Abstract
Purpose
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.
Method
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.
Results
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.
Conclusions
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.
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References
Belfer ML (2008) A global perspective on child and adolescent mental health. Editorial Int Rev Psychiatry 20:215–216. doi:10.1080/09540260802028967
Rescorla LA, Achenbach TM, Ivanova MY et al (2007) Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries. J Consul Clin Psych 75:351–358. doi:10.1037-0022-006X.75.2.351
Rescorla LA, Achenbach TM, Ivanova MY et al (2007) Behavioral and emotional problems reported by parents of children ages 6 to 16 in 31 societies. J Emot Behav Disord 15:130–142. doi:10.1177/10634266070150030101
Giel R, De Arango MV, Climent CE et al (1981) Childhood mental disorders in primary health care: results of observations in four developing countries. Pediatrics 68:677–683
Patel V, Flisher AJ, Hetrick S, McGorry P (2007) Mental health of young people: a global public-health challenge. Lancet 369:1302–1313. doi:10.1016/S0140-6736(07)60368-7
Collins PY, Patel V, Joestl SS et al (2011) Grand challenges in global mental health. Nature 475:27–30. doi:10.1038/475027a
Patel V, Araya R, Chatterjee S et al (2007) Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 370:991–1005. doi:10.1016/S0140-6736(07)61240-9
Anand S, Hanson K (1997) Disability-adjusted life years: a critical review. J Health Econ 16:685–702. doi:10.1016/S0167-6296(97)00005-2
The World Bank Group (2011) http://data.worldbank.org/about/country-classifications/country-and-lending-groups. Accessed 09 sep 2011
Polanczyk G, De Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948. doi:10.1176/appi.ajp.164.6.942
Rowe R, Maughan B, Goodman R (2004) Childhood psychiatric disorder and unintentional injury: findings from a national cohort study. J Pediatr Psychol 29:119–130. doi:10.1093/jpepsy/jsh015
Fayyad JA, Sadek M, Cordahi C (2001) Attention deficit hyperactivity disorder (ADHD). In: Okasha A, Maj M (eds) Images in psychiatry: an Arab perspective. World Psychiatric Association, Cairo, pp 167–174
Fayyad JA, Farah L, Cassir Y, Salamoun MM, Karam EG (2010) Dissemination of an evidence-based intervention to parents of children with behavioral problems in a developing country. Eur Child Adolesc Psychiatry 19:629–636. doi:10.1007/s00787-010-0099-3
Donenberg GR, Pao M (2005) Youths and HIV/AIDS: psychiatry’s role in a changing epidemic. J Am Acad Child Adolesc Psychiatry 44:728–747. doi:10.1097/01.chi.0000166381.68392.02
Hong L, Yufeng W, Agho K, Jacobs J (2011) Preventing behavior problems among elementary schoolchildren: impact of a universal school-based program in China. J Sch Health 81:273–280. doi:10.1111/j.1746-1561.2011.00592.x
Oveisi S, Ardabili HE, Dadds MR, Majdzadeh R, Mohammadkhani P, Rad JA, Shahrivar Z (2010) Primary prevention of parent-child conflict and abuse in Iranian mothers: a randomized-controlled trial. Child Abuse Negl 34:206–213. doi:10.1016/j.chiabu.2009.05.008
Baker-Henningham H, Walker SP, Powell C, Gardner JM (2009) Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study. West Indian Med J 58:460–464
Baker-Henningham H, Walker S, Powell C, Gardner JM (2009) A pilot study of the incredible years teacher training programme and a curriculum unit on social and emotional skills in community pre-schools in Jamaica. Child Care Health Dev 35:624–631. doi:10.1111/j.1365-2214.2009.00964.x
