Professional Documents
Culture Documents
2
.06 constitutes a medium and
2
.14 a large effect size.
* p .001.
R. Berger et al. / Journal of Adolescent Health 51 (2012) 453461 459
nomic background and were traditionally religious, the general-
izabilty of our results to the entire student population has to be
further studied. Third, the self-assessments could have been
inuenced by social desirability. Fourth, we could not evaluate
whether the impact of the intervention was maintained over
time. Fifth, as we do not know why some of the parents did not
return the signed consent forms, it is possible that at least some
of them had higher symptomatology levels. Conversely, this
study has important strengths, including a quasi-randomized
designwithina naturalistic setting, the use of a structuredmanu-
alized program, a delity check, the use of clearly dened target
outcomes, and a comprehensive, reliable, and valid assessment
battery.
Future studies should assess the long-termimpact of EES and
use objective measures such as students school attendance, ac-
ademic performance, health status, and behavior at school and at
home, as well as ratings by both teachers and parents. In addi-
tion, research should investigate which students may be candi-
dates for other modalities, such as targeted interventions or
psychotherapy.
Conclusions and implications
Although the past decade has seen a major increase in the
number of school-based interventions designed to deal with the
impact of war and terror on children [32], most were trauma-
targetedinterventions anddeliveredby professionals. Only a few
were universal interventions delivered by teachers [12,14,
15,22,26]. This is the rst study that shows the efcacy of a
universal, teacher-delivered intervention in signicantly dis-
tressed adolescents exposed to intense and ongoing war-related
stress. Given the fact that such approaches are more accessible,
feasible, and affordable and tend to be nonstigmatizing, this
nding is important in terms of providing broad public mental
health services for traumatized children of diverse social and
ethnic populations, who would otherwise be deprived of those
services.
Most major disasters present an enormous challenge for local
health systems, as the needs of affected populations usually far
exceed the capacity for providing adequate mental health ser-
vices [34]. Universal interventions should be considered an im-
portant component of any postdisaster community mental
health approach [35]. Indeed, a similar intervention was imple-
mented in the aftermath of the tsunami in Sri Lanka and was
shown to be both feasible and efcacious in reducing PTS in
children [13,15]. However, future research will need to sort out
wheneither universal or targetedinterventions shouldbe imple-
mented, and with which kind of affected populations. Until then,
a two-stage approach starting with a universal intervention fol-
lowed by targeted specialized interventions for those who still
suffer from posttraumatic distress may be advisable. Finally, our
study also illustrates the importance of developing culturally
sensitive interventions and adapting it to specic targeted pop-
ulations even within the same country and society [15].
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