The impact of mental health and psychosocial support programmes on children and young people’s mental health in the context of humanitarian emergencies in low- and middle-income countries: A systematic review and meta-analysis

Humanitarian emergencies pose a significant global health challenge for children and young people’s mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low- and middle-income countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments.


Introduction
In recent years, millions of children and young people worldwide have been affected by extreme weather episodes, migration, conflicts, forced displacement and global public health emergencies, including COVID-19 (UNICEF, 2021).Many of them are displaced from their homes and separated from their parents and guardians, at risk of being recruited into their national armed forces, or exposed to adverse childhood experiences, including violence, serious physical injuries and extreme poverty (Bennouna et al., 2020;Ceccarelli et al., 2022).Repeated, sudden or prolonged exposures to these traumatic events can have a severe and long-term impact on their mental health and well-being (Miller and Jordans, 2016;Ataullahjan et al., 2020).Children and young people living in low-and middle-income countries (LMICs) often are less prepared and have limited access to basic services and essential resources to respond to humanitarian emergencies.
Mental health and psychosocial support (MHPSS) is increasingly considered an essential element of humanitarian responses to support children and young people affected by humanitarian crises in LMICs (Meyer and Morand, 2015).International organisations, such as UNICEF, consider MHPSS as a priority, aiming to enhance the implementation of MHPSS across humanitarian sectors (UNICEF, 2019).Similarly, the WHO-funded Inter-Agency Standing Committee (IASC) has introduced guidelines for MHPSS implementation in emergencies, providing a framework to understand different layers of programming and valuable activities to facilitate the development of effective, evidence-based MHPSS across agencies and practices (IASC, 2007b).
Several systematic reviews have explored the impact of MHPSS on mental health outcomes in children and young people affected by humanitarian crises (Jordans et al., 2009;Tol et al., 2013;Jordans et al., 2016;Brown et al., 2017;Morina et al., 2017;Bosqui and Marshoud, 2018;Purgato et al., 2018b;Pedersen et al., 2019;Barbui et al., 2020;Kamali et al., 2020;Papola et al., 2020;Pfefferbaum et al., 2020;Purgato et al., 2020;Uppendahl et al., 2020;Galvan et al., 2021).In general, most reviews indicate a positive impact of psychological and psychosocial interventions on post-traumatic symptoms in children and young people.However, the effect of MHPSS on internalised symptoms such as depression and anxiety remains uncertain.Purgato and colleagues (2018), in their individual patient data meta-analysis, observed no impact of the focused psychosocial interventions on depression and anxiety.In contrast, the Uppendahl study (2020) suggested that psychological and psychosocial interventions had a positive effect on the combined outcomes of posttraumatic stress disorders (PTSD), depression and anxiety.Moreover, MHPSS programmes evaluated in previous reviews were tailored to the varied needs of children and young people in humanitarian contexts.This complex nature of MHPSS programming poses a challenge in identifying effective modalities.Recent evidence reviews on health interventions during humanitarian crises have recommended future research to enhance understanding of the effectiveness and implementation of different MHPSS modalities for diverse populations including children (Barbui et al., 2020;Doocy et al., 2022).Given the considerable number of children and young people in need of MHPSS in humanitarian emergencies in LMICs, this systematic review is timely.It builds on existing literature, by systematically describing the current research landscape and the nature of existing MHPSS modalities evaluated and delivered to children and young people affected by humanitarian emergencies in LMICs.We also examine the effects and potential adverse consequences to inform policy and practice in LMICs.

Search strategy and selection criteria
We carried out a systematic review of research evidence following PRISMA guidelines (Page et al., 2021).We searched 12 bibliographic databases across disciplines and specialist databases: Medline, ERIC, PsycINFO, Econlit, Cochrane Library, IDEAS, IBSS, CINHAL, Scopus, ASSIA, Web of Science and Sociological Abstracts.Both published and unpublished studies were comprehensively searched from the websites of relevant organisations.We searched the citations of included studies and relevant systematic reviews.Search strategies were informed by the scoping exercise (Bangpan et al., 2016) and were developed based on three key concepts (mental health and psychosocial support, humanitarian emergencies and study designs).The search was first performed in November 2015 and updated and finalised in May 2023 (see S1 for the example of database search strategies and a list of websites searched).We included studies that aimed to evaluate the impact of MHPSS programmes on mental health and well-being of children and young people aged at or below 25, who were affected by humanitarian emergencies in LMICs1 MHPSS programmes were broadly defined as interventions seeking to 'provide or promote psychosocial well-being and/or prevent or treat mental health disorder' p. 1, (IASC, 2007b).We included only experimental studies with control groups that were published in English in or after 1980 (see S2 for eligibility criteria).Two reviewers (MB and KD) piloted the eligibility criteria.A pilot screening exercise was performed by the review team members (MB, LF, KD, FS, ZD, AJ) before independently screening the studies on titles and abstracts.Any discrepancies identified during both the pilot and independent screening were addressed through discussions between the reviewers.When there was insufficient information, full reports were obtained to assess the eligibility for inclusion.
The data extraction tool, developed and piloted by two reviewers (MB, KD), aimed to collect information on key characteristics of MHPSS programmes, implementation strategies, study design, findings and conclusions.Three reviewers (MB, FS, PD) independently extracted information from eligible studies, and the second reviewer carried out a consistency check of all included studies using EPPI-Reviewer (Thomas et al., 2020).Four reviewers (MB, FS, PD, LF) assessed the risk of bias of the studies included in the synthesis using the Cochrane risk-of-bias tool for randomised controlled trials (RCTs) (RoB2) (Sterne et al., 2019) and cluster randomised controlled trials (cRCTs) (RoB 2 for cRCTs) (Eldridge et al., 2017).The overall quality of the included studies was subsequently judged as a high risk of bias, some concerns or a low risk of bias according to RoB 2 framework.We resolved any disagreements by discussing and consulting with a third review member when required.The review protocol was registered at PROSPERO database (CRD42016033578).