Graeff-Martins AS, Oswald S, Comassetto JO, Kieling C, Gonçalves RR, Rohde LA (2006) A package of interventions to reduce school dropout in public schools in a developing country. A feasibility study. Eur Child Adolesc Psychiatry 15:442–449. doi:10.1007/s00787-006-0555-2
Uçkardes Y, Ozmert EN, Unal F, Yurdakök K (2009) Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children. Acta Paediatr 98:731–736. doi:10.1111/j.1651-2227.2008.01186.x
Nair V, Mahadevan S (2009) Randomised controlled study-efficacy of clonidine versus carbamazepine in children with ADHD. J Trop Pediatr 55:116–121. doi:10.1093/tropej/fmn117
Szobot CM, Ketzer C, Parente MA, Biederman J, Rohde LA (2004) The acute effect of methylphenidate in Brazilian male children and adolescents with ADHD: a randomized clinical trial. J Atten Disord 8:37–43. doi:10.1177/108705470400800201
Du YS, Li HF, Vance A et al (2008) Randomized double-blind multicentre placebo-controlled clinical trial of the clonidine adhesive patch for the treatment of tic disorders. Aust N Z J Psychiatry 42:807–813. doi:10.1080/00048670802277222
Matos M, Bauermeister JJ, Bernal G (2009) Parent-child interaction therapy for Puerto Rican preschool children with ADHD and behavior problems: a pilot efficacy study. Fam Process 48:232–252. doi:10.1111/j.1545-5300.2009.01279.x
Taylor E, Sonuga-Barke E (2008) Disorders of attention and activity. In: Rutter M, Bishop DVM, Pine DS, Scott S, Stevenson J, Taylor E, Thapar A (eds) Rutter’s child and adolescent psychiatry, 5th edn. Blackwell Publishing Ltd, Oxford, pp 521–542
Santosh PJ, Henry A, Varley CK (2008) ADHD and hyperkinetic disorder. In: Tyrer PJ, Silk KR (eds) Cambridge textbook of effective treatments in psychiatry, 1st edn. Cambridge University Press, Cambridge, pp 782–795
Collett T (2009) Bipolar and attention deficit hyperactivity disorder in children: An analysis of the recent literature. Dissertation. Alliant International University, San Diego
Woolfenden SR, Williams K, Peat J (2001) Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10–17. Cochrane Database Syst Rev 2:1469–1493
Barlow J, Coren E, Stewart-Brown S (2004) Parent-training programmes for improving maternal psychosocial health. Cochrane Database Syst Rev. doi:10.1002/14651858.CD002020.pub2
Pelham WE Jr, Fabiano GA (2008) Evidence-based psychosocial treatments for attention deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 37:184–214. doi:10.1080/15374410701818681
Yule W, Smith P (2008) Post-traumatic stress disorder. In: Rutter M, Bishop DVM, Pine DS, Scott S, Stevenson J, Taylor E, Thapar A (eds) Rutter’s child and adolescent psychiatry, 5th edn. Blackwell Publishing Ltd, Oxford, pp 686–697
Ertl V, Pfeiffer A, Schauer E, Elbert T, Neuner F (2011) Community-implemented trauma therapy for former child soldiers in northern Uganda: a randomized controlled trial. JAMA 306:503–512. doi:10.1001/jama.2011.1060
Tol WA, Komproe IH, Jordans MJD, Gross AL, Susanty D, Macy RD, de Jong JTVM (2010) Mediators and moderators of a psychosocial intervention for children affected by political violence. J Consult Clin Psychol 78:818–828. doi:10.1037/a0021348
Jordans MJD, Komproe IH, Tol WA, Kohrt BA, Luitel NP, Macy RD, de Jong JTVM (2010) Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: a cluster randomized controlled trial. J Child Psychol Psychiatry 51:818–826. doi:10.1111/j.1469-7610.2010.02209.x
Schaal S, Elbert T, Neuner F (2009) Narrative exposure therapy versus interpersonal psychotherapy. A pilot randomized controlled trial with Rwandan genocide orphans. Psychother Psychosom 78:298–306. doi:10.1159/000229768
