Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries

Abstract

Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators. We searched 9 international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including posttraumatic stress disorder [PTSD] and obsessive-compulsive disorder), depression, conduct problems, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at posttreatment and follow-up for intervention vs control conditions. Of 5,145 articles identified, 34 articles (with 43 treatment-control comparisons and 4,176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI= 0.72-1.29, p< .001) at posttreatment and 0.68 (95% CI= 0.29-1.07, p= .003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay providers (g= 1.59 vs 0.53), butall interventions for conduct problems were delivered by professionals, and thedifferenceforinterventions targeting internalizing problems(g = 1.33 vs .53) was not significant.Interventions developed non-locally were more effective if they were not adapted to local contexts than if they were adapted locally (g= 2.31 vs 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified. Overall, pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs, as well as a need for more RCTs and improved study quality. Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries (LMICs): A Systematic Review and Meta-Analysis of Randomized Clinical Trials; https://www.crd.york.ac.uk/PROSPERO/; CRD42021240031.