Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review

Tania Bosqui, Department of Psychology, American University of Beirut, Beirut, Lebanon; Trinity Centre for Global Health, Trinity College Dublin, Republic of Ireland. Electronic address: tb33@aub.edu.lb.
Anas Mayya, Department of Psychology, American University of Beirut, Beirut, Lebanon. Electronic address: akm15@mail.aub.edu.
Sally Farah, Department of Psychology, American University of Beirut, Beirut, Lebanon. Electronic address: sallygfarah@gmail.com.
Zahraa Shaito, Department of Psychology, American University of Beirut, Beirut, Lebanon. Electronic address: zahraa.shaito@gmail.com.
Mark J. Jordans, War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: mark.jordans@warchild.net.
Gloria Pedersen, Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, the George Washington University School of Medicine and Health Sciences, Washington D.C., United States.
Theresa S. Betancourt, Boston School of Social Work, Boston, United States. Electronic address: theresa.betancourt@bc.edu.
Alan Carr, University College Dublin, Dublin, Republic of Ireland. Electronic address: alan.carr@ucd.ie.
Michael Donnelly, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom. Electronic address: michael.donnelly@qub.ac.uk.
Felicity L. Brown, War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: felicitylbrown@gmail.com.

Document Type

Journal Article

Publication Date

4-5-2024

Journal

Comprehensive psychiatry

Volume

132

DOI

10.1016/j.comppsych.2024.152483

Keywords

Adolescents; Child; Family; Humanitarian crises; Low- and middle-income countries; Parenting; Psychosocial interventions

Abstract

BACKGROUND: Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential. METHOD: This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0-24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes. MAIN FINDINGS: We found a total of 80 studies (n = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs. PRELIMINARY CONCLUSIONS: Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions.

Department

Public Health Student Works

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