Research Review: Psychological and psychosocial interventions for children and adolescents with depression, anxiety, and post‐traumatic stress disorder in low‐ and middle‐income countries – a systematic review and meta‐analysis

Author:

Alozkan‐Sever Cansu1ORCID,Uppendahl Jana R.2,Cuijpers Pim1,de Vries Ralph3,Rahman Atif4,Mittendorfer‐Rutz Ellenor5,Akhtar Aemal5,Zheng Zhuoli6,Sijbrandij Marit1

Affiliation:

1. Department of Clinical, Neuro‐ and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands

2. Chair of Social Pediatrics, TUM School of Medicine Technical University of Munich Munich Germany

3. Medical Library Vrije Universiteit Amsterdam Amsterdam The Netherlands

4. Department of Primary Care and Mental Health, Institute of Population Health University of Liverpool Liverpool UK

5. Division of Insurance Medicine, Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden

6. Faculty of Psychology and Educational Sciences KU Leuven Leuven Belgium

Abstract

BackgroundThe incidence of depression, anxiety, and post‐traumatic stress disorder (PTSD) among children and adolescents residing in low‐ and middle‐income countries (LMICs) poses a significant public health concern. However, there is variation in the evidence of effective psychological interventions. This meta‐analysis aims to provide a complete overview of the current body of evidence in this rapidly evolving field.MethodsWe conducted searches on PubMed, Embase.com, and EBSCO/APA PsycInfo databases up to June 23, 2022, identify randomized controlled trials (RCTs) investigating the effectiveness of psychological interventions in LMICs that targeted children and adolescents with elevated symptoms above a cut‐off score for depression, anxiety, and PTSD, comparing a psychological or psychosocial intervention with other control conditions. We conducted random effects meta‐analyses for depression, anxiety, and PTSD symptoms. Sensitivity analysis for outliers and high‐risk studies, and analyses for the publication bias were carried out. Subgroup analyses investigated how the intervention type, intervention format, the facilitator, study design, and age group of the participant predicted effect sizes.ResultsThirty‐one RCTs (6,123 participants) were included. We found a moderate effect of interventions on depression outcomes compared to the control conditions (g = 0.53; 95% CI: 0.06–0.99; NNT = 6.09) with a broad prediction interval (PI) (−1.8 to 2.86). We found a moderate to large effect for interventions on anxiety outcomes (g = 0.88; 95% CI: −0.03 to 1.79; NNT = 3.32) with a broad PI (−3.14 to 4.9). Additionally, a moderate effect was observed on PTSD outcomes (g = 0.54; 95% CI: 0.19–0.9; NNT = 5.86) with a broad PI (−0.64 to 1.72).ConclusionsPsychological and psychosocial interventions aimed at addressing depression, anxiety, and PTSD among children and adolescents in LMICs have demonstrated promising results. However, future studies should consider the variation in evidence and incorporate long‐term outcomes to better understand the effectiveness of these interventions.

Funder

Vetenskapsrådet

Publisher

Wiley

Subject

Psychiatry and Mental health,Developmental and Educational Psychology,Pediatrics, Perinatology and Child Health

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1. Editorial: Innovation in child and adolescent mental health interventions;Journal of Child Psychology and Psychiatry;2023-11-28

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