Kumakech E, Cantor-Graae E, Maling S, Bajunirwe F (2009) Peer-group support intervention improves the psychosocial well-being of AIDS orphans: cluster randomized trial. Soc Sci Med 68:1038–1043. doi:10.1016/j.socscimed.2008.10.033
Catani C, Kohiladevy M, Ruf M, Schauer E, Elbert T, Neuner F (2009) Treating children traumatized by war and Tsunami: a comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry 9:22. doi:10.1186/1471-244X-9-22
Tol WA, Komproe IH, Susanty D, Jordans MJD, Macy RD, De Jong JTVM (2008) School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial. JAMA 300:655–662. doi:10.1001/jama.300-6-655
Layne CM, Saltzman WR, Poppleton L et al (2008) Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 47:1048–1062. doi:10.1097/CHI.0b013e31817eecae
Gordon JS, Staples JK, Blyta A, Bytyqi M, Wilson AT (2008) Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind–body skills groups: a randomized controlled trial. J Clin Psychiatry 69:1469–1476. doi:10.4088/JCP.v69n0915
Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty KF, Neugebauer R, Murray L, Verdeli H (2007) Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA 298:519–527. doi:10.1001/jama.298.5.519
Lesmana CB, Suryani LK, Jensen GD, Tiliopoulos N (2009) A spiritual-hypnosis assisted treatment of children with PTSD after the 2002 Bali terrorist attack. Am J Clin Hypn 52:23–34. doi:10.1080/00029157.2009.10401689
Berger R, Gelkopf M (2009) School-based intervention for the treatment of tsunami-related distress in children: a quasi-randomized controlled trial. Psychother Psychosom 78:364–371. doi:10.1159/000235976
Thabet AA, Vostanis P, Karim K (2005) Group crisis intervention for children during ongoing war conflict. Eur Child Adolesc Psychiatry 14:262–269. doi:10.1007/s00787-005-0466-7
Dybdahl R (2001) Children and mothers in war: an outcome study of a psychosocial intervention program. Child Dev 72:1214–1230. doi:10.1111/1467-8624.00343
Berger R, Pat-Horenczyk R, Gelkopf M (2007) School-based intervention for prevention and treatment of elementary-students’ terror-related distress in Israel: a quasi-randomized controlled trial. J Trauma Stress 20:541–551. doi:10.1002/jts.20225
Shechtman Z, Mor M (2010) Groups for children and adolescents with trauma-related symptoms: outcomes and processes. Int J Group Psychother 60:221–244. doi:10.1521/ijgp.2010,60(2),pp.221
Gelkopf M, Berger R (2009) A school-based, teacher-mediated prevention program (ERASE-Stress) for reducing terror-related traumatic reactions in Israeli youth: a quasi-randomized controlled trial. J Child Psychol Psychiatry 50:962–971. doi:10.1111/j.1469-7610.2008.02021.x
Bangirana P, Allebeck P, Boivin MJ, John CC, Page C, Ehnvall A, Musisi S (2011) Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial. BMC Neurol 11:96. doi:10.1186/1471-2377-11-96
Potterton J, Stewart A, Cooper P, Becker P (2010) The effect of a basic home stimulation programme on the development of young children infected with HIV. Dev Med Child Neurol 52:547–551. doi:10.1111/j.1469-8749.2009.03534.x
Boivin MJ, Busman RA, Parikh SM, Bangirana P, Page CF, Opoka RO, Giordani B (2010) A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV. Neuropsychology 24:667–673. doi:10.1037/a0019312
Shin JY, Nhan NV, Lee SB, Crittenden KS, Flory M, Hong HTD (2009) The effects of a home-based intervention for young children with intellectual disabilities in Vietnam. J Intellect Disabil Res 53:339–352. doi:10.1111/j.1365-2788.2008.01151.x
Piravej K, Tangtrongchitr P, Chandarasiri P, Paothong L, Sukprasong S (2009) Effects of Thai traditional massage on autistic children’s behavior. J Altern Complement Med 15:1355–1361. doi:10.1089/acm.2009.0258
