Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: systematic review

Abstract

Background Millions of children and adolescents are exposed to wars, affecting their psychological well-being. This review focuses on psychosocial interventions in low and middle-income countries (LMICs) in the Middle East, where mental health services are limited. Aims Our primary aim was to evaluate the effectiveness of trial-assessed psychosocial interventions in reducing post-traumatic stress disorder (PTSD) symptoms in children and adolescents aged ≤18 years who were exposed to war in LMICs in the Middle East. Changes in other psychological conditions and symptoms were evaluated where reported. Method PubMed, Cochrane Library and Ovid were searched without year restriction, in December 2021. Previous review reference lists were also checked. Only studies published in English were included. Each study was evaluated for risk of bias and results are presented as a narrative synthesis. Results Three group-based interventions were identified and evaluated across six studies: ‘Teaching Recovery Techniques’, ‘Writing for Recovery’ and ‘Advancing Adolescents’. Two studies took place in post-war settings, and four in a context of ongoing conflict. Positive experiences and improved social skills were indicated following most interventions, but Teaching Recovery Techniques was the only programme associated with a statistically significant reduction in PTSD score. Differences in follow-up interval limited comparability of outcomes. Conclusions This review highlights a paucity of evidence for effective treatment options for children and adolescents affected by war from LMICs in the Middle East. Promising indications of reductions in PTSD symptoms, specifically from Teaching Recovery Techniques, require further rigorous evaluation and long-term follow-up.

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis

“…Thereby, they are at particular risk for the onset and persistence of mental disorders (Fazel et al, 2012 ), making mental health promotion and prevention of mental symptoms a priority in this age group (World Health Organization, 2018 ). Our findings tie in with a recent meta-analysis on the efficacy of psychotherapies for PTSD and depression in forcibly displaced children and adolescents finding no evidence for an effect favouring psychotherapies over control conditions (Morina & Sterr, 2019 ) and another review finding symptom reductions only for one out of three programmes (Alzaghoul et al, 2022 ). These results raise the question of what may account for these null effects.…”

“…Thus, based on our findings we cannot answer the question of what makes these interventions ineffective. However, the weak evidence – in line with previous reviews (Alzaghoul et al, 2022 ; Soltan et al, 2020 ; Soltan et al, 2022 ; Morina & Sterr, 2019 ) – points to the urgent need to critically evaluate and improve interventions for young forcibly displaced persons and to rigorously test their efficacy and (their likely questionable) cost-effectiveness. In case, a more solid evidence base provides support for the finding that existing interventions have no favourable effects for children/adolescents, care providers need to respond with adapting existing programmes or develop new evidence-based prevention programmes.…”

Brief psychological interventions to improve mental health outcomes in refugee populations: A systematic review

“…Subgroup analysis of age groups revealed no evidence for favourable effects of the brief CBT-based psychological interventions in children and adolescents compared with adults, in line with previous findings 22,43,44 . This is concerning given the high prevalence of mental health problems in forcibly displaced children and adolescents 9,45 , as well as evidence that evidence suggests that early interventions for children and adolescents can prevent long-term psychological problems 46,47 .…”

Training non-specialists in teaching recovery techniques (TRT) to help traumatised children in humanitarian settings: a qualitative analysis of experiences gained from 20 years of practice

“…Several guidelines and manuals suggest the form and content for such support [ 11 ], such as Skills for Psychological Recovery: Field Operations Guide IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings [ 12 , 13 ] and The mhGAP Intervention Guide Module [ 14 , 15 ]. Although the guidelines might differ in form and focus, there seems to be broad agreement on certain core principles, including ‘do no harm’, human rights and integrated services.…”