Jeannie Annan

• PhD
• Research Associate at University of Chicago

We describe an effort to develop a consensus-based research agenda for mental health and psychosocial support (MHPSS) interventions in humanitarian settings for 2021-30. By engaging a broad group of stakeholders, we generated research questions through a qualitative study (in Indonesia, Lebanon, and Uganda; n=101), consultations led by humanitarian...

Violence committed by men against women in intimate relationships is a pervasive problem around the world. Patriarchal norms that place men as the head of household are often to blame. Previous research suggests that trusted authorities can shift perceptions of norms and create behavior change. In many settings, a compelling authority on behavior i...

Background Despite the growth of psychotherapy trials in low- and middle-income countries, there have been limited follow-up studies of more than 2 years. This study follows up female sexual violence survivors approximately 6 years after completing a 12-session group cognitive processing therapy (CPT) program in the eastern Democratic Republic of C...

Despite calls forincreased mental health programming in low-resource and humanitarian contexts and effectiveness trials of psychotherapy in these settings, little research exists on the extent to which providers and recipients continue to practice skills learned during trials of these programs. To understand if and how providers continued to use me...

Background There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising...

There is a paucity of evidence regarding interventions that can improve the mental health of adversity-affected young adolescents living in low-resource settings. We evaluated the feasibility, acceptability, relevance, and safety of the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention among Burundian refugee adol...

Background: There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising...

Background Conducting ethical and rigorous research to measure the effectiveness of humanitarian programs is urgently needed given the global level of displacement and conflict, yet traditional approaches to evaluation research may be too slow and disruptive for acute humanitarian settings. The current case study utilizes an experience of implement...

Background: While evidence is growing for the efficacy of trauma-focused mental health interventions in low- and middle-income countries, concerns have been raised about whether these types of interventions can be effectively delivered in contexts with ongoing conflict and violence. Cognitive Processing Therapy (CPT) has been shown to be effective...

This paper examines women’s power relative to that of their husbands in 23 Sub-Saharan African countries to determine how it affects women’s health, reproductive outcomes, children’s health and children’s education. The analysis uses a novel measure of women’s empowerment that is closely linked to classical theories of power, built from spouses’ of...

Raqqa Governorate has been grappling with dual crisis-related burdens from the civil conflict and ISIS occupation. As part of a response to support households within this area, a three-month, unconditional cash assistance program was implemented by the International Rescue Committee to help households meet their basic needs. A quantitative, pre-pos...

Improving women’s agency, namely their ability to define goals and act on them, is crucial for advancing gender equality and the empowerment of women. Yet, existing frameworks for measuring women’s agency – both disorganized and partial – provide a fragmented understanding of the constraints women face in exercising their agency, thus restricting t...

Background Raqqa Governorate, Syria has recently been affected by overlapping conflicts related to the Syrian Civil war and occupation by ISIS, resulting in widespread displacement and disruption of economic livelihoods. However, little information is currently known about mental health needs and risk factors among women. Therefore, this study soug...

The number of research studies in the humanitarian field is rising. It is imperative, therefore, that institutional review boards (IRBs) consider carefully the additional risks present in crisis contexts to ensure that the highest ethical standards are upheld. Ethical guidelines should represent better the specific issues inherent to research among...

We used a cluster-randomized, wait-list controlled trial to examine impacts of a school-based social-emotional learning intervention on Congolese students and teachers. Seventy-six school clusters in two groups (A and B) were randomized to treatment or control. The groups differed in geographic location, accessibility, exposure to violence, and ext...

Cash and voucher assistance is an efficient way to deliver assistance in emergency settings, and evidence demonstrates that cash programmes have consistent positive impacts on food security and other health and economic outcomes in these contexts. Nevertheless, while evidence from development settings shows that cash has the potential to reduce int...

Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC). Methods: Drawing from baseline survey data collected in eastern DRC, researchers...

Background Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) o...

Background Women living in war-affected contexts face high levels of gender-based violence, including intimate partner violence (Stark & Ager, 2011). Despite well-documented negative consequences, including posttraumatic stress disorder (PTSD) (Garcia-Moreno et al. 2006; Steel et al. 2009), evidence remains thin regarding intervention effectiveness...

Objective To conduct a randomized controlled trial assessing the impact of a family-based intervention delivered to Burmese migrant families displaced in Thailand on parenting and family functioning. Participants and procedures Participants included 479 Burmese migrant families from 20 communities in Thailand. Families, including 513 caregivers an...

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Intimate partner violence (IPV) and child maltreatment (CM) by a parent or caregiver are prevalent and overlapping issues with damaging consequences for those affected. This scoping review aimed to identify opportunities for greater coordination between IPV and CM programmes in low- and middle-income countries (LMIC). Nine bibliographic databases w...

