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Table 2 Summary characteristics of included studies

From: A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries

Study Name, Country, Study author Target Group Type of Intervention & Duration Implementation Issues Study design Outcomes * Quality Assessment
Life Skills education programme[35]
India
Srikala & Kumar, 2010
Youth (14–16 years) in secondary schools Lifeskills education intervention. Skills taught include critical thinking, decision making, problem solving, communication, and coping skills
Implemented once a week, (1 hr) over 12 to 20 sessions during one academic year
Sessions taught by class teacher
Programme content and materials based on needs assessment with students, parents, NGOs and policy makers
Teachers trained over 3 days
Quasi-Experimental - random selection of schools with matched control design:
N = 1028 adolescents
Control received standard civic education classes
Significant improvement in:
- self-esteem,
- perceived self-efficacy
- pro-social behavior
- perceived adequate coping
Participants had significant:
- better adjustment with teachers
- better adjustment in school
- improved classroom behaviour
No change in adjustment with parents and peers
Moderate
School based physical fitness programme[36]Santiago, Chile
Bonhauser et al., 2005
Secondary school students age 15 years in low socioeconomic area in Chile School based physical fitness
Four units made up of three sessions each week (90 min each) for ten weeks for each unit
Sessions taught by regular teachers
Teachers and students designed intervention Quasi-experimental design
N = 198 students from high school
Students in control group received 90 minute exercise class once a wee
Significant improvement in adolescents’:
- anxiety scores
- self-esteem scores
No significant changes in depression scores
Significant increases in physical fitness:
- oxygen capacity
- speed and jump performance scores
Moderate
Involvement of the Board of Directors was viewed as essential in order to incorporate intervention into curriculum activities.
HealthWise Program[37, 38]
Cape Town, South Africa
Smith et al., 2008; Caldwell et al., 2010
Secondary school students grades 8–9 (mean of 14 years) in low income township in Cape Town School based leisure, life skills and sexuality education intervention
12 lessons provided in grade 8 followed by 6 booster sessions in grade 9
Programme delivered by class teacher.
Cultural adaptation of the TimeWise programme [39] and Botvin’s Lifeskills programme [40]
Schools with greatest involvement in teacher training and implementation reported more positive outcomes on intrinsic student motivation.
Quasi-experimental
N = 2193 adolescents mean age 14 years
Life Orientation curriculum taught in control schools
Significant
- increase in intrinsic motivation
- decrease in introjected motivation and amotivation
Increase in perception of condom availability in intervention group
Control group had ‘steeper increase’ in recent and heavy use of alcohol and cigarette use. Programme effects on alcohol, cigarette use greater for girls.
Moderate
Resiliency Programme[41]
South Africa
de Villiers & van den Berg, 2012
Children age 11–12 in Grade 6 in middle-class suburbs of South Africa Resiliency intervention provided 15 sessions on promoting emotional regulation, stress management, interpersonal skills and problem solving. Each session lasted 90 minutes and delivered over three weeks Parents and teachers were not involved with the programme Solomon Four Group Design
N = 161 children age 11–12 years from four schools
Waitlist control
Three month follow up
Significant improvement in
- interpersonal strength
- emotional regulation
- self appraisal
- emotional reactivity
Improved self appraisal scores maintained at three months follow up.
No significant improvement in
- family involvement
- intrapersonal strength
- school functioning
- affective strength
- sense of mastery
- sense of relatedness
- family appraisal
- general social support.
Weak
Resourceful Adolescent Program – (RAP-A) Depression Prevention Programme[42]
Mauritius
Rivet-Duval et al., 2011
Secondary school students age 12–16 years in Mauritius Universal depression prevention programme includes cognitive behavioural and interpersonal approaches
11 one hour weekly sessions with 8–12 participants per group.
Teachers implemented sessions
RAP-A is an Australian evidenced based intervention [43]. Details of cultural adaptations not reported
Teachers attended two day training workshop involving 16 hours of training, received ongoing support and half day booster training session 6 months post initial training
RCT
N = 160 students from two single sex secondary schools age 12–16 years
Waitlist control
Six months follow-up
Significant improvement in
- depressive symptoms
- hopelessness
- self esteem
- coping skills.
