Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries.

Background: Mental disorders affect about one in seven children and adolescents worldwide. Investment in effective child and adolescent mental health prevention, promotion and care is essential. To date, however, the evidence from this field is yet to be comprehensively collected and mapped. Objectives: The objective of this evidence and gap map (EGM) is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in lower-middle-income countries (LMICs). Search Methods: We searched for studies from a wide range of bibliographic databases, libraries and websites. All searches were conducted in December 2021 and covered the period between 2010 and 2021. Selection Criteria: We included evidence on the effectiveness of any Mental Health and Psychosocial Support (MHPSS) interventions targeting children and adolescents from 0 to 19 years of age in LMICs. The map includes systematic reviews and effectiveness studies in the form of randomised control trials and quasi-experimental studies, and mixed-methods studies with a focus on intervention effectiveness. Data Collection and Analysis: A total of 63,947 records were identified after the search. A total of 19,578 records were removed using machine learning. A total of 7545 records were screened independently and simultaneously by four reviewers based on title and abstract and 2721 full texts were assessed for eligibility. The EGM includes 697 studies and reviews that covered 78 LMICs. Main Results: School-based interventions make up 61% of intervention research on child and adolescent mental health and psychosocial support. Most interventions (59%) focusing on treating mental health conditions rather than preventing them or promoting mental health. Depression (40%, N = 282) was the most frequently researched outcome sub-domain analysed by studies and reviews, followed by anxiety disorders (32%, N = 225), well-being (21%, N = 143), and post-traumatic stress disorder (18%, N = 125). Most included studies and reviews investigated the effectiveness of mental health and psychosocial support interventions in early (75%, N = 525) and late adolescence (64%, N = 448). Conclusions: The body of evidence in this area is complex and it is expanding progressively. However, research on child and adolescent MHPSS interventions is more reactive than proactive, with most evidence focusing on addressing mental health conditions that have already arisen rather than preventing them or promoting mental health. Future research should investigate the effectiveness of digital mental health interventions for children and adolescents as well as interventions to address the mental health and psychosocial needs of children in humanitarian settings. Research on early childhood MHPSS interventions is urgently needed. MHPSS research for children and adolescents lacks diversity. Research is also needed to address geographical inequalities at the regional and national level. Important questions also remain on the quality of the available research-is child and adolescent MHPSS intervention research locally relevant, reliable, well-designed and conducted, accessible and innovative? Planning research collaborations with decision-makers and involving experts by experience in research is essential.

Trends in mortality patterns in two countries with different welfare models: comparisons between CUBA and Denmark 1955-2020.

Cuba and Denmark represent states with different welfare models that have reached the same level of life expectancy. The purpose was to investigate and compare mortality changes in the two countries. Systematically collected information on population numbers and deaths for the entire Cuban and Danish populations was the basis of life table data used to quantify differences in the change in age-at-death distributions since 1955, age-specific contributions to differences in life expectancy, lifespan variation, and other changes in mortality patterns in Cuba and Denmark. Life expectancy in Cuba and Denmark converged until 2000, when the increase in life expectancy for Cuba slowed down. Since 1955, infant mortality has fallen in both countries but mostly in Cuba. Both populations experienced compression of mortality as lifespan variation decreased markedly, primarily due to postponement of early deaths. Given the different starting point in the mid-1900s and living conditions for Cubans and Danes, health status achieved among Cubans is striking. A rapidly ageing population is challenging both countries, but Cuban health and welfare are further burdened by a deteriorating economy in recent decades.

PROTOCOL: Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries.

This is the protocol for a Campbell review. The objective of this evidence and gap map is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in low- and middle-income countries.

Impact of social protection on gender equality in low- and middle-income countries: A systematic review of reviews.