Children living in conflict-affected settings often face cognitive, physical, and social-emotional challenges that not only impact how they learn, grow, and interact with others, but also impact the wellbeing of future generations. While parents and caregivers can serve a critical role in mitigating the negative effects of crisis and conflict by pr...

Background: Globally, one in 10 children live in regions affected by armed conflict. Children exposed to armed conflict are vulnerable to social and emotional difficulties, along with disrupted educational and occupational opportunities. Most armed conflicts occur in low- and middle-income countries (LMICs), where mental health systems are limited...

Commentary on Aber et al. - Sarah Smith, Aissatou Balde, Paul Frisoli, Nina Weisenhorn, Jeannie Annan

Improving children's learning and development in conflict-affected countries is critically important for breaking the intergenerational transmission of violence and poverty. Yet there is currently a stunning lack of rigorous evidence as to whether and how programs to improve learning and development in conflict-affected countries actually work to b...

The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children livi...

This paper examines the effects of one year of exposure to ?Learning to Read in a Healing Classroom? (LRHC) on the reading and math skills of 2nd to 4th grade children in the low-income and conflict-affected Democratic Republic of the Congo. LRHC consists of two primary components: Teacher Resource Materials that infuse social-emotional learning pr...

Conflict-affected communities face poverty and mental health problems, with sexual violence survivors at high risk for both given their trauma history and potential for exclusion from economic opportunity. To address these problems, we conducted a randomized controlled trial of a group-based economic intervention, Village Savings and Loans Associat...

We show that extremely poor, war-affected women in northern Uganda have high returns to a package of $150 cash, five days of business skills training, and ongoing supervision. Sixteen months after grants, participants doubled their microenterprise ownership and incomes, mainly from petty trading. We also show these ultrapoor have too little social...

By 2009, two decades of war and widespread displacement left the majority of the population of Northern Uganda impoverished. Methods. This study used a cluster-randomized design to test the hypothesis that a poverty alleviation program would improve economic security and reduce symptoms of depression in a sample of mostly young women. Roughly 120...

This article examines the impacts of a partial year of implementation of Learning to Read in a Healing Classroom (LRHC), a curricular and social-emotional teacher professional development intervention in southeastern Democratic Republic of the Congo, on teacher professional well-being. Using a cluster-randomized control trial, this study assesses L...

Stigma related to sexual violence (SV) is associated with many negative physical and social outcomes. We sought to create a contextually relevant measure of SV-related stigma for women in the Democratic Republic of Congo (DRC) and assess itspsychometrics and validity. Using baseline screening data from two randomized controlled trials of services f...

Purpose: Little is known about whether effectiveness of intimate partner violence prevention programming varies for women who were married as child brides, given their additional social vulnerabilities. This subanalysis sought to assess treatment heterogeneity based on child marriage status for an intervention seeking to reduce intimate partner vi...

A growing body of U.S.-based research demonstrates that reproductive coercion is an important consideration regarding the negative health impacts of intimate partner violence (IPV). However, less work on IPV and reproductive coercion has been done in West African settings. Cross-sectional data of 981 women who participated in the baseline survey of...

Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically "empower" women have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of vi...

Engaging men is a critical component in efforts to reduce intimate partner violence (IPV). Little is known regarding men's perspectives of approaches that challenge inequitable gender norms, particularly in settings impacted by armed conflict. This article describes men's experiences with a women's empowerment program and highlights men's perceptio...

Objectives: We evaluated changes in social capital following group-based cognitive processing therapy (CPT) for female survivors of sexual violence. Methods: We compared CPT with individual support in a cluster-randomized trial in villages in South Kivu province, Democratic Republic of the Congo. Local psychosocial assistants delivered the inter...

Objectives were to assess associations between intimate partner violence (IPV), violence during armed conflict (i.e. crisis violence), and probable post-traumatic stress disorder (PTSD). Using a sample of 950 women in rural Côte d'Ivoire, logistic generalized estimating equations assessed associations between IPV and crisis violence exposures with...

Evidence from armed conflict settings points to high levels of intimate partner violence (IPV) against women. Current knowledge on how to prevent IPV is limited--especially within war-affected settings. To inform prevention programming on gender-based violence in settings affected by conflict, we evaluated the impact of adding a targeted men's inte...

We evaluate an agricultural training and inputs program for high-risk Liberian men, mainly ex-fighters engaged in illegal resource extraction with opportunities for mercenary work. We show that increasing farm productivity raised the opportunity cost of illicit work. After 14 months, treated men shifted from illicit extraction to agriculture, thoug...

Do the “ultra-poor” have high returns to capital or are they otherwise constrained? Impoverished Ugandans, mostly women, were experimentally offered individual business training, $150, supervision, and business advising. We evaluated the full package plus the marginal effects of components: supervision (pressure to invest); advice; and stronger soc...