Improvements in self esteem and coping skills maintained at 6 months follow up.
Improvements in depression symptoms and hopelessness not maintained at 6 months follow up.
Strong
Make a Difference (MAD) about Art: Community-Based Art Therapy Intervention[44]
Nekkies township, South Africa
Mueller et al., 2011
Children affected by HIV and AIDS age 8–18 in deprived community in South Africa Community based psychosocial intervention which consisted of art education activities designed to build a sense of self-worth, self-concept, empowerment and emotional control
Children attended sessions for six months.
Programme implemented in school by trained ‘Youth Ambassadors’ (youth workers)
Sessions were led by team of trained and supervised ‘youth ambassadors’
Being violent towards others and witnessing violence in the home were key predictors of self-efficacy
Quasi-experimental
N = 297 youth age 8–18 years from one school
Significant programme effect on self-efficacy scores
No programme effect on:
- depression scores
- emotional and behavioural scores
- self esteem scores
Moderate
Peer-support group intervention for AIDS orphans[45]
Uganda
Kumakech et al., 2009
Children age 10–15 years reported to have lost one or both parents due to AIDS Peer-support intervention aims to encourage participants to reflect, challenge and face difficult experiences and to develop coping skills
Two peer support exercises held per week in classroom for 10 weeks.
Teachers trained to deliver intervention
Peer-group support exercises were originally intended for adults [46] and were modified for children Cluster-randomized control trial
N = 326 children age 10–15 from 20 schools
Significant reduction in:
- anxiety scores
- depression scores
- anger scores
No significant reduction effect on self-concepts
Strong
Classroom based psychosocial intervention (CBI)[47]
Nepal
Jordans et al., 2010
Children affected by armed conflict age 11 – 14 years School based psychosocial intervention aims to reduce distress and increase resilience and empowerment through enhancing coping, pro-social behaviour
15 sessions delivered over course of 5 weeks.
Delivered by para-professionals.
Intervention was developed by Centre for Trauma Psychology in Boston
Interventionists from targeted communities were selected and trained over 15 days
Counsellor provided regular supervision
Cluster randomised controlled trial
N = 325 students age 11–14 years from 8 schools
Waitlist control
No significant effect on social emotional wellbeing
Significant gender effects including:
- reductions in general psychological difficulties and aggression for boys
- increased pro-social behaviour for girls
Significant increase in sense of hope for older children
Strong
Classroom-Based psychosocial Intervention (CBI)[48]
Palestine
Khamis et al., 2004
Children and adolescents affected by armed conflict aged 6–11 and 13–16 years School based psychosocial intervention aims to reduce distress and increase resilience and empowerment
(same as intervention above)
Programme implemented by trained CBI counselors
Recommendations:
- provide booster training to CBI interventionists
- organize monthly group meetings among intervention coordinators to assure fidelity of the interventionists and to address ongoing technical issues that arise
RCT
N = 664:
- 406 children age 6–11 years
- 258 adolescents, age 13–16 years]
Waitlist control
Intervention group had significantly:
- better attributional style
- reduced level of self-blame
- higher perceived credibility
- increased inter-personal trust
- improved communication skills
- reduced hyperactivity
- emotional symptoms
- conduct problems
- peer problems
Hyperactivity levels decreased significantly in adolescent control group.
CBI had more positive effect on adolescent girls than boys. No significant gains observed among adolescent boys age 12–16 years
Strong
Psychosocial Structured Activities (PSSA) intervention[49]
Uganda
Ager et al., 2011
Displaced children aged 7 – 12 years in primary schools in Uganda PSSA intervention, school-based multi-phased approach designed to enhance resilience, coping skills, self esteem and future planning through structured activities- play therapy, art, drama
15 × 60 min sessions delivered over course of five weeks.
