Interventions for Children Affected by Armed Conflict: a Systematic Review of Mental Health and Psychosocial Support in Low- and Middle-Income Countries

Abstract

Over one billion children under the age of 18 live in countries affected by armed conflict. This systematic review replicates an earlier study, aiming to provide a comprehensive update of the most current developments in interventions for children affected by armed conflict. For the period 2009–2015, a total of 1538 records were collected from PubMed, PsycINFO, and PILOTS. Twenty-four studies met the inclusion criteria, and the included interventions involve data from 4858 children. Although the number of publications and level of evidence has improved since the previous review, there is still a general lack of rigor and clarity in study design and reported results. Overall, interventions appeared to show promising results demonstrating mostly moderate effect sizes on mental health and psychosocial well-being. However, these positive intervention benefits are often limited to specific subgroups. There is a need for increased diversification in research focus, with more attention to interventions that focus at strengthening community and family support, and to young children, and improvements in targeting and conceptualizing of interventions.

Psychological and Psychosocial Interventions for PTSD, Depression and Anxiety Among Children and Adolescents in Low- and Middle-Income Countries: A Meta-Analysis

“…The majority of the reviews that have previously been conducted to test which of these psychological treatments are most effective focused on children and adolescents who witnessed or experienced adverse events through war or humanitarian crisis (11,13,15,16). However, these reviews did not take into account the general population of children and adolescent in low-and middle-income countries.…”

Annual Research Review: Breaking cycles of violence – a systematic review and common practice elements analysis of psychosocial interventions for children and youth affected by armed conflict

“…A growing body of research has documented that evidence‐based interventions developed in high‐income countries can be effective across cultures in LMICs (Barry, Clarke, Jenkins, & Patel, ; Patel, Araya, et al., ) and in conflict‐affected areas (Betancourt, Meyers‐Ohki, Charrow, & Tol, ; Jordans, Pigott, & Tol, ; OʼSullivan, Bosqui, & Shannon, ; Tol et al., ). Two recent systematic reviews of children and adolescents affected by armed conflict have highlighted promising effects of interventions, particularly trauma‐focused cognitive behavioral therapy (CBT) for clinical populations (Jordans et al., ; OʼSullivan et al., ). Yet there is less consistent evidence for other intervention modalities and for nonclinical populations.…”

Children in the 2015 South Indian floods: community members’ views

“…Interventions developed to suit this population would benefit from attuning to this attitude to mental health and design interventions adapted to this context. Cultural adaptation and keeping contextual factors at the heart of an intervention align with much of resilience research (Masten, 2014; Ungar et al, 2013), including helping children to build resilience in conflict and complex emergency settings (Jordans et al, 2016; Tol, Song, & Jordans, 2013). …”

“…Any intervention that aims to foster resilience needs to have a multisystemic approach (Masten, 2014) in order to be effective, accounting for the complexity of children’s environment, their experiences and other factors across various systems: biological, micro, meso, exo, macro and chrono (Ungar, Ghazinour, & Richter, 2013). A systematic review found that interventions that were culturally and contextually adapted resulted in creating a more positive impact on the recipients and their communities (Jordans, Pigott, & Tol, 2016). …”