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

• 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
• ISSN: 0021-9630; 1469-7610; 1469-7610
• DOI: 10.1111/jcpp.13891

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.