOLTON, Auteur ; Chiara BONETTO, Auteur ; Chiara GASTALDON, Auteur ; James GORDON, Auteur ; Paul O'CALLAGHAN, Auteur ; Davide PAPOLA, Auteur ; Kirsi PELTONEN, Auteur ; Raija-Leena PUNAMAKI, Auteur ; Justin RICHARDS, Auteur ; Julie K. STAPLES, Auteur ; Johanna UNTERHITZENBERGER, Auteur ; Joop DE JONG, Auteur ; Mark J.D. JORDANS, Auteur ; Alden L. GROSS, Auteur ; Wietse A. TOL, Auteur ; Corrado BARBUI, Auteur Article en page(s) : p.584-593 Langues : Anglais (eng) Mots-clés : Mediation analysis  children  humanitarian setting  individual participant data  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways. METHODS: We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review. RESULTS: We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%. CONCLUSIONS: Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency. En ligne : http://dx.doi.org/10.1111/jcpp.13151 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422 [article] Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants [texte imprimé] / Marianna PURGATO, Auteur ; Federico TEDESCHI, Auteur ; Theresa S. BETANCOURT, Auteur ; Paul BOLTON, Auteur ; Chiara BONETTO, Auteur ; Chiara GASTALDON, Auteur ; James GORDON, Auteur ; Paul O'CALLAGHAN, Auteur ; Davide PAPOLA, Auteur ; Kirsi PELTONEN, Auteur ; Raija-Leena PUNAMAKI, Auteur ; Justin RICHARDS, Auteur ; Julie K. STAPLES, Auteur ; Johanna UNTERHITZENBERGER, Auteur ; Joop DE JONG, Auteur ; Mark J.D. JORDANS, Auteur ; Alden L. GROSS, Auteur ; Wietse A. TOL, Auteur ; Corrado BARBUI, Auteur . - p.584-593. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.584-593 Mots-clés : Mediation analysis  children  humanitarian setting  individual participant data  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways. METHODS: We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review. RESULTS: We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%. CONCLUSIONS: Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency. En ligne : http://dx.doi.org/10.1111/jcpp.13151 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422

Screening for psychosocial distress amongst war-affected children: cross-cultural construct validity of the CPDS / Mark J.D. JORDANS in Journal of Child Psychology and Psychiatry, 50-4 (April 2009)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 50-4 (April 2009) . - p.514-523 Titre : Screening for psychosocial distress amongst war-affected children: cross-cultural construct validity of the CPDS Type de document : texte imprimé Auteurs : Mark J.D. JORDANS, Auteur ; Ivan H. KOMPROE, Auteur ; Wietse A. TOL, Auteur ; Joop T.V.M. DE JONG, Auteur Année de publication : 2009 Article en page(s) : p.514-523 Langues : Anglais (eng) Mots-clés : Screening psychosocial-distress cross-cultural-validation war children Index. décimale : PER Périodiques Résumé : Background: Large-scale psychosocial interventions in complex emergencies call for a screening procedure to identify individuals at risk. To date there are no screening instruments that are developed within low- and middle-income countries and validated for that purpose. The present study assesses the cross-cultural validity of the brief, multi-informant and multi-indicator Child Psychosocial Distress Screener (CPDS). Methods: The CPDS data of total samples in targeted catchment areas of a psychosocial care program in four conflict-affected countries (Burundi n = 4193; Sri Lanka n = 2573; Indonesia n = 1624; Sudan n = 1629) were studied to examine the cross-cultural construct validity of the CPDS across settings. First, confirmatory factor analyses were done to determine the likelihood of pre-determined theory-based factor structures in each country sample. Second, multi-sample confirmatory factor analyses were done within each country sample to test measurement equivalence of the factor structure as a measure of construct validity. Results: A 3-factor structure reflecting the theoretical premises of the instrument (e.g., child distress, child resilience and contextual factors) was found in the samples from Burundi, Sri Lanka and Indonesia, albeit with context specific deviations. The robustness of the 3-factor structure as an indicator of construct validity was confirmed within these three samples by means of multi-sample confirmatory factor-analyses. A 3-factor structure was not found in the Sudan sample. Conclusions: This study demonstrates the comparability of the assessment by the CPDS of the construct 'non-specific psychosocial distress' across three out of four countries. Robustness of the factor