Data analysis
We first narratively described the key characteristics of all included studies.We included only RCTs and cRCTs.We classified types of MHPSS into five broad domains, including cognitive behavioural therapy (CBT), narrative exposure therapy (NET), interpersonal and body psychotherapy modalities, psychosocial programmes and psychoeducation (see Table 1) (Bangpan et al., 2019).The iterative process of MHPSS programme classification was undertaken.We read the description of the MHPSS programmes described by the authors of the included studies and then matched the programme descriptions against pre-defined programme definitions developed by the current review team.When appropriate, the meta-analysis was performed on conceptually similar outcome measures reported in more than one study using a random effect model.The pooled standardised mean difference (SMD) effect sizes were estimated and presented in forest plots with a 95% confidence interval (CI).We extracted outcome data at the longest follow up timepoint.When we included cRCTs, we checked whether the outcome data had been adjusted for intra-cluster correlation (ICC).In cases where studies did not report ICC, we used the ICC data based on other included studies.We assessed the extent of heterogeneity using I 2 statistics to quantify the magnitude of statistical heterogeneity and tested the statistical significance of heterogeneity using Q statistics.We ran a meta-analysis using STATA version 17.

Results
We identified 18,556 records.16,822 records were screened on title and abstract.1,342 records were rescreened based on full-text reports.A total of 60 studies were included in the review, and 43 RCTs and cRCTs were considered for the synthesis (see Figure 1).Twelve electronic databases, key websites and citation checking were undertaken.Forty-three RCTs published in English between January 1980 and May 2023 were included in the review.Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies (pooled ES = -0.15;95% CI (À0.29,À0.01),I 2 = 51.86%).Narrative exposure therapy may reduce feelings of guilt (pooled ES = À0.43,95% CI (À0.79,À0.07),I 2 = 0%).However, the impact of the other MHPSS modalities across outcomes is inconsistent.In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people.These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments.
Forty-two (70%) of 60 studies were published since 2010.Most studies were conducted in the Middle East and Asia (n = 36, 60%) and 19 (33.33%) in sub-Saharan Africa.The majority of the research evidence (n = 49) was conducted in war and conflict settings.Onefifth of the studies (n = 11) evaluated the impact of MHPSS programmes on displaced and refugee children (Dybdahl, 2001;Thabet Abdel et al., 2005;Bolton et al., 2007;Ertl et al., 2011;Kalantari et al., 2012;Lange-Nielsen et al., 2012;Morris et al., 2012;Annan et al., 2017;Sirin et al., 2018;Yankey and Biswas Urmi, 2019;Fine et al., 2021).Nearly one-quarter investigated the impact of MHPSS programmes on children and young people affected by natural disasters such as earthquakes, tsunami (Goenjian et al., 2005;Schauer von, 2008;Shooshtary et al., 2008;Berger and Gelkopf, 2009;Catani et al., 2009;SHoaakazemi et al., 2012;Chen et al., 2014;Cluver, 2015;Pityaratstian et al., 2015;Akiyama and Gregorio Ernesto, 2018;Cleodora et al., 2018;Dhital et al., 2019;Nopembri et al., 2019).The majority of the studies assessed the impact of MHPSS programmes in the aftermath of disasters.Only four studies aimed to measure the impact of MHPSS programmes on young women and girls (SHoaakazemi et al., 2012;O'callaghan et al., 2013;Robjant et al., 2019;Ahmadi et al., 2023) and only one study focused on former child soldiers and war-affected boys (McMullen et al., 2013).Most MHPSS programmes were delivered in school or classroom.Additional locations included the community (Khamis and Cambridge Prisms: Global Mental Health Coignez, 2004;Loughry et al., 2006;Morris et al., 2012;Betancourt et al., 2014;Annan et al., 2017;Panter-Brick et al., 2018;Sirin et al., 2018;Robjant et al., 2019;Brown et al., 2023), refugee camps (Khamis and Coignez, 2004;Thabet Abdel et al., 2005;Bolton et al., 2007;Ertl et al., 2011;Lange-Nielsen et al., 2012;Fine et al., 2021), family home (Dybdahl, 2001;Brown et al., 2009;Chen et al., 2014), outdoor areas (Richards et al., 2014;Pityaratstian et al., 2015;Akiyama and Gregorio Ernesto, 2018) or within church settings (O'callaghan et al., 2014).The majority of MHPSS programmes (n = 50, 83.33%) were conducted in group settings, while four (6.7%) were delivered in group and individual formats.Of 60 studies, 22 studies evaluated the impact of CBT; 20 studies evaluated psychosocial programmes.Other studies focused on NET (n = 10), psychoeducation (n = 3) and other interpersonal and body psychotherapy modalities (n = 11).Eight studies evaluated more than one MHPSS model.Approximately three-quarters of the MHPSS programmes included in the review provided advice and support to children and young people by sharing dialogue and discussing experiences within groups or with specialists.Other implementation strategies included exercise, drawing, arts and crafts, relaxation and breathing techniques.Some included social activities such as sports, games, drama, film or providing life skill training.Several MHPSS programmes were designed to engage with carers and work with teachers and school management, and/or the wider community.MHPSS programme implementation varied in terms of intