A sport-for-protection program reduces suicidal ideation in youth affected by displacement: a secondary analysis of the Game Connect trial in Uganda

Kathleen Latimer¹Rita Larok²John Paul Nyeko²Bashir Lukungu³Simon Rosenbaum⁴Lydia Murungi²Robinah Nannungi²Jeroen Carrin¹Esther Nanfuka Kalule³Ronald Luwangula³Davy Vancampfort^5*

• ¹Olympic Refuge Foundation, Lausanne, Switzerland
• ²Association of Volunteers in International Service, Kampala, Uganda
• ³Makerere University, Kampala, Central Region, Uganda
• ⁴University of New South Wales, Kensington, New South Wales, Australia
• ⁵KU Leuven, Leuven, Belgium

Introduction: Displaced youth face numerous stressors and are at high risk of experiencing suicidal ideation. Sport-for-protection programs offer a potentially effective strategy to reduce this risk; however, randomized controlled trials (RCTs) evaluating interventions in displacement contexts are lacking.Methods: Displaced youth and youth from host communities in five humanitarian settings across Uganda, aged 15 to 24 years, with at least mild symptoms of anxiety and/or depression and suicidal ideation, were randomized to a 13-session sport-for-protection program or a wait-list control. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9, adolescent version (PHQ-9-A) were assessed pre- and post-intervention. Logistic and linear regression modeling were conducted.Results: In total, 542 of 817 young people (66.3%) reported suicidal ideation (PHQ-9-A ≥1) in the past 2 weeks. Of these 542, 277 were randomized to the experimental group and 265 to the control group. The median age was 19.0 years, 45.6% were boys, 13.1% had a self-reported or observed disability, 25.8% were from host communities, and 74.2% were displaced youth. The prevalence of suicidal ideation dropped to 11.5% following the sport-for-protection intervention, compared to 53.2% in the control group (Cohen’s h = 0.94, P<0.001, indicating a large difference; odds ratio for no suicidal ideation following sport-for-protection vs the control condition = 8.7, 95% confidence interval = 5.6-13.5).Conclusion: Sport-for-protection is an effective stand-alone or adjunctive intervention to reduce suicidal ideation among young people affected by displacement in humanitarian settings.