WhatsApp-delivered versus in-person life skills education and mental health outcomes among internally displaced persons in Abuja, Nigeria: a two-site, nonrandomized comparative study

Abstract Armed conflict and forced displacement are associated with symptoms of post-traumatic stress, depression, and anxiety. How outcomes differ between in-person and mobile delivery of life-skills education remains uncertain. We assessed a 12‑session life‑skills intervention delivered either in person (Wassa) or via WhatsApp (Durumi) in a prospective, nonrandomized study involving 228 participants. Outcomes were assessed at baseline and weeks 12 and 18. Linear mixed-effects models estimated adjusted within-group changes and between-group differences. The primary outcome was change in post‑traumatic symptom severity, measured using the Posttraumatic Stress Disorder Checklist for DSM‑5 (PCL‑5), expressed as the Durumi‑minus‑Wassa difference from baseline to week 12. Secondary outcomes were changes in depressive and anxiety symptoms, well‑being, and resilience. At week 12, adjusted PCL-5 scores decreased by 7.22 points in Wassa and 7.60 points in Durumi. The between-group difference was −0.38 points (95% CI, −4.67 to 3.90; p = 0.86). At week 18, between-group differences were −7.83 points for PCL-5 (95% CI, −12.25 to −3.41; Holm-adjusted p = 0.004) and −3.19 points for the Patient Health Questionnaire-9 (95% CI, −4.86 to −1.53; Holm-adjusted p = 0.002). Other comparisons were nonsignificant after Holm adjustment. Follow-up completion was lower in Durumi than Wassa at weeks 12 and 18. PCL-5 scores declined in both groups by week 12, with no evidence of a between-format difference. Week 18 differences do not establish superiority because campsite and delivery format were confounded, follow-up differed, and no control group was included. Randomized trials across multiple campsites are needed to compare WhatsApp and in-person delivery.