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 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.

Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol.

Background: Refugee youth experience hardships associated with exposure to trauma in their homelands and during and after displacement, which results in higher rates of common mental disorders. The World Health Organization (WHO) developed Problem Management Plus (PM+), a non-specialist-delivered brief psychological intervention, for individuals who have faced adversity. PM+ comprises problem-solving, stress management, behavioural activation and strengthening social support. However, it does not include an emotional processing component, which is indicated in trauma-exposed populations. Objective: This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and acceptability of PM+, adapted to Syrian, Eritrean and Iraqi refugee youth residing in the Netherlands, with and without a newly developed Emotional Processing (EP) Module. Methods: Refugee youth (N = 90) between 16 and 25 years of age will be randomized into PM+ with care-as-usual (CAU), (n = 30), PM+ with Emotional Processing (PM+EP) with CAU (n = 30) or CAU only (n = 30). Inclusion criteria are self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 > 16). Participants will be assessed at baseline, one-week post-intervention and three-month follow-up. The main outcome is the feasibility and acceptability of the adapted PM+ and PM+EP. The secondary outcomes are self-reported psychological distress, functional impairment, post-traumatic stress disorder (PTSD) symptom severity and diagnosis, social support, and self-identified problems. The pilot RCT will be succeeded by a process evaluation including trial participants, participants' significant others, helpers, and mental health professionals (n = 20) to evaluate their experiences with the PM+ and PM+EP programmes. Results and Conclusion: This is the first study that evaluates the feasibility of PM+ for this age range with an emotional processing module integrated. The results may inform larger RCTs and implementation of PM+ interventions among refugee youth. Trial Registration: Registered to Dutch Trial Registry, NL8750, on 3 July 2020. Medical Ethical Committee of the Amsterdam University Medical Centre, location Vrije Universiteit Medical Centre, Protocol ID: 2020.224, 1 July 2020.

Antecedentes: Los jóvenes refugiados experimentan dificultades relacionadas con la exposición al trauma en sus países de origen, tanto durante como después del desplazamiento. Esto resulta en tasas más elevadas de trastornos mentales comunes. La Organización Mundial de la Salud (OMS) desarrolló el programa Enfrentando Problemas Plus (EP+), una intervención psicológica breve brindada por personal no especializado para individuos que han sido expuestos a la adversidad. EP+ abarca la resolución de problemas, el manejo del estrés, la activación conductual y el fortalecimiento del soporte social. Sin embargo, no incluye un componente de procesamiento emocional, el cual es indicado en poblaciones expuestas al trauma.Objetivo: Este piloto de un ensayo clínico controlado y aleatorizado (ECA) tiene como objetivo evaluar la viabilidad y la aceptabilidad de EP+ adaptado para jóvenes refugiados sirios, eritreos e iraquíes que residen en los Países Bajos, con y sin un módulo de Procesamiento Emocional (PE) recientemente desarrollado.Métodos: Se aleatorizará a un grupo de refugiados jóvenes (N= 90) de entre 16 a 25 años a un grupo EP+ con atención habitual (AH), (n= 30), a un grupo EP+ con Procesamiento Emocional (EP+PE) con AH (n= 30), o un grupo de solamente AH (n= 30). Los criterios de inclusión son el completar los cuestionarios de autoreporte de malestar psicológico (Escala de Malestar Psicológico de Kessler; K10 >15) y de deterioro del funcionamiento diario (Cuestionario de Evaluación de la Discapacidad de la OMS; WHODAS 2.0 >16). Los participantes serán evaluados al inicio del estudio, una semana después de la intervención y a los 3 meses del seguimiento. El resultado principal es la viabilidad y aceptabilidad del programa EP+ adaptado y del EP+PE. Los resultados secundarios son el autoreporte de malestar psicológico, la discapacidad funcional, los síntomas de severidad y diagnóstico del trastorno de estrés postraumático (TEPT), el soporte social y los problemas autoidentificados. Luego de concluido el piloto del ECA, se procederá a una evaluación del proceso que incluirá a los participantes del ensayo, a las personas significativas de los participantes, a los colaboradores y a los profesionales de la salud mental (n=20) para evaluar sus experiencias con los programas EP+ y EP+PE.Resultados y conclusiones: Este es el primer estudio que evalúa la viabilidad de EP+ para este grupo de edad y con un módulo integrado de procesamiento emocional. Los resultados pueden brindar información al elaborar ECAs más grandes y a la implementación de intervenciones de EP+ entre jóvenes refugiados.

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

BACKGROUND: In low- and middle-income countries, rates of common mental health disorders are found to be very high among children and adolescents while individuals, particularly in these countries, face barriers to mental health care. In the recent years, randomized controlled trials (RCTs) have been conducted that implemented and tested different psychological and psychosocial treatment approaches to treat common mental disorders. This review aims to analyze psychological interventions among children and adolescents in low- and middle-income countries. METHODS: RCTs carried out in low- and middle-income countries on psychological and psychosocial interventions for children and adolescents with symptoms of trauma- and stressor related disorders, depression or anxiety were identified in bibliographic databases. Databases were systematically searched until December 14, 2018. Effect sizes indicating differences between treatment and control groups at post-test were computed using a random-effects model. Outcomes were symptoms of depression, anxiety and posttraumatic stress disorder (PTSD). RESULTS: Thirteen studies with a total of 2,626 participants aged between 5 and 18 years were included. Treatments varied between studies and number of treatment sessions ranged from 1 to 16. The pooled effect size, combining outcomes of depression, anxiety and PTSD of psychological or psychosocial intervention versus care-as-usual or a control conditions yielded a medium effect (g = 0.62; 95% CI: 0.27-0.98). Heterogeneity was very high (I2 = 94.41; 95% CI = 80-91). The beneficial effect of interventions increased after excluding outliers (g = 0.72; 95% CI: 0.37-1.07), while heterogeneity remained high (I2 = 86.12; 95% CI = 87-94). CONCLUSION: High quality RCTs investigating the effect of psychological and psychosocial interventions on PTSD, depression and anxiety among children and adolescents in low- and middle-income countries are scarce. Results of the available studies may suggest that psychological and psychosocial interventions might be more effective in reducing symptoms of anxiety, depression and PTSD compared to control conditions. Due to very high heterogeneity, this evidence must be considered with caution.