Implemented by trained school teachers
PSSA intervention builds upon work of CBI intervention implemented in Palestine [50]. Intervention implemented previously in US and Indonesia
PSSA encourages parental involvement through periodic meetings.
Quasi experimental
N = 403 primary school students (mean age 10.23 years) from 12 schools (8 intervention) in Uganda
12 month follow up
Significant improvement in participants’ wellbeing, as measured by parents and children (but not teacher).
Evidence from parent and teacher report of girls making greater progress than boys
Evidence of older children making greater progress than younger children.
Moderate
Teaching Recovery Techniques (TRT) intervention for war affected children[50]
Gaza, Palestine
Quota et al., 2012
War affected children age 10–13 years in Palestine TRT intervention aims at creating safety and feelings of mastery, and incorporates trauma-related psychoeducation, CBT methods, coping skills training
16 sessions implemented over 4 weeks after school (two weekly 2 hour sessions)
Programme implemented by psychologists
Evidence based intervention [5153]
Programme implemented by psychologists as an extra curricular activity on school premises. Families involved through homework activities
RCT
N = 722 children age 10–13 years from four schools assigned to intervention and control group
Six months follow up
Control received normal school-provided support.
Intervention significantly reduced proportion of clinically significant Post-Traumatic Stress syndrome at post-intervention.
No programme effect for girls.
Strong
Girls significantly benefited from intervention (in symptoms and proportion of clinically significant PTSS) if they showed low peritraumatic dissociation.
Classroom-based group intervention for children exposed to war[54]
Lebanon
Karam et al., 2008
War affected children age 6–18 years in Lebanon Intervention consisted of cognitive behavioural strategies and stress inoculation training
12 × 90 min sessions implemented over 12 consecutive school days
Intervention delivered by teachers
Teachers received one day training and supervised every 2–3 sessions
Study used only diagnostic assessment measures
Quasi experimental
N = 209 students (mean age 11.7 years) from six schools
Matched control group did not receive structured activities
No significant effect of the intervention of rates of major depressive disorder, separation anxiety disorder and post-traumatic stress disorder.
Rates of disorders peaked one month post-war and decreased over one year.
Post-war major depressive disorder, separation anxiety disorder and post-traumatic stress disorder were associated with pre-war SAD and PTSD scores, family violence parameters, financial problems and witnessing war events.
Strong
Writing for Recover (WfR) intervention[55]
Gaza
Lange-Nielsen et al., 2012
Adolescents age 12–17 from refugee camp in Gaza Manual based short term writing intervention involves adolescents undertaking unstructured and structured writing detailing their traumatic memories and insights from what they have experienced
Six short writing sessions over 3 consecutive days (2x15 min session each day).
Programme implemented by teachers who have received 1 day training
88.4% of participants reported participation as a positive experience at T3 and 94.3% at T4.
Lack of adherence to manual reported
RCT
N = 139 adolescents age 12–17 years from six schools
Waitlist control
Four-five month follow up
Significant decline in PTSD symptoms in both intervention and control group.
Significant increase in intervention groups’ depression symptoms from T1-T2. Significant decline in depression symptoms from T3-T4.
No significant change in intervention groups’ anxiety scores from T1 – T2 or T3 to T4.
Strong
Child-focused intervention for children living in conflict areas[56]
Palestine (Gaze and West Bank)
Loughry et al., 2006
Children and adolescents (age 6–17 years) and their parents living in areas of conflict Interventions aims to provide structured activities that support the resilience of children in conflict
Intervention implemented over one year and focused on participation in recreational, cultural and other non-formal activities. Included parental involvement
Children’s activities included after-school recreation activities in community setting (e.g. summer camps)
Activities for children’s parents included information classes and opportunities to join with children in structured activities
Quasi experimental
N = 400 children and adolescents
Control group did not receive structured activities
Significant reduction in intervention groups’
- total problem scores
- externalizing problem scorers
- internalizing problem scores
Intervention had some effect in improving parental support in West Bank children only.
