# Randomised clinical trial investigating memory training for recovery-adolescents in addressing psychiatric concerns among adolescents in Iraq

## TL;DR

A study in Iraq tested a memory training program for adolescents with mental health issues but found it no better than usual care, though it was cheaper.

## Contribution

The study evaluates a low-cost memory training intervention for adolescents in a humanitarian context, comparing it to standard care.

## Key findings

- METRA showed a significant decrease in PTSD and depression symptoms post-intervention, but not better than treatment as usual.
- Improvements in symptoms were maintained at the three-month follow-up.
- METRA was found to be less costly than standard treatment.

## Abstract

In this randomised clinical trial, we investigated the efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychiatric symptoms among adolescents in Iraq.

In the study, we included adolescents aged 10–19 years with heightened psychiatric distress living in Kirkuk. It was a parallel-group trial comparing METRA with treatment as usual (TAU), with a three-month follow-up. The study occurred between July 2023 and January 2024. Participants assigned to METRA received a 10-session group-intervention comprised of memory specificity training and writing for recovery. Assessments occurred at baseline, post-intervention, and three months after treatment. Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms post-intervention. Secondary outcomes were measures of anxiety and psychiatric difficulties. We also examined the costs and affordability of METRA in a humanitarian context. The sample size for primary analyses included 67 adolescents in the METRA group and 65 adolescents in TAU.

Following the intention-to-treat principle, linear mixed effects models found at post-intervention the METRA group had a 10.96-point decrease (95% confidence interval (CI) = –13.82, –8.09) in PTSD symptoms and a 3.27-point decrease (95% CI = –4.67, –1.87) in depression symptoms. Improvements were maintained at the three-month follow-up. While the time main effects were significant (P < 0.001), the group × time interactions were not significant (P = 0.61 for PTSD and P = 0.71 for depression); thus, there was no evidence that these improvements were superior to the symptom improvements observed in TAU.

In this study, we found that while METRA was not more effective than TAU, it was less costly, offering an option for replacing current practice. The findings highlight a need for further research in this area of global mental health.

Australian New Zealand Clinical Trials Registry (ACTRN12622001413718).