Abstract
Despite increasing research and clinical interest in delivering psychosocial interventions for children affected by war, little research has been conducted on the underlying mechanisms of change associated with these interventions. This review aimed to identify these processes in order to inform existing interventions and highlight research gaps. A systematic review of reviews was conducted drawing from academic databases (PubMed, PILOTS, Cochrane Library for Systematic Reviews) and field resources (e.g. Médecins Sans Frontières and the Psychosocial Centre of the International Federation of Red Cross and Red Crescent Societies), with extracted data analysed using Thematic Content Analysis. Thirteen reviews of psychosocial or psychological interventions for children and adolescents (< 25 years old) affected by war, armed conflict or political violence were identified, covering over 30 countries worldwide. Qualitative analysis identified 16 mechanisms of change, one of which was an adverse mechanism. Themes included protection from harm, play, community and family capacity building, strengthening relationships with caregivers, improved emotional regulation, therapeutic rapport, trauma processing, and cognitive restructuring; with the adverse mechanism relating to the pathologising of normal reactions. However, only 4 mechanisms were supported by strong empirical evidence, with only moderate or poor quality evidence supporting the other mechanisms. The poor quality of supporting evidence limits what can be inferred from this review’s findings, but serves to highlight clinically informed mechanisms of change for existing and widely used non-specialist interventions in the field, which urgently need rigorous scientific testing to inform their continued practice.
Highlights
The detrimental effect on the mental health and wellbeing of children and adolescents exposed to war, armed conflict and political violence has long been established [1], and are increasingly addressed by humanitarian agencies [2, 3]
Search strategy The databases PILOTS (Published International Literature On Traumatic Stress), PubMed, and the Cochrane Library for Systematic Reviews were searched on the 25th April 2017 for reviews of any intervention for populations affected by war, published in English or French, in any country or region, and with no date restrictions
Some reviews covered countries not identified as conflict-affected within the last 9 years, this was largely due to sub-regional political violence such as in Poso, Indonesia ([34], reviewed in 15) or follow ups of historical conflicts such as the Spanish Civil War ([35], reviewed in 1)
Summary
The detrimental effect on the mental health and wellbeing of children and adolescents exposed to war, armed conflict and political violence has long been established [1], and are increasingly addressed by humanitarian agencies [2, 3]. Be it the treatment of psychiatric disorders such as Trauma-Focused Cognitive Behavioural Therapy (TFCBT) [16], the promotion of wellbeing such as Psychosocial Structured Activities [17], the prevention of mental health problems and psychiatric disorders such as the school-based intervention Overshadowing the Threat of Terrorism [18], capacity building or resilience building such as the School-Based Psychosocial Program [19], or a mixture of all or parts of these aims, muddies the waters when trying to make conclusive statements about the effectiveness of interventions This is in the context of vast diversity in countries, cultures, types of conflict and of war experience, making it conceptually difficult to group interventions together
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