A sport-for-protection program reduces anxiety and depression in youth affected by displacement : A randomized controlled trial of the Game Connect program in Uganda

Introduction
Youth affected by displacement are at risk for anxiety and depression. Supervised sport programs are a potentially effective strategy, however trials from displacement contexts are lacking.
 

Methods
Displaced youth and youth from host communities in five humanitarian settings across Uganda aged 15 to 24 years, and with at least mild anxiety and/or depression, were randomized to a 16-week sport-for-protection program or a wait-list control condition. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9, adolescent version (PHQ-9-A) were assessed pre- and post-intervention. Linear mixed modelling was conducted.
 

Results
834 young people were randomized (421 in the experimental and 413 in the control condition; median age = 19.0 years; 46.9 % boys; 14.7 % with self-reported or observed disability; 29.5 % from host community and 70.5 % displaced youth). Large effect sizes were found for the anxiolytic (Cohen d = 1.21, 95%CI = 1.06–1.36) and antidepressant (Cohen d = 1.32, 95%CI = 1.17–1.47) effects of sport-for-protection in comparison with a wait-list control condition. In subgroup analyses, large effect sizes were observed in displaced youth (Cohen d GAD-7 = 1.15, 95%CI = 1.0–1.32; Cohen d PHQ-9-A = 1.33, 95%CI = 1.16–1.51) and youth from host communities (Cohen d GAD-7 = 1.34, 95%CI = 1.06–1.61; Cohen d PHQ-9-A = 1.30, 95%CI = 1.03–1.58); in boys (Cohen d GAD-7 = 1.23, 95%CI = 1.03–1.43; Cohen d PHQ-9-A = 1.36, 95%CI = 1.14–1.58) and girls (Cohen d GAD-7 = 1.11, 95%CI = 0.89–1.33; Cohen d PHQ-9-A = 1.26, 95%CI = 1.05–1.47); and in those with (Cohen d GAD-7 = 0.99, 95%CI = 0.61–1.37.; Cohen d PHQ-9-A = 1.53, 95%CI = 1.12–1.94) and without disability (Cohen d GAD-7 = 1.24, 95%CI = 1.08–1.49; Cohen d PHQ-9-A = 1.28, 95%CI = 1.12–1.44).
 

Conclusion
Sport-for-protection is an effective stand-alone or adjunctive intervention to reduce symptoms of anxiety and depression among young people affected by displacement within humanitarian settings.

Highlights
• Sport-for-protection reduces symptoms of anxiety and depression in displaced youth.
• Sport-for-protection reduces the mental health burden in youth from host communities.
• Mental health benefits were observed in both those with and without disability.