Randomized studies on the effectiveness of focused psychosocial support interventions for children exposed to traumatic events in humanitarian settings in low-income countries have generated conflicting results. Evaluations of school-based interventions have found promising improvements in child mental health, including reduced distress symptoms and increased protective factors, such as peer and family support. However, results have been inconsistent across settings, with different results for specific subgroups (by gender, age, or previous trauma exposure) or outcomes.
This paper provides a detailed assessment of the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in humanitarian settings in low-income and middle-income countries (LMICs), and identifies which children are likely to benefit most from these interventions. The assessment covers interventions for both displaced and non-displaced children, permitting comparisons between these two groups. Interventions tend to involve techniques from evidence-based psychotherapeutic interventions (for example, cognitive behavioral therapy) but do not follow complete standard treatment protocols (for example, trauma-focused cognitive behavioral therapy including exposure-based techniques). They also tend to include additional techniques aimed at establishing strengths, such as creative expressive techniques (drama, dance, music, art, and games), social support-building activities (cooperative games, trust-focused activities, sharing difficulties, and coping methods), or mind–body oriented skills (meditation and breathing exercises).
The analysis is based on a systematic review and meta-analysis of individual participant data (IPD) from 3,143 children recruited to 11 randomized controlled trials of focused psychosocial support interventions in children exposed to traumatic events in LMICs, compared with children on waiting lists (so-called ‘inactive controls’). The studies recruited participants in Africa (two studies in Uganda, one study in Sierra Leone, Rwanda, Burundi, Democratic Republic of the Congo), Kosovo, Gaza, Nepal, Sri Lanka, and Indonesia.
The main outcomes examined were continuous scores in PTSD symptoms, depressive symptoms, and anxiety symptoms assessed with rating scales administered immediately (0–4 weeks) after the intervention. Secondary outcomes included: strengths (coping, hope, and social support); functional impairment; and PTSD symptoms, depressive symptoms, and anxiety symptoms assessed at follow-up (6 weeks after the end of the intervention or later). The meta-analysis of individual participant data groups children by age, gender, displacement status, regions, and household size, in order to identify which children are likely to benefit most from interventions.
Key findings:
- Focused psychosocial support interventions had a small, beneficial effect on PTSD symptoms (at 0-4 weeks after intervention). This beneficial effect was reduced but still significant at follow-up at least six weeks after the intervention was completed. There wasn’t any effect found on depressive and anxiety symptoms at either the end of the intervention or at follow-up.
- Focused psychosocial support interventions had a beneficial effect on functional impairment. There were also significant positive effects on hope, coping, and social support (at 0-4 weeks after intervention).
- Interventions were effective across gender, age, and displacement status, but were more effective for particular subgroups, i.e. children aged 15–18 years, non-displaced children, and children living in smaller households. There weren’t any different benefit effects by gender. Additionally, no difference between interventions was identified for depressive symptoms and anxiety symptoms at endpoint and follow up for the different groups, except that focused psychosocial support interventions were associated with a significant improvement in anxiety symptoms at endpoint in the subgroup of displaced people.
The authors conclude that focused psychosocial interventions are effective in reducing PTSD and functional impairment, and in increasing hope, coping, and social support. The authors recommend that future studies focus on strengthening interventions for younger children, displaced children, and children living in larger households.