structure of the CPDS within different samples refers to the construct validity of the instrument. However, owing to context-specific deviations of inter-item relationships, the CPDS scores cannot be compared cross-culturally, a finding that confirms the need for attention to contextual factors when screening for non-specific psychosocial distress. En ligne : http://dx.doi.org/10.1111/j.1469-7610.2008.02028.x Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=724 [article] Screening for psychosocial distress amongst war-affected children: cross-cultural construct validity of the CPDS [texte imprimé] / Mark J.D. JORDANS, Auteur ; Ivan H. KOMPROE, Auteur ; Wietse A. TOL, Auteur ; Joop T.V.M. DE JONG, Auteur . - 2009 . - p.514-523. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 50-4 (April 2009) . - p.514-523 Mots-clés : Screening psychosocial-distress cross-cultural-validation war children Index. décimale : PER Périodiques Résumé : Background: Large-scale psychosocial interventions in complex emergencies call for a screening procedure to identify individuals at risk. To date there are no screening instruments that are developed within low- and middle-income countries and validated for that purpose. The present study assesses the cross-cultural validity of the brief, multi-informant and multi-indicator Child Psychosocial Distress Screener (CPDS). Methods: The CPDS data of total samples in targeted catchment areas of a psychosocial care program in four conflict-affected countries (Burundi n = 4193; Sri Lanka n = 2573; Indonesia n = 1624; Sudan n = 1629) were studied to examine the cross-cultural construct validity of the CPDS across settings. First, confirmatory factor analyses were done to determine the likelihood of pre-determined theory-based factor structures in each country sample. Second, multi-sample confirmatory factor analyses were done within each country sample to test measurement equivalence of the factor structure as a measure of construct validity. Results: A 3-factor structure reflecting the theoretical premises of the instrument (e.g., child distress, child resilience and contextual factors) was found in the samples from Burundi, Sri Lanka and Indonesia, albeit with context specific deviations. The robustness of the 3-factor structure as an indicator of construct validity was confirmed within these three samples by means of multi-sample confirmatory factor-analyses. A 3-factor structure was not found in the Sudan sample. Conclusions: This study demonstrates the comparability of the assessment by the CPDS of the construct 'non-specific psychosocial distress' across three out of four countries. Robustness of the factor structure of the CPDS within different samples refers to the construct validity of the instrument. However, owing to context-specific deviations of inter-item relationships, the CPDS scores cannot be compared cross-culturally, a finding that confirms the need for attention to contextual factors when screening for non-specific psychosocial distress. En ligne : http://dx.doi.org/10.1111/j.1469-7610.2008.02028.x Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=724

Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention / Kenneth E. MILLER in Journal of Child Psychology and Psychiatry, 64-1 (January 2023)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 64-1 (January 2023) . - p.71-82 Titre : Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention Type de document : texte imprimé Auteurs : Kenneth E. MILLER, Auteur ; Alexandra CHEN, Auteur ; Gabriela V. KOPPENOL-GONZALEZ, Auteur ; Ioannis BAKOLIS, Auteur ; Maguy ARNOUS, Auteur ; Fadila TOSSYEH, Auteur ; Ahmad EL HASSAN, Auteur ; Ahmad SALEH, Auteur ; Joy SAADE, Auteur ; Nayla NAHAS, Auteur ; Marianne ABBOUD, Auteur ; Lya JAWAD, Auteur ; Mark J.D. JORDANS, Auteur Article en page(s) : p.71-82 Langues : Anglais (eng) Index. décimale : PER Périodiques Résumé : Background Parenting interventions in humanitarian settings have prioritized the acquisition of parenting knowledge and skills, while overlooking the adverse effects of stress and distress on parenting ”a key mediator of refugee children's mental health. We evaluated the effectiveness of the Caregiver Support Intervention (CSI), which emphasizes caregiver wellbeing together with training in positive parenting. Methods We conducted a two-arm randomized controlled trial of the CSI with Syrian refugees in Lebanon, with an intent-to-treat design, from September 2019-December 2020. A total of 480 caregivers from 240 families were randomized