Background: More than half of the global population is not effectively covered by any type of social protection benefit and women's coverage lags behind. Most girls and boys living in low-resource settings have no effective social protection coverage. Interest in these essential programmes in low and middle-income settings is rising and in the context of the COVID-19 pandemic the value of social protection for all has been undoubtedly confirmed. However, evidence on whether the impact of different social protection programmes (social assistance, social insurance and social care services and labour market programmes) differs by gender has not been consistently analysed. Evidence is needed on the structural and contextual factors that determine differential impacts. Questions remain as to whether programme outcomes vary according to intervention implementation and design. Objectives: This systematic review aims to collect, appraise, and synthesise the evidence from available systematic reviews on the differential gender impacts of social protection programmes in low and middle-income countries. It answers the following questions: 1.What is known from systematic reviews on the gender-differentiated impacts of social protection programmes in low and middle-income countries?2.What is known from systematic reviews about the factors that determine these gender-differentiated impacts?3.What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes? Search Methods: We searched for published and grey literature from 19 bibliographic databases and libraries. The search techniques used were subject searching, reference list checking, citation searching and expert consultations. All searches were conducted between 10 February and 1 March 2021 to retrieve systematic reviews published within the last 10 years with no language restrictions. Selection Criteria: We included systematic reviews that synthesised evidence from qualitative, quantitative or mixed-methods studies and analysed the outcomes of social protection programmes on women, men, girls, and boys with no age restrictions. The reviews included investigated one or more types of social protection programmes in low and middle-income countries. We included systematic reviews that investigated the effects of social protection interventions on any outcomes within any of the following six core outcome areas of gender equality: economic security and empowerment, health, education, mental health and psychosocial wellbeing, safety and protection and voice and agency. Data Collection and Analysis: A total of 6265 records were identified. After removing duplicates, 5250 records were screened independently and simultaneously by two reviewers based on title and abstract and 298 full texts were assessed for eligibility. Another 48 records, identified through the initial scoping exercise, consultations with experts and citation searching, were also screened. The review includes 70 high to moderate quality systematic reviews, representing a total of 3289 studies from 121 countries. We extracted data on the following areas of interest: population, intervention, methodology, quality appraisal, and findings for each research question. We also extracted the pooled effect sizes of gender equality outcomes of meta-analyses. The methodological quality of the included systematic reviews was assessed, and framework synthesis was used as the synthesis method. To estimate the degree of overlap, we created citation matrices and calculated the corrected covered area. Main Results: Most reviews examined more than one type of social protection programme. The majority investigated social assistance programmes (77%, N = 54), 40% (N = 28) examined labour market programmes, 11% (N = 8) focused on social insurance interventions and 9% (N = 6) analysed social care interventions. Health was the most researched (e.g., maternal health; 70%, N = 49) outcome area, followed by economic security and empowerment (e.g., savings; 39%, N = 27) and education (e.g., school enrolment and attendance; 24%, N = 17). Five key findings were consistent across intervention and outcomes areas: (1) Although pre-existing gender differences should be considered, social protection programmes tend to report higher impacts on women and girls in comparison to men and boys; (2) Women are more likely to save, invest and share the benefits of social protection but lack of family support is a key barrier to their participation and retention in programmes; (3) Social protection programmes with explicit objectives tend to demonstrate higher effects in comparison to social protection programmes without broad objectives; (4) While no reviews point to negative impacts of social protection programmes on women or men, adverse and unintended outcomes have been attributed to design and implementation features. However, there are no one-size-fits-all approaches to design and implementation of social protection programmes and these features need to be gender-responsive and adapted; and (5) Direct investment in individuals and families' needs to be accompanied by efforts to strengthen health, education, and child protection systems. Social assistance programmes may increase labour participation, savings, investments, the utilisation of health care services and contraception use among women, school enrolment among boys and girls and school attendance among girls. They reduce unintended pregnancies among young women, risky sexual behaviour, and symptoms of sexually transmitted infections among women. Social insurance programmes increase the utilisation of sexual, reproductive, and maternal health services, and knowledge of reproductive health; improve changes in attitudes towards family planning; increase rates of inclusive and early initiation of breastfeeding and decrease poor physical wellbeing among mothers. Labour market programmes increase labour participation among women receiving benefits, savings, ownership of assets, and earning capacity among young women. They improve knowledge and attitudes towards sexually transmitted infections, increase self-reported condom use among boys and girls, increase child nutrition and overall household dietary intake, improve subjective wellbeing among women. Evidence on the impact of social care programmes on gender equality outcomes is needed. Authors' Conclusions: Although effectiveness gaps remain, current programmatic interests are not matched by a rigorous evidence base demonstrating how to appropriately design and implement social protection interventions. Advancing current knowledge of gender-responsive social protection entails moving beyond effectiveness studies to test packages or combinations of design and implementation features that determine the impact of these interventions on gender equality. Systematic reviews investigating the impact of social care programmes, old age pensions and parental leave on gender equality outcomes in low and middle-income settings are needed. Voice and agency and mental health and psychosocial wellbeing remain under-researched gender equality outcome areas.

Towards an integrated model for supervision for mental health and psychosocial support in humanitarian emergencies: A qualitative study.

BACKGROUND: Despite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies. METHODS: Semi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group. RESULTS: Results reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees' wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision. CONCLUSION: An integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process.

Patterns of childhood adversity and their associations with internalizing and externalizing problems among at-risk boys and girls.

