What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries
Child and adolescent mental health (CAMH) problems are common and serious all over the world and are linked to pre-mature deaths and serious dysfunction in adult life. Effective interventions have been developed in high income countries (HIC), but evidence from low income settings is scarce and scattered. The aim of this paper is to identify the most promising interventions in the area of global CAMH.
A systematic review of all randomised controlled trials in CAMH in low and middle income countries (LAMIC) was carried out and supplemented by 1a level evidence from HIC as well as suitable information from child programme evaluations and adult studies in LAMIC.
In behavioural disorders parent training is a highly promising intervention, which can successfully improve children’s compliance and bring down rates of conduct problems significantly. In young children cognitive, emotional and behavioural development can be enhanced through nutritional supplements and by stimulation through play, praise and reading. Trauma treatments can bring positive results even in severely traumatised children, who remain in unstable living conditions. In developmental disorders, there are successful prevention strategies as well as programmes that bring children out of isolation and improve their independence. Some classroom-based interventions for adolescents have reduced symptoms of common mental disorders as well as risk taking behaviours.
While many results are still tentative the evidence suggests that it is possible to develop affordable and feasible interventions that significantly improve the lives of affected children, their families and their communities around the world.
KeywordsChild and adolescent mental health Low and middle income countries Systematic review Interventions Prevention
We thank the Centre for Global Mental Health at the Institute of Psychiatry in London and in particular Professor Martin Prince for hosting and advising HK, during the majority of this work. This gave us not only the inspiration for this article, but also helped us to be much more systematic and rigorous in our literature searches. Very special thanks also go to Professor Eric Taylor, who commented extensively on earlier drafts of this article, which led to great improvements. Stimulating discussions and comments from many colleagues including Robert Goodman, Matthew Hodes, Robert Vermeiren, AnnePauline Cohen and Elena Garralda as well as the constructive criticism of our anonymous reviewers have further shaped and improved this paper. Back in Holland great thanks go to the staff of the library of De Jutters, Den Haag, especially to Anja Bosker for help with the literature searches and to Albert Boon and Anna de Haan for technical support. Finally we thank our employers at De Jutters for giving us the time and support to do this work, for which no grants or subsidies were received and no interests are declared.
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