Abstract
Where low- and middle-income countries have limited economic resources to provide individualized mental health services to people exposed to conflict, community-based interventions may be more appropriate. We aimed to evaluate community level interventions for improving mental health outcomes in Low- and Middle-income countries (LMIC). A realist review of community-based interventions (CBIs) to improve mental health for people in LMIC following conflict. Five databases (Cochrane, PubMed, PsychINFO, Medline, and CINAHL) and a manual search of individual papers. We found 1318 articles, of which 29 were selected. Out of the 29 primary articles, 19 showed successful results, 4 showed mixed results, 1 showed inconclusive results, and 1 showed unsuccessful results. After analyzing the results, we found 3 mechanisms that may influence the effectiveness of these CBIs: the use of lay community members as intervention deliverers, the application of transdiagnostic approaches, and customized outcome assessment tools. Community-based approaches to improve mental health in LMICs are rare and evidence for their effectiveness is limited. Interventions that have a wide scope, train lay mental health workers, and use contextually adapted outcome assessment tools show promise.
Highlights
In 2019, an estimated 132 million people in 142 countries were affected by war and violent conflict (WHO, 2019), of whom 87% were living in conflict-affected places, 10% were internally displaced, and 3% were refugees (Guha-Sapir et al, 2015)
Out of the 58 studies excluded in the full-text assessment, 18 were removed because they involved a non-Low- and Middle-income countries (LMIC), 13 were removed because the study included non-conflictaffected groups, and 27 were removed because the interventions did not meet the criteria of a community-based intervention
A few community-based interventions for trauma-related symptoms have been studied in the field, and even fewer have been studied in low-resource settings, according to Tyrer and Fazel (2014)
Summary
In 2019, an estimated 132 million people in 142 countries were affected by war and violent conflict (WHO, 2019), of whom 87% were living in conflict-affected places, 10% were internally displaced, and 3% were refugees (Guha-Sapir et al, 2015). According to the World Health Organization (van Ommeren, 2019), 20% of people affected by conflict experience a mental disorder and another 10% will go on to develop behaviors that negatively impact their well-being (Murthy & Lakshminarayana, 2006). Post-traumatic stress disorder (PTSD) are commonly noted in the conflict literature (van Ommeren, 2019; Kessler et al, 2014), survivors of conflict are at risk of more common mental disorders such as depression, anxiety and substance use disorders. People affected by conflict often experience multiple stressful life events including separation from family members and displacement prior to mental healthcare access (Roberts et al, 2009; Williams & Thompson, 2011). While post-traumatic stress disorder (PTSD) is the most commonly
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