BACKGROUND: Different types of childhood adversity often cluster and overlap, underlining the importance of studying likely patterns of adversity co-occurrences and their impact on child functioning. Further sex-specific investigations of adversity co-occurrences and their associations with child mental health are warranted. OBJECTIVE: To investigate if different sex-specific patterns of childhood adversity exist among at risk-children living in Denmark and to explore if divergent constellations of adversity are differentially associated with externalizing and internalizing problems. PARTICIPANTS AND SETTING: Participants (N = 2198) were a sample of children ages 1-17 who have been in contact with the Danish child protection system due to suspected child abuse. The study included existing data collected as a part of child case procedures. METHOD: Latent class analysis was used to identify patterns of adversity co-occurrences among girls and boys, respectively. Inter-class differences on age and child mental health were assessed using ANOVAs. RESULTS: Greater variation and complexity in adversity exposure was found among girls (5 classes) compared to boys (3 classes). The female classes differed on age (p < .001, η2 = 0.06), internalizing (p < .001, η2 = 0.05), and externalizing problems (p = .002, η2 = 0.02). The male classes differed on internalizing (p < .001, η2 = 0.02) and externalizing problems (p < .001, η2 = 0.04). Overall, classes characterized by multiple adversities displayed higher scores of mental health problems compared to less exposed classes. CONCLUSIONS: Exposure to multiple adversities is common among at-risk children. Information on different sex-specific patterns of adversity co-occurrences can guide intervention planning for affected children.

PROTOCOL: Impact of social protection on gender equality in low- and middle-income countries: A systematic review of reviews.

This is the protocol for a Campbell review. The review aims to systematically collect, appraise, map and synthesise the evidence from systematic reviews on the differential gender impacts of social protection programmes in Low- and Middle-Income Countries (LMICs). Therefore, it will answer the following questions: (1) What is known from systematic reviews on the gender-differentiated impacts of social protection programmes in LMICs? (2) What is known from systematic reviews about the factors that determine these gender-differentiated impacts? (3) What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes?

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings.

BACKGROUND: Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. METHODS: The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. RESULTS: The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols. CONCLUSION: The proposed four-step process offers a useful guide for how to adapt low-intensity psychological intervention within humanitarian settings. Despite some limitations, we show that even when time and resources are scarce it is possible and necessary to culturally adapt psychological interventions. We invite further testing, replication, and improvements to this methodology.

Polyvictimization and psychopathology among children and adolescents: A systematic review of studies using the Juvenile Victimization Questionnaire.

BACKGROUND: Exposure to child abuse can lead to lasting mental health problems. Extant research has found that different types of child abuse tend to co-occur and overlap, which merits the investigation of the effects of exposure to multiple types of childhood mistreatment. OBJECTIVE: The aim of this study was to systematically review the evidence on the associations between multiple different types of interpersonal victimization or polyvictimization, and indicators of psychopathology among children ages 0-17. METHODS: The review included studies across all economic strata and research on nationally representative, community, and at-risk samples, using the same standardized assessment tool (i.e. the Juvenile Victimization Questionnaire or JVQ). The review was conducted using peer-reviewed evidence published up until August 2019 from Scopus, EMBASE, PsycINFO, Medline, CINAHL, and ERIC. Out of 4998 relevant references screened, 255 met the inclusion criteria, 22 of which aimed to address childhood polyvictimization and psychopathology. RESULTS: A total of 21 of the 22 included studies identified a significant positive association between polyvictimization and various indicators of psychopathology comprising both externalizing (e.g. anger), internalizing problems (e.g. depression) and total psychological distress. A range of studies demonstrated that polyvictimization was a stronger risk factor for psychopathology than individual (sub)types of victimization. Based on the study findings, we provide a set of recommendations for future research on polyvictimization and psychopathology. CONCLUSION: The present systematic review was the first to review the evidence on the associations between polyvictimization (as measured by the JVQ) and child and adolescent psychopathology in the global research literature. As a novel approach, the present review included both normative and high-risk samples. The results showed that polyvictimization is a substantial risk factor for mental health problems spanning both inner-directed and outer-directed mental health difficulties. However, the inconsistency in methods of defining and measuring polyvictimization severely undermines the scientific impact of this body of work. Additional well-designed, longitudinal studies that take account of the context-specific nature of polyvictimization are required to better establish the causal relationships between childhood polyvictimization and psychopathology so as to improve prevention and intervention efforts.

Females have more complex patterns of childhood adversity: implications for mental, social, and emotional outcomes in adulthood.