to the CSI or a waitlist control group (1:1). Retention from baseline to endline was 93%. Data on parenting and caregiver psychological wellbeing were collected at baseline, endline, and three-month follow-up. Prospective trial registration: ISRCTN22321773. Results We did not find a significant change on overall parenting skills at endline (primary outcome endpoint) (d=.11, p=.126) or at follow-up (Cohen's d=.15, p=.054). We did find a significant effect on overall parenting skills among participants receiving the full intervention ”the sub-sample not interrupted by (COVID-19) (d=0.25, p < .05). The CSI showed beneficial effects in the full sample at endline and follow-up on harsh parenting (d=â’.17, p < .05; d=.19, p < .05), parenting knowledge (d=.63, p < .001; d=.50, p < .001), and caregiver distress (d=â’.33, p < .001; d=.23, p < .01). We found no effects on parental warmth and responsiveness, psychosocial wellbeing, stress, or stress management. Changes in caregiver wellbeing partially mediated the impact of the CSI on harsh parenting, accounting for 37% of the reduction in harsh parenting. Conclusions The CSI reduced harsh parenting and caregiver distress, and demonstrated the value of addressing caregiver wellbeing as a pathway to strengthening parenting in adversity. These effects were achieved despite a pandemic-related lockdown that impacted implementation, a severe economic crisis, and widespread social unrest. Replication under less extreme conditions may more accurately demonstrate the intervention's full potential. En ligne : https://doi.org/10.1111/jcpp.13668 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=490 [article] Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention [texte imprimé] / Kenneth E. MILLER, Auteur ; Alexandra CHEN, Auteur ; Gabriela V. KOPPENOL-GONZALEZ, Auteur ; Ioannis BAKOLIS, Auteur ; Maguy ARNOUS, Auteur ; Fadila TOSSYEH, Auteur ; Ahmad EL HASSAN, Auteur ; Ahmad SALEH, Auteur ; Joy SAADE, Auteur ; Nayla NAHAS, Auteur ; Marianne ABBOUD, Auteur ; Lya JAWAD, Auteur ; Mark J.D. JORDANS, Auteur . - p.71-82. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 64-1 (January 2023) . - p.71-82 Index. décimale : PER Périodiques Résumé : Background Parenting interventions in humanitarian settings have prioritized the acquisition of parenting knowledge and skills, while overlooking the adverse effects of stress and distress on parenting ”a key mediator of refugee children's mental health. We evaluated the effectiveness of the Caregiver Support Intervention (CSI), which emphasizes caregiver wellbeing together with training in positive parenting. Methods We conducted a two-arm randomized controlled trial of the CSI with Syrian refugees in Lebanon, with an intent-to-treat design, from September 2019-December 2020. A total of 480 caregivers from 240 families were randomized to the CSI or a waitlist control group (1:1). Retention from baseline to endline was 93%. Data on parenting and caregiver psychological wellbeing were collected at baseline, endline, and three-month follow-up. Prospective trial registration: ISRCTN22321773. Results We did not find a significant change on overall parenting skills at endline (primary outcome endpoint) (d=.11, p=.126) or at follow-up (Cohen's d=.15, p=.054). We did find a significant effect on overall parenting skills among participants receiving the full intervention ”the sub-sample not interrupted by (COVID-19) (d=0.25, p < .05). The CSI showed beneficial effects in the full sample at endline and follow-up on harsh parenting (d=â’.17, p < .05; d=.19, p < .05), parenting knowledge (d=.63, p < .001; d=.50, p < .001), and caregiver distress (d=â’.33, p < .001; d=.23, p < .01). We found no effects on parental warmth and responsiveness, psychosocial wellbeing, stress, or stress management. Changes in caregiver wellbeing partially mediated the impact of the CSI on harsh parenting, accounting for 37% of the reduction in harsh parenting. Conclusions The CSI reduced harsh parenting and caregiver distress, and demonstrated the value of addressing caregiver wellbeing as a pathway to strengthening parenting in adversity. These effects were achieved despite a pandemic-related lockdown that impacted implementation, a severe economic crisis, and widespread social unrest. Replication under less extreme conditions may more accurately demonstrate the intervention's full potential. En ligne : https://doi.org/10.1111/jcpp.13668 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=490

---

1 (1 - 5 / 5) Par page : 25 50 100 200