Daisy R Singla1, Ahmed Waqas2, Syed Usman Hamdani3, Nadia Suleman2, Syeda Wajeeha Zafar2, Khalid Saeed4, Chiara Servili5, Atif Rahman6. 1. Sinai Health System, University of Toronto, Toronto, Canada. Electronic address: daisy.singla@utoronto.ca. 2. Human Development Research Foundation, Islamabad, Pakistan. 3. Human Development Research Foundation, Islamabad, Pakistan; Department of Psychological Sciences, Health and Society, University of Liverpool, United Kingdom. 4. Mental Health and Substance Abuse Unit, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt. 5. Department of Mental Health and Substance Abuse, World Health Organization, Geneva,Switzerland. 6. Department of Psychological Sciences, Health and Society, University of Liverpool, United Kingdom.
Abstract
BACKGROUND: Adolescence represents an unprecedented opportunity to invest in health. Individual adolescent life skills programs in low- and middle-income countries (LMICs) have demonstrated success but neither their relative effectiveness across multiple health arenas, including mental health, nor their key ingredients have been examined. METHODS: We conducted a systematic review and meta-analysis to identify key implementation processes and effectiveness of life skills programs among adolescents in LMICs which targeted at least one mental health outcome, as well as their relative effectiveness. Six academic databases, including PubMed and PsychInfo and bibliographies of related reviews, were systematically searched until July 1, 2016, with no restrictions on language or publication year. Studies were excluded if they were conducted in HIC settings, among chronically ill populations or lacking adolescents aged 10-19 years. Data from published reports related to the characteristics of RCTs and their implementation processes related to 'who, what, how and where' were extracted, including the development of a taxonomy to determine which life skills constituted each program. Meta-analyses with random effects models examined the overall trial effectiveness, as determined by their primary outcomes. Subsequent exploratory analyses determined which implementation processes predicted trial effectiveness (PROSPERO CRD42016043448). RESULTS: We included 50 eligible RCTs from 45 articles with a focus on an adolescent health program, which targeted at least one or more mental health outcomes. Most of the RCTs, conducted across 19 LMICs, targeted students (82%) and refugees (7%), and both genders (71%). Most of the interventions were delivered by teachers (n = 12), and specialist providers (n = 11), and most were focused on high-risk groups rather than clinically-disordered populations. These interventions were effective in reducing symptoms of anger (SMD = 1.234), improving life skills (SMD = 0.755) and functioning (SMD = 0.491), and decreasing PTSD (SMD = 0.327), depression and anxiety (SMD = 0.305). Trial effectiveness was positively associated with the following life skills: interventions focused on parent-child interactions (β = 0.557, p < 0.05), assessing interpersonal relations (β = 0.204, p < 0.05) and stress management (β = 0.216, p < 0.05). DISCUSSION: Our results demonstrate the benefits of life skills programs targeting one or more mental health outcomes and co-occurring risk factors in school and community settings. Comprehensive programs focusing on multiple life skills related to the individual, his or her social environment and, in particular, interventions promoting parent-child interactions may hold particular promise in LMICs to address the burden of poor mental health and other health arenas.
BACKGROUND: Adolescence represents an unprecedented opportunity to invest in health. Individual adolescent life skills programs in low- and middle-income countries (LMICs) have demonstrated success but neither their relative effectiveness across multiple health arenas, including mental health, nor their key ingredients have been examined. METHODS: We conducted a systematic review and meta-analysis to identify key implementation processes and effectiveness of life skills programs among adolescents in LMICs which targeted at least one mental health outcome, as well as their relative effectiveness. Six academic databases, including PubMed and PsychInfo and bibliographies of related reviews, were systematically searched until July 1, 2016, with no restrictions on language or publication year. Studies were excluded if they were conducted in HIC settings, among chronically ill populations or lacking adolescents aged 10-19 years. Data from published reports related to the characteristics of RCTs and their implementation processes related to 'who, what, how and where' were extracted, including the development of a taxonomy to determine which life skills constituted each program. Meta-analyses with random effects models examined the overall trial effectiveness, as determined by their primary outcomes. Subsequent exploratory analyses determined which implementation processes predicted trial effectiveness (PROSPERO CRD42016043448). RESULTS: We included 50 eligible RCTs from 45 articles with a focus on an adolescent health program, which targeted at least one or more mental health outcomes. Most of the RCTs, conducted across 19 LMICs, targeted students (82%) and refugees (7%), and both genders (71%). Most of the interventions were delivered by teachers (n = 12), and specialist providers (n = 11), and most were focused on high-risk groups rather than clinically-disordered populations. These interventions were effective in reducing symptoms of anger (SMD = 1.234), improving life skills (SMD = 0.755) and functioning (SMD = 0.491), and decreasing PTSD (SMD = 0.327), depression and anxiety (SMD = 0.305). Trial effectiveness was positively associated with the following life skills: interventions focused on parent-child interactions (β = 0.557, p < 0.05), assessing interpersonal relations (β = 0.204, p < 0.05) and stress management (β = 0.216, p < 0.05). DISCUSSION: Our results demonstrate the benefits of life skills programs targeting one or more mental health outcomes and co-occurring risk factors in school and community settings. Comprehensive programs focusing on multiple life skills related to the individual, his or her social environment and, in particular, interventions promoting parent-child interactions may hold particular promise in LMICs to address the burden of poor mental health and other health arenas.
Authors: Ricardo Araya; Paulo Rossi Menezes; Heloísa Garcia Claro; Lena R Brandt; Kate L Daley; Julieta Quayle; Francisco Diez-Canseco; Tim J Peters; Daniela Vera Cruz; Mauricio Toyama; Suzana Aschar; Liliana Hidalgo-Padilla; Hellen Martins; Victoria Cavero; Thais Rocha; George Scotton; Ivan F de Almeida Lopes; Mark Begale; David C Mohr; J Jaime Miranda Journal: JAMA Date: 2021-05-11 Impact factor: 157.335
Authors: Maya M Boustani; Eric Daleiden; Adam Bernstein; Daniel Michelson; Resham Gellatly; Kanika Malik; Vikram Patel; Bruce Chorpita Journal: Glob Health Action Date: 2020-12-31 Impact factor: 2.640
Authors: Fatemeh Mohammadipour; Marjan Fathi; Manzar Amirkhani; Sarah Nouriyengejeh; Ata Pourabbasi Journal: Int J Community Based Nurs Midwifery Date: 2021-01