The effect of combined psychosocial and spiritual care for war-exposed Ethiopian women with high PHQ-9, GAD-7, and PTSD scores: a pilot trial in Woldia, Ethiopia

Abstract

Gender-based violence (GBV) in wartime is relatively common and is associated with depression, anxiety, and post-traumatic stress disorder (PTSD), but there are limited scalable, culture-specific interventions for these common mental health problems in low-resource settings. We conducted a pilot intervention, a pre- and post-intervention design among war-affected married women with elevated PHQ-9, GAD-7, and PCL-5 scores in Woldia, northern Ethiopia. After completing a baseline survey, 20 women participated in a five-week group intervention. It combined individual psychosocial support by psychologists with spiritually focused content facilitated by a religious leader. Symptom scales were administered at baseline, post-intervention, and at the end of a one-month follow-up. Changes were evaluated using paired t-tests and repeated-measures models. The majority of the participants experienced lifetime or wartime GBV and low social support. The intervention demonstrated large reductions in mean scores and large effect sizes in depression, anxiety, and PTSD scores from baseline to endline. The mean score persisted lower at one month, with all changes statistically significant. Sociodemographic features did not significantly moderate these patterns, but women’s education status and social support might be associated with greater reductions in depressive symptoms from the multivariate models. This pilot trial indicates that a short-term, culturally adapted psychosocial and spiritual group intervention seems to be effective in reducing common mental health symptoms in GBV-exposed women in a conflict setting and warrants further investigation through larger controlled trials.