(PS8-65) Effects of a Brief Digital Problem-Solving Intervention on Depression and Anxiety Symptoms in Ukrainian Children and Adolescents Displaced by War: a Randomized Controlled Trial

Abstract Text:

Background: Children and adolescents (“youths”) displaced from home and country by war face myriad problems and increased risk of depression and anxiety (i.e., internalizing) symptoms but have little access to in-person mental health care. We tested the hypothesis that a digital mental health intervention (DMHI) might reduce internalizing symptoms among a sample of Ukrainian youth who emigrated to Poland due to the Russo-Ukrainian War.

Method: In what is apparently the first randomized controlled trial of any DMHI with war-exposed youths, we tested Project SOLVE, a 30-minute intervention that teaches problem-solving skills. Refugee Ukrainian youths (inclusion criteria: grade 5-12, Ukrainian reading ability) in five schools in Poland were randomized (1:1) to SOLVE or control (academic practice), implemented during class. The pre-registered primary outcome was internalizing symptoms on the standardized Behavior and Feelings Survey (item-level means, 0-4 scale). Using beta-distributed linear mixed-effects models, we analyzed longitudinal outcomes separately for the full sample and the subsample with elevated baseline symptoms (>1 SD), testing whether SOLVE was effective as a universal intervention and/or for highly symptomatic youths. Trial registration: ClinicalTrials.gov (NCT06064578), OSF (https://osf.io/u495j).

Results: The study spanned October 2023-June 2024 (recruitment: October 23-December 18). 898 youths aged 10-18 were assessed for eligibility; 818 were eligible; 709 (86.67%) were randomized and provided usable data. In full-sample (Mean Age = 13.38 years; 46.79% boys) intent-to-treat analyses, SOLVE participants (N = 345) showed greater internalizing symptom reduction than control participants (N=364) at both post-intervention assessments: one-month (item-level mean symptom scores = 1.08 out of 4 [SD=0.89] and 1.26 [SD=0.93]), between-groups effect size (OR=1.31, p=.007); and four-months (M = 0.99 [SD = 0.89] and 1.20 [SD = 0.93]; OR = 1.36, p = .008). Among youths with elevated symptoms (N = 123 [SOLVE = 57; Control = 66]) the effect sizes increased relative to the corresponding assessment time points in the full-sample analysis (OR = 2.37 at one-month; OR = 1.71 at four-months).

Discussion: As hypothesized, a brief problem-solving DMHI, efficiently implemented in schools, reduced internalizing symptoms in refugee Ukrainian youths. DMHIs may prove useful as part of a stepped-care approach for treating mental health problems among displaced Ukrainian youths and for other war-displaced youths who lack access to in-person professional care.