Mechanisms of Change for Interventions Aimed at Improving the Wellbeing, Mental Health and Resilience of Children and Adolescents Affected by War and Armed Conflict: A Systematic Review of Reviews

Tania Josiane Bosqui and Bassam Marshoud

Conflict and Health (2018) 12:15


Children and adolescents exposed to war, armed conflict or political violence have higher prevalence of psychiatric disorders, e.g. Posttraumatic Stress Disorder, depression and anxiety. They also experience cognitive, emotional and behavioral impacts, such as externalizing (e.g. aggression), internalizing (e.g. self-harm) and toxic stress. This report identifies mechanisms of change associated with psychosocial interventions for children and adolescents affected by war, armed conflict or political violence:

  • Basic services and security: (1) creating a protective environment; and (2) playing.
  • Strengthening family and community support: (3) community capacity building; (4) increasing social support; (5) family and caregiver capacity building; (6) family and caregiver relationship strengthening; and (7) engaging with values, traditions, beliefs, and ideologies.
  • Focused non-specialist support: (8) learning about the presenting problem, medication, and how to access services; (9) learning stress management skills; (10) emotional regulation and bearing negative emotions (pschoeducation); (11) problem solving; and (12) learned helpfulness.
  • Specialist support: (13) pathologizing normal reactions (adverse mechanism), which can be avoided by combining psychosocial interventions with basic health and welfare interventions; (14) trauma processing; (15) restructuring unhelpful cognitions and appraisals; and (16) therapeutic rapport.

Only four mechanisms were supported by strong empirical evidence (family and caregiver capacity building, family and caregiver relationship strengthening, problem solving, and therapeutic rapport). The poor quality of supporting evidence limits what can be inferred from this review’s findings. The poor coverage of conflict-affected countries and regions limits the generalizability of research findings to these settings. The authors conclude that existing and widely used non-specialist interventions in the field urgently need rigorous scientific testing to inform their continued practice.




Health | Mental Health