Introduction: Child marriage has been associated with poor sexual and reproductive health outcomes. However, little is known about the prevalence of child marriage and its association with lifetime sexually transmitted infections (STIs) in conflict-affected regions, including Cte d'Ivoire. Methods: Data taken from a randomized controlled trial amon...

Gender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding "gender dialogue gr...

Findings from a representative survey of youth in northern Uganda suggest that former female child soldiers experience a range of distress symptoms, have initial problems reintegrating, and have fewer education and employment opportunities than males. Given the multiple layers of needs, the findings pose a question of where best to intervene. Would...

Violence against women in the aftermath of conflict represents a growing area of concern. However, little is known about violence perpetrated by a woman's in-laws and how these experiences may be related to adverse experiences during a crisis. Therefore, guided by the ecological model, the objectives of the following analysis were to (1) document a...

The international community is paying increased attention to the 25 percent of the world’s population that lives in fragile and conflict affected settings, acknowledging that these settings represent daunting development challenges. To deliver better results on the ground, it is necessary to improve the understanding of the impacts and effectivenes...

Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries. In this trial in the Democratic Republic of Congo, we rand...

Aims and scope: This article reviews the available quantitative research on psychosocial adjustment and mental health among children (age <18 years) associated with armed forces and armed groups (CAAFAG)--commonly referred to as child soldiers. Methods: PRISMA standards for systematic reviews were used to search PubMed, PsycInfo, JSTOR, and Soci...

To document the lifetime prevalence of abuse from in-laws (both nonphysical maltreatment and physical violence), the forms of in-law abuse and reproductive control, and the relationship between experiences of in-law abuse and reproductive control among partnered women in rural Côte d'Ivoire. Cross-sectional study using baseline data (October 2010)...

What are the impacts of war on the participants, and do they vary by gender? Are ex-combatants damaged pariahs who threaten social stability, as some fear? Existing theory and evidence are both inconclusive and focused on males. New data and a tragic natural quasi-experiment in Uganda allow us to estimate the impacts of war on both genders, and ass...

Little is known about the impacts of military service on human capital and labor market outcomes due to an absence of data as well as sample selection: recruits are self-selected, screened, and selectively survive. We examine the case of Uganda, where rebel recruitment methods provide exogenous variation in conscription. Economic and educational im...

The research on the determinants of mental health among refugees has been largely limited to traumatic events, but recent work has indicated that the daily hassles of living in refugee camps also play a large role. Using hierarchical linear modelling to account for refugees nested within camp blocks, this exploratory study attempted to model stress...

We investigate one of the world's most pernicious forms of exploitation: child soldiering. Most theories can be captured by a principal-agent model that incorporates punishments, indoctrination, and age-varying productivity. For rebel leaders, we show it is almost always optimal to coerce rather than re-ward children, and that leaders will tend to...

The Lord's Resistance Army is Africa’s most persistent and notorious 'terrorist' group. Led by the mysterious Joseph Kony, it has committed a series of horrific human rights abuses, including massacres and mutilations. Since the mid 1980s, it has abducted tens of thousands of people, including large numbers of children forced to train as fighters....

In war’s aftermath, many young soldiers attempt to reintegrate and reestablish their lives. Disarmament, Demobilization, and Reintegration (DDR) programs are a priority intervention for youth in postconflict countries; yet there is little evidence to suggest what aids reintegration. This research uses qualitative methodology to describe the issues...

The physical and psychological consequences of armed conflict and intimate partner violence are well documented. Less research focuses on their intersection and the linkages between domestic violence, gender-based discrimination, and the structural violence of poverty in armed conflict. This paper describes emerging themes from qualitative intervie...

Data from Uganda challenge conventional notions about the role of females during and after war. Women and girls recruited by the LRA play active roles and are not passive victims. We show how LRA treatment of females—especially strict rules against civilian rape and the use of forced marriage—serves an instrumental purpose, enhancing control of the...

At a recent Paris conference on child soldiering, the keynote speaker, French foreign minister Philippe Douste-Blazy, warned that the use of child soldiers is “a time bomb that threatens stability and growth in Africa and beyond. ” They are “lost children, ” he argued, “lost for peace and lost for the development of their countries. ” (BBC, 2007) T...

In many cases, up to a third of male youth (including children) are drawn into armed groups, making soldiering one of the world’s most common occupations for the young. Little is known, however, about the impacts of military service on human capital and labor market outcomes due to an absence of data as well as sample selection: recruits are usuall...

We describe how racial identity theory is being applied in a U.S. community through the Heritage Project (HP), a multi-leveled intervention aimed at promoting peace and social justice among schoolchildren, pre-service and in-service teachers, and parents and community members. The HP targets its attention on racial disparities in the school achieve...

This paper describes the way that counselors in northern Uganda are working to promote healing and build peace in a region plagued by war since 1986. In this area where the entire community is affected by the armed conflict, the counselors work as part of a community program. This paper attempts to describe (1) the background and nature of the nort...

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