Beyond self-reports: Testing psychosocial, biological, and cognitive signatures of profound stress in a randomized controlled trial impact evaluation for adolescents affected by the Syria crisis
Background: Evidence of ‘what works’ in humanitarian programming is especially important for addressing the disruptive consequences of conflict and forced displacement on adolescent mental health and development. However, the instability of crisis-affected settings renders rigorous methodologies and designs challenging to implement. Discussion: We evaluated a structured, 8-week psychosocial intervention (Advancing Adolescents), implemented by Mercy Corps as part of the No Lost Generation initiative deployed in the Middle East region. Our aims were to test the psychosocial, biological, and cognitive impacts of the intervention with Syrian refugee and host-community youth in Jordanian cities near active war zones and to develop a robust and contextually-relevant toolkit to support research goals and humanitarian practice. We faced challenges with respect to study design, methods, and dissemination: this included the logistics and acceptability of implementing a randomized controlled trial in a humanitarian context, the selection and refinement of culturally-relevant research tools and practices, and the dissemination of results to multiple stakeholders. We sought to go beyond self-reports in testing the effectiveness of a brief, scalable, community-based program to improve the psychosocial wellbeing of war-affected adolescents. We demonstrated beneficial and sustained impacts on self-reports of insecurity, stress, and mental health; developed a reliable and culturally-relevant measure of resilience; experimentally tested cognitive skills; and showed that levels of cortisol, a biomarker of chronic stress, reduced by one third in response to intervention. Using stress biomarkers offered proof-of-concept evidence: interventions targeting mental health and psychosocial wellbeing can improve self-reports of mental health and psychosocial wellbeing, as well as regulate physiological stress in the body. We fostered a strong sense of local ownership through community engagement, and built a network of partnerships between scholars, our local research team, humanitarian practitioners, and policy-makers. Conclusions: The study demonstrates that high-quality scientific research is feasible, useful, and ethical in humanitarian settings, and that fostering partnerships with multiple, diverse partners develops a coherent, productive research agenda, given opportunities for constructive dialogue, time, funding, and an ethos of building trust, respect, and meaningful engagement. Findings encourage the adoption of cognitive measures and stress biomarkers alongside self-report surveys in evaluating programme impacts.