Strong
Community-Based Interventions
Study Name, Country, Study author Target Group Type of Intervention & Duration Implementation Issues Study design Outcomes* Effect Sizes Quality Assessment
Population based intervention to promote youth health[57]
Goa, India
Balaji et al., (2011)
Youth age 16-24 Community based intervention designed to promote youth health
Intervention implemented over 12 months and consists of 3 main components: (i) Peer Education (ii) Teacher Training (iii) Health information
Intervention implemented by intervention team which consisted of social worker, two psychologist and three peer educators
Community actively involved in programme planning
Difficulties noted in the integration of peer education within existing school structures
Community peer education was feasible and acceptable in rural community but not the urban community
Exploratory controlled evaluation
N = 1803 students from two urban and rural communities
Control communities were wait listed.
18 months follow up
Significant:
- decrease in probable depression score (rural & urban)
- greater knowledge and attitudes about emotional health (rural)
- lower levels of suicidal behaviour (urban)
Peer leaders reported increase in skills:
- self-confidence
- leadership ability
- stress managements
- conflict resolution
- anger management and
Improved student-teacher relationship post-intervention
Significant:
- increase in attitudes about reproductive and sexual health (rural & urban)
- decrease in perpetration of physical violence (rural & urban) and substance abuse (urban)
- Rural sample reported significant:
- fewer menstrual complaints
- higher levels of help- seeking for reproductive and sexual health problems by women
Urban sample reported significant lower levels of
- sexual abuse
- RSH complaints
- menstrual complaints
Not reported Strong
Familias Fuertas[58]
Honduras
Vasquez et al., 2010
Parents and their 10–14 year old adolescents Evidence based family skills building training programme. Focused on promoting consistent discipline, parental monitoring and positive communication patterns
7 activity based sessions
Local nurses trained as FF facilitators
Programme is based on the evidence based “Strengthening Families” programme in US Quasi-experimental design
N = 41 parent-adolescent pairs
Control received informational brochures
12 months follow-up
Significant improvement in intervention groups’:
- positive parenting behaviours
- positive perceptions among parents about their family relationships
- parental self esteem
Non significant reduction in adolescent or family member drug alcohol or tobacco use.
Not reported Moderate
Ishraq Programme[59]
Egypt
Brady et al., 2007
Out of school adolescent girls age 13-15 Multidimensional community based programme aimed at improving girls’ life skills, functional literacy, recreational opportunities, health knowledge and attitudes and mobility and civic participation.
Girls meet four times a week for 30 months in in groups of around 25 girls
Programme implemented by ‘Promoters’ – young local women (age 17–25) trained in their role.
Important part of the programme was work carried out with brothers and other male relatives in helping them to think and act in a more gender equitable manner Quasi-experimental
N = 587 adolescent girls from four villages in Upper Egypt
Significant improvement in social participation.
Girls in the programme significantly more likely
- to know about key health and rights issues
- to score higher on gender role attitude index
- to make and keep friends
Full term participants showed greatest increase in academic skills.
Strong association between desire to delay marriage and participation in Ishraq.
Not reported Moderate
Stepping Stones[60]
South Africa
Jewkes et al., 2008
Men and women age 16-23 HIV prevention programme aims to improve sexual and emotional health by developing strong, more equal relationships
Programme delivered to single sex groups. Programme lasts 50 hours over 6–8 weeks
Workshops cover relationship skills, including assertiveness training as well as information of STIs and condoms. Facilitators were the same sex as the participants.
Programme generally run on school premises after school hours
Cluster RCT
N = 2776 men and women age 15–26 years
Two year follow-up
Reduced (but not significant) levels of depression reported in men at 24 month follow up.
No significant change in women’s depression levels in intervention group.
Significant reduction in male:
- physical and sexual partner violence (two year follow up)
- problem drinking (one year follow up)
- number of HSV-2 infections over 2 years
No evidence of desired behaviour change in women.
No evidence of lowered incidence of HIV.