Background: Adverse childhood experiences (ACEs) have been identified as an important public health problem with serious implications. Less well understood is how distinct configurations of childhood adversities carry differential risks for mental health, emotional, and social outcomes later in life. Objective: To determine if distinct profiles of childhood adversities exist for males and females and to examine if unique associations exist between the resultant latent profiles of childhood adversities and multiple indicators of mental health and social and emotional wellbeing in adulthood. Method: Participants (N = 1,839) were a nationally representative household sample of adults currently residing in the USA and the data were collected via online self-report questionnaires. Latent class analysis was used to identify the optimal number of classes to explain ACE co-occurrence among males and females, separately. ANOVAs, chi-square tests, and t-tests were used to compare male and female classes across multiple mental health, emotional, and social wellbeing variables in adulthood. Results: Females were significantly more likely than males to report a range of ACEs and mental health, social, and emotional difficulties in adulthood. Two- and four-class models were identified as the best fit for males and females, respectively, indicating more complexity and variation in ACE exposures among females. For males and female, ACEs were strongly associated with poorer mental health, emotional, and social outcomes in adulthood. Among females, growing up in a dysfunctional home environment was a significant risk factor for adverse social outcomes in adulthood. Conclusions: Males and females have distinct patterns of childhood adversities, with females experiencing more complex and varied patterns of childhood adversity. These patterns of ACEs were associated with numerous negative mental, emotional, and social outcomes among both sexes.

Antecedentes: Las experiencias adversas infantiles (ACEs en su sigla en inglés) se han identificado como un problema de salud pública importante, con serias implicaciones. Menos comprendido es el cómo distintas configuraciones de adversidades infantiles acarrean riesgos diferenciales para los resultados de salud mental, emocional y social.Objetivo: Determinar si existen distintos perfiles de adversidades infantiles para hombres y para mujeres y examinar si existen asociaciones únicas entre los perfiles latentes resultantes de adversidad infantil y múltiples indicadores de salud mental y bienestar social y emocional en la adultez.Método: Los participantes (N = 1,839) fueron una muestra representativa de hogares de adultos actualmente residiendo en los Estados Unidos y los datos se recolectaron en cuestionarios de auto-reporte vía online. El análisis de clases latentes se utilizó para identificar el número óptimo de clases que explican la co-ocurrencia de ACEs entre hombres y mujeres, separadamente. Se empleó pruebas de ANOVA, chi-cuadrado y t para comparar clases de hombres y mujeres a través de múltiples variables de salud mental y bienestar social y emocional en la adultez.Resultados: Las mujeres fueron significativamente más propensas que los hombres a reportar un rango de ACEs y dificultades de salud mental y dificultades sociales y emocionales en la adultez. Modelos de dos y cuatro clases se identificaron como los de mejor ajuste para hombres y mujeres, respectivamente, indicando mayor complejidad y variación de exposición a ACEs en las mujeres. Para hombres y mujeres, las ACEs se asociaron fuertemente a resultados más pobres en salud mental, emocionales y sociales en la adultez. En las mujeres, crecer en un ambiente de hogar disfuncional fue un factor de riesgo significativo para resultados sociales adversos en la adultez.Conclusiones: Los hombres y mujeres tienen distintos patrones de adversidad infantil, en tanto las mujeres experimentan más complejos y variados patrones de adversidad infantil. Estos patrones de ACEs se asociaron con numerosos resultados negativos mentales, emocionales y sociales entre ambos sexos.

Health expectancies among non-white and white populations living in Havana, 2000-2004.

This study explored the role of skin color in health expectancies by computing average lifetime in self-rated good health and lifetime without functional limitations in activities of daily living (ADL) among non-white and white 60+ adults living in Havana (Cuba) in 2000-2004. The Sullivan method was used to estimate health expectancies. The contributions from the mortality and health effect to the differences in health expectancies were assessed by decomposition. White males aged 60 were expected to live longer in self-rated good health than non-white males, white and non-white females. Most of the differences among males are attributed to the health effect. No differences were found between white and non-white females in expected lifetime in moderate to full ADL functioning while a difference in ADL functioning of 0.8 years favored white over non-white males. The mortality effect accounted for most difference across the two male groups. From age 80, both non-white groups could expect to live longer than their white counterparts. The results showed that skin color is a risk marker of mortality and morbidity among older adults living in Havana. Although health behaviors vary, the differences were not anticipated due to high social equity and equal health care provision in Cuba. This finding calls for further research on health expectancies by skin color that is representative of the Cuban population and includes information on different diseases and conditions.

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT).

In this paper we present a description of the Horizon2020, Marie Sklodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology.

En este artículo presentamos una descripción de un nuevo programa de investigación y formación, Horizon2020, con fondos de Marie Sklodowska-Curie Action, llamado CONTEXT o 'Red coordinadora para la formación y la excelencia en psicotraumatología'. Se presentan los tres objetivos del programa y cada uno de los cuales hace referencia a un componente clave del programa CONTEXT. Primero, resumimos los doce proyectos individuales de investigación que se llevarán a cabo en tres poblaciones prioritarias: (i) refugiados y solicitantes de asilo, (ii) personal de respuesta en emergencias y (iii) perpetradores y sobrevivientes de violencia infantil y de género. En segundo lugar, detallamos el programa de tutoría y formación, eje central de CONTEXT. Finalmente, describimos cómo la investigación, junto con la formación, contribuirá a una mejor política, directrices y práctica en el campo de la psicoterapia.