Bangirana PMS, Giordani B, John CC, Page C, Opoka RO, Boivin MJ (2009) Immediate neuropsychological and behavioral benefits of computerized cognitive rehabilitation in Ugandan pediatric cerebral malaria survivors. J Dev Behav Pediatr 30:310–318. doi:10.1097/DBP.0b013e3181b0f01b
Bumin G, Kayihan H (2001) Effectiveness of two different sensory-integration programmes for children with spastic diplegic cerebral palsy. Disabil Rehabil 23:394–399. doi:10.1080/09638280010008843
McConachie H, Huq S, Munir S, Ferdous S, Zaman SS, Khan NZ (2000) A randomized controlled trial of alternative modes of service provision to young children with cerebral palsy in Bangladesh. J Pediatr 137:769–776
Russell PS, al John JK, Lakshmanan JL (1999) Family intervention for intellectually disabled children. Randomised controlled trial. Br J Psychiatry 174:254–258. doi:10.1192/bjp.174.3.254
Dave UP, Chauvan V, Dalvi J (1993) Evaluation of BR-16 A (Mentat) in cognitive and behavioural dysfunction of mentally retarded children-a placebo-controlled study. Indian J Pediatr 60:423–428. doi:10.1007/BF02751207
Velema JP, Ebenso B, Fuzikawa PL (2008) Evidence for the effectiveness of rehabilitation-in-the-community programmes. Lepr Rev 79:65–82
Lagerkvist B (1992) Community-based rehabilitation—outcome for the disabled in the Philippines and Zimbabwe. Disabil Rehabil 14:44–50. doi:10.3109/09638289209166427
Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J, Minz S, Abraham VJ, Bose A (2004) Suicides in young people in rural southern India. Lancet 363:1117–1118. doi:10.1016/S0140-6736(04)15896-0
Pao M, Lyon M, D’Angelo LJ, Schuman WB, Tipnis T, Mrazek DA (2000) Psychiatric diagnoses in adolescents seropositive for the human immunodeficiency virus. Arch Pediatr Adolesc Med 154:240-244. doi:10-1001/pubs.Pediatr Adolesc Med.-ISSN-1072-4710-154-3-poa9086
Bonhauser M, Fernandez G, Püschel K, Yañez F, Montero J, Thompson B, Coronado G (2005) Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promot Int 20:113–122. doi:10.1093/heapro/dah603
Yu DL, Seligman MEP (2002) Preventing depressive symptoms in Chinese children. Prev Treatment 5:9. doi:10.1037/1522-3736.5.1.59a
Bass J, Neugebauer R, Clougherty KF, Verdeli H, Wickramaratne P, Ndogoni L, Speelman L, Weissman M, Bolton P (2006) Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: randomised controlled trial. BJP 188:567–573. doi:10.1192/bjp.188.6.567
Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, Speelman L, Ndogoni L, Weissman M (2003) Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA 289:3117–3124. doi:10.1001/jama.289.23.3117
Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, Peters TJ (2003) Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet 361:995–1000. doi:10.1016/S0140-6736(03)12825-5
Ali BS, Rahbar MH, Naeem S, Gul A, Mubeen S, Iqbal A (2003) The effectiveness of counseling on anxiety and depression by minimally trained counselors: a randomized controlled trial. Am J Psychother 57:324–336
Brent D, Weersing V (2008) Depressive disorders in childhood and adolescence. In: Rutter M, Bishop D, Pine D et al (eds) Rutter’s child and adolescent psychiatry, 5th edn. Blackwell Publishing Ltd, Oxford, pp 587–612
Schlorendt K, Gershenson R, Varley C, Goodyear I (2008) Treatment of depressive disorders in children and adolescents. In: Tyrer P, Silk K (eds) Cambridge textbook of effective treatments in psychiatry. Cambridge University Press, Cambridge, pp 808–818
Maulik PK, Darmstadt GL (2009) Community-based interventions to optimize early childhood development in low resource settings. J Perinatol 29:531–542. doi:10.1038/jp.2009.42
