Discussion
anxiety, heightened distress, psychiatric, PTSD, depression
SECONDARY, RECRUITMENT
This study investigated METRA in addressing psychiatric concerns among adolescent girls in an LMIC humanitarian context. After the intervention, those adolescents allocated to METRA had fewer symptoms of PTSD, depression, anxiety, cultural distress, and psychiatric difficulties than those allocated to TAU. These improvements were maintained at 3-month follow-up. Acceptability of METRA was generally high. While dropout rates were significantly higher for METRA compared with TAU (22.5% vs 8.9%), the METRA dropout rate was similar to that observed in other low-intensity PTSD interventionsThis RCT was conducted in the months following the Taliban regaining power and the United States and its allies leaving Afghanistan. These changes posed several challenges to conducting the RCT as planned, and modifications were made to accommodate the current situation. Due to security concerns, the planned 10 weekly sessions were administered over a fortnight; assessments were shortened; and we only recruited from Kabul as our second recruitment site (Herat) was deemed insecure. Nevertheless, METRA was still able to be delivered to groups of adolescents by those with limited training, and adolescents reported satisfaction with METRA. Improvements in secondary outcomes suggest that METRA may drive nonspecific psychiatric improvement. This suggests there is potential for METRA to be generalized to other humanitarian settings and in cases where adolescents have not received a specific diagnosis but are experiencing symptoms of heightened distress.