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.