Walker SP, Chang SM, Vera-Hernandez M, Grantham-McGregor S (2011) Early childhood stimulation benefits adult competence and reduces violent behavior. Pediatrics 127:849–857. doi:10.1542/peds.2010-2231
Walker SP, Chang SM, Younger N, Grantham-McGregor SM (2010) The effect of psychosocial stimulation on cognition and behaviour at 6 years in a cohort of term, low-birthweight Jamaican children. Dev Med Child Neurol 52:148–154. doi:10.1111/j.1469-8749.2010.03637.x
Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM (2006) Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial. BMJ 333:472. doi:10.1136/bmj.38897.555208.2F
Tessier R, Charpak N, Giron M, Cristo M, de Calume ZF, Ruiz-Pelaez JG (2009) Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr 98:1444–1450. doi:10.1111/j.1651-2227.2009.01370.x
Ramanathan K, Paul VK, Deorari AK, Taneja U, George G (2001) Kangaroo mother care in very low birth weight infants. Indian J Pediatr 68:1019–1023. doi:10.1007/BF02722345
Barros AJD, Matijasevich A, Santos IS, Halpern R (2010) Child development in a birth cohort: effect of child stimulation is stronger in less educated mothers. Int J Epidemiol 39:285–294. doi:10.1093/ije/dyp272
Medicine NRCaIo (2009) Implementation and dissemination of prevention programs. In: O’Connell ME, Boat T, Warner KE (eds) preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. National Academies Press, Washington DC, pp 297–336
Dick B, Ferguson J, Ross DA (2006) Preventing HIV/AIDS in young people. A systematic review of the evidence from developing countries. Introduction and rationale. WHO Tech Rep Ser 938:1–341
Magnussen L, Ehiri JE, Ejere HOD, Jolly PE (2004) Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective? Int J Adolesc Med Health 16:303–323. doi:10.1515/IJAMH.2004.16.4.303
Medley A, Kennedy C, O’Reilly K, Sweat M (2009) Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev 21:181–206. doi:10.1521/aeap.2009,21(3),pp.181
Cowan FM, Pascoe SJS, Langhaug LF, Mavhu W, Chidiya S, Jaffar S, Mbizvo MT, Stephenson JM, Johnson AM, Power RM, Woelk G, Hayes RJ (2010) The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth. AIDS 24:2541–2552. doi:10.1097/QAD.0b013e32833e77c9
Doyle AM, Ross DA, Maganja K, Baisley K, Masesa C et al (2010) Long-term biological and behavioural impact of an adolescent sexual health intervention in Tanzania: follow-up survey of the community-based MEMA kwa Vijana Trial. PLoS Med 7:e1000287. doi:10.1371/journal.pmed.1000287
Ross DA, Dick B, Ferguson J (2006) Preventing HIV/AIDS in young people: a systematic review of the evidence from developing countries. WHO Tech Rep Ser 938:357
Patel V, Weiss HA, Chowdhary N et al (2010) Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet 376:2086–2095. doi:10.1016/S0140-6736(10)61508-5
Kleinman A (1989) The illness narratives: suffering, healing, and the human condition. Basic Books, New York
Kleinman A (1978) Clinical relevance of anthropological and cross-cultural research: concepts and strategies. Am J Psychiatry 135:427–431
Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394. doi:10.1016/j.jclinepi.2010.04.026
Acknowledgments
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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Klasen, H., Crombag, AC. What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries. Soc Psychiatry Psychiatr Epidemiol 48, 595–611 (2013). https://doi.org/10.1007/s00127-012-0566-x
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DOI: https://doi.org/10.1007/s00127-012-0566-x