Mental health and psychosocial support in humanitarian settings: linking practice and research

Abstract

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007-10); funding by analysis of the financial tracking service and the creditor reporting system (2007-09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] -0·38, 95% CI -0·55 to -0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (-0·36, -0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD -0·24, -0·40 to -0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.

Figure 1. Studies included in systematic review and meta-analysis

We included studies according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PTSD=post-traumatic stress disorder.

Figure 2. Studies included in the systematic review

The studies are classed according to the Inter-Agency Standing Committee mental health and psychosocial support pyramid. RCT=randomised controlled trial. CCT=controlled clinical trial. IPT=interpersonal psychotherapy. CBT=cognitive behavioural therapy. ERASE=enhancing resiliency among students experiencing. NET=narrative exposure therapy. KIDNET=narrative exposure therapy for children.

Figure 3. Random-effects meta-analysis of psychological support for adults with post-traumatic stress disorder symptoms in humanitarian settings

*Narrative exposure therapy.†Trauma counselling. ‡Trauma healing and reconciliation without post-traumatic stress disorder psychoeducation. §Trauma healing and reconciliation with post-traumatic stress disorder psychoeducation.

Figure 4. Random-effects meta-analysis of school-based interventions for children and adolescents with post-traumatic stress disorder symptoms in humanitarian settings

*A classroom-based intervention for 12–16 year olds. †A classroom-based intervention for 6–11 year olds.

Figure 5. Random-effects meta-analysis of school-based and other psychosocial and psychological supports for children and adolescents with internalising symptoms in humanitarian settings

*Group interpersonal psychotherapy. †Creative play. ‡A classroom-based intervention for 6–11 year olds. §A classroom-based intervention for 12–16 year olds.