Not reported Strong
The Collaborative HIV Adolescent Mental Health Programme South Africa (CHAMPSA)[61]
South Africa
Bell et al., 2008
Adolescents (4th and 5th grade) and their families HIV prevention programme aims to strengthen family relationships as well as target peer influences
10 (90 minute) sessions delivered by community caregivers over 10 weekends to families
CHAMPSA is an adaptation version of the evidence based CHAMP Family programme [62]
Community members involved in programme design, delivery and research
Families paid $8 for each session attended
RCT
N = 478 families rearing 579 children
Control received existing school based HIV prevention curriculum
Significant increase in caregivers’:
- communication skills
- monitoring of children
- social primary networks
Caregiver data:
HIV transmission knowledge ES = 0.631
Less stigma toward HIV infected people ES = 0.403
Caregiver monitoring 3 family rules ES = 0.307
Caregiver communication comfort ES 0.407
Caregiver communication frequency ES = 0.197
Social networks – primary ES = 0.265
Child data:
AIDS transmission knowledge ES = 0.496
Less stigma towards HIV infected people ES = 0.698
Strong
South Africa’s Intervention with Microfinance for AIDS and Gender Equity: IMAGE study[63]
South Africa
Kim et al., 2009
Women age 18 years and over Community based combined gender and HIV training programme and microfinance initiative aims to address gender roles, poverty self-esteem, communication, domestic violence and HIV
Delivered over 12–15 months. Phase 1 (6 months) consisted of 10 training sessions. Phase 2 encouraged wider community mobilization to engage youth and young men in the intervention
Microfinance only intervention provided women with small loans to women
IMAGE ‘Sisters for Life’ gender and HIV training programme integrated gender and HIV training programme into fortnightly microfinance meetings
The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits
Cluster randomized trial
Three randomly selected matched clusters (i) four villages with 2 year exposure to IMAGE combined with microfinance (ii) four villages with 2 year exposure to microfinance and (iii) control villages not targeted by any intervention.
N = 860 female loan recipients enrolled
Significant improvements in empowerment among women in combined IMAGE microfinance group
Micro finance only group showed no improvements in empowerment.
Significant improvements in:
- intimate partner violence (IPV) and HIV risk behaviour (women in combined IMAGE - microfinance group)
- economic wellbeing (women in microfinance only and combined group)
Micro finance only group showed no improvements in IPV and HIV risk behaviour
Not reported Moderate
IMAGE and microfinance study[64]
South Africa
Pronjk et al., 2006
Women in rural areas in South Africa (age 14–35 years) Community based combined gender and HIV training programme and microfinance initiative aims to address gender roles, poverty self-esteem, communication, domestic violence and HIV (same as above) Programme consists of poverty-focused microfinance initiative and a 12–15 month participatory ‘Sisters for Life’ gender and HIV training programme RCT
N = 3339 women from 8 villages
Two year follow up
Programme participants reported:
- 55% fewer acts of violence by their intimate partners in previous 12 months
- fewer experiences of controlling behaviour by their partners
- increased economic wellbeing among intervention group
Significant higher levels of social participation
Not reported Moderate
SUUBI - economic empowerment intervention[6568]
Uganda
Ssewamala et al., (2009a, 2012, 2010, 2009b)
AIDS-orphaned children in final year of primary school Economic intervention that involves creating asset-building opportunities and promotion of life options by providing (i) 1–2 hour workshops focused on asset building and future planning (ii) monthly mentorship programme for adolescents with peer mentors on life options (iii) Child Development Account dedicated to paying for secondary schooling, vocational training and/or family small business Girls were likely to have higher self-esteem than boys
Homeownership was significantly associated with positive changes in children’s self-esteem
Children in treatment group saves, on average an equivalent of USD$6.33 a month or UDS$76 a year
RCT
N = 267 children from Grade 7 in 15 primary schools
Control group received usual care for orphaned children
Ten month follow up
Significant
- increase in self-rated self esteem at 10 months post-intervention
- decrease in depression
- increase in academic performance educational
- aspirations and attitudes towards sexual risk taking behaviour
- reduction in sexual risk taking intentions
- increase in self rated physical health functioning
Not reported Strong
  1. * Significance levels p ≤ 0.05.