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

Background The 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 interventio...

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Published in:	Journal of child psychology and psychiatry Vol. 64; no. 12; pp. 1776 - 1788
Main Authors:	Alozkan‐Sever, Cansu, Uppendahl, Jana R., Cuijpers, Pim, Vries, Ralph, Rahman, Atif, Mittendorfer‐Rutz, Ellenor, Akhtar, Aemal, Zheng, Zhuoli, Sijbrandij, Marit
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-12-2023
Subjects:	Adolescent Adolescents Analysis Anxiety Child Children Clinical trials Cognitive Behavioral Therapy - methods depression Depression (Psychology) Depression - epidemiology Depression - therapy Developing Countries Effect Size Evidence Humans Intervention low‐ and middle‐income countries (LMICs) Medicin och hälsovetenskap Mental depression Meta-analysis Post traumatic stress disorder Posttraumatic Stress Disorder post‐traumatic stress disorder (PTSD) psychological interventions Psychosocial factors Psychosocial Intervention Psychotherapy - methods Public health Random effects Randomized Controlled Trials Sensitivity analysis Stress Disorders, Post-Traumatic - epidemiology Stress Disorders, Post-Traumatic - psychology Stress Disorders, Post-Traumatic - therapy Symptoms Systematic review Teenagers anxiety adolescents meta-analysis Children depression low- and middle-income countries (LMICs) post-traumatic stress disorder (PTSD) psychological interventions
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Summary:	Background The 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. Methods We 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. Results Thirty‐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). Conclusions Psychological 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.
Bibliography:	Conflict of interest statement: No conflicts declared. SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Review-1 ObjectType-Article-3 ObjectType-Undefined-4
ISSN:	0021-9630 1469-7610 1469-7610
DOI:	10.1111/jcpp.13891