Forced Displacement and Mental Health

Last registered on April 10, 2020

Pre-Trial

Trial Information

General Information

Title
Forced Displacement and Mental Health
RCT ID
AEARCTR-0004516
Initial registration date
April 09, 2020
Last updated
April 10, 2020, 11:46 AM EDT

Locations

Region

Primary Investigator

Affiliation
Technical University of Munich

Other Primary Investigator(s)

PI Affiliation
Monash University
PI Affiliation
University of Newcastle
PI Affiliation
BRAC University

Additional Trial Information

Status
On going
Start date
2019-09-01
End date
2021-05-31
Secondary IDs
Abstract
This document lays out the research design and analysis plan for evaluating the impact of a program that aims to improve the mental health of forcibly displaced women and their children under 2 years. Through a home-based counseling program, Rohingya refugee women, residing in refugee camps in Bangladesh, are counseled weekly on mental health and child-rearing issues. The primary aim is to help them and their children overcome conflict and displacement induced trauma and depression. We evaluate the effect of this program using a cluster randomized control trial. The intervention began in early November 2019 and is scheduled to run for 60 weeks.
External Link(s)

Registration Citation

Citation
Das, Narayan et al. 2020. "Forced Displacement and Mental Health." AEA RCT Registry. April 10. https://doi.org/10.1257/rct.4516-1.0
Experimental Details

Interventions

Intervention(s)
Counselings Rohingya refugee mothers (with 0-2-year-old children) weekly, in small groups, on issues related to mental health and childcare.
Intervention Start Date
2019-11-01
Intervention End Date
2021-02-28

Primary Outcomes

Primary Outcomes (end points)
Trauma and depression of mothers and children.
Primary Outcomes (explanation)
The primary symptoms of psychological trauma are fear that is usually caused by re-experiencing traumatic memories and unusual emotional outbursts. Survey questions on trauma symptoms are asked on a 5-point scale (never (=0); less often (=1); sometimes (=2); very often (=3); always (=4)). We will construct a simplistic trauma index for each mother and child using survey questions on trauma symptoms. This index weights each question equally and, hence, would simply be the average of the responses satisfying 0<=Index<=1. Therefore, a higher value of the index means a mother/child has severe trauma.

We will construct the depression indices of mothers and children in the same manner as described above. The analysis plan describes these indices more in detail.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary outcomes of mothers: happiness, aspiration, belongingness.

Secondary outcomes of 0-2-year-old children: physical health (underweight and stunting), motor skills (gross and fine), communication skills, problem-solving skills, and personal-social skills.

General secondary outcome: mother-child relationship.
Secondary Outcomes (explanation)
Mothers: Similar to indices explained in 'Primary Outcomes', indices on 'Happiness', 'Aspiration' and 'Belongingness' will also be created using survey questions (with answers on a 5-point scale). These indices weights each question equally and, hence, would simply be the average of the responses satisfying 0<=Index<=1. Therefore, a higher value of the index means a mother is better-off in that category.

Children: Motor (gross and fine), communication, problem-solving, and personal-social skills development questions from the survey (which are age-specific) will be used to create 4 different indices. For each age-group (i.e., below 2 months, 4 months, 6 months, etc., until 24 months), questions vary in order to match with the concerned age-group. These questions are answered on a 3-point scale. We will put equal weights on each question to work out the index, so that we have the average of the responses satisfying 0<=Index<=1. For 'Physical Health', we will explore the height-for-age and weight-for-age z-scores of children to explore stunting and underweightness respectively.

We will also create a 'Parent-Child Relationship' index that will use 6 survey questions on children's behavior with their mother. These questions are also answered on a 3-point scale and will be constructed in the same way as the 'Skills' indices.

The analysis plan (attached) describes these indices more in detail.

Experimental Design

Experimental Design
Through a home-based counseling program developed by BRAC, Rohingya refugee women, residing in refugee camps in Bangladesh, are counseled weekly on mental health and child-rearing issues. The primary aim is to help them and their children overcome conflict and displacement induced trauma and depression. We evaluate the effect of this program using a cluster randomized control trial.
Experimental Design Details
In August 2017, nearly one million Rohingya people, one of the many ethnic minorities in Myanmar, have fled violence and persecution in their homeland and are now living in crowded settlements in southern Bangladesh, resulting in one of the world's fastest-growing refugee crises. The majority of these refugees are women and children who have witnessed an abundance of physical and non-physical violence and abuse in their homeland that are likely to induce severe trauma, stress, and depression among this vulnerable group. To improve the mental health of mothers and young children (under 2 years), BRAC provides weekly counseling to the recently-displaced Rohingya mothers about mental health and childcare issues. The aim is to reduce both mothers' and children's trauma and depression that were induced by conflict and forced displacement.

Mother along with their children under 2 years attend a session-home every week for 60 weeks. Counseling to mothers is provided through small group sessions comprising 5 to 10 mother-child pairs. Each session is divided into four steps: (i) greetings, (ii) wellbeing of mothers, (iii) wellbeing of children, and (iv) homework. Sessions are 1 hour long and are conducted in the local Rohingya language by 3 trained administers. This trial has been randomized across 252 clusters, which are blocks inside refugee camps. 137 blocks have been assigned to the treatment and 114 blocks to the control groups. Mothers in the control arm do not receive counseling or attend any session-home.
Randomization Method
Randomization was done by a computer (using STATA).
Randomization Unit
A refugee camp consists of many blocks. Our unit of randomization is at the block level.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
252 blocks.
Sample size: planned number of observations
Between 5 and 10 mother-child pairs attend each session. A total of 3,621 mother-child pairs enrolled for the program.
Sample size (or number of clusters) by treatment arms
137 blocks are in the treatment and 114 blocks are in the control arm.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We computed the number of blocks required in each arm with an improvement in mental health by 0.05 units (on a mental health index scale between 0 and 1) at 5% significance level for a cluster-RCT study with 80% power. With the average number of observations in each cluster being 14 with cluster sizes varying by 2 observations, intra-cluster correlation of 0.4, and a within-cluster variation of 0.2, we found that a minimum of 112 blocks with 1,568 mother-child pairs are required in each arm to satisfy this requirement.
IRB

Institutional Review Boards (IRBs)

IRB Name
BRAC James P Grant School of Public Health, BRAC University
IRB Approval Date
2019-11-06
IRB Approval Number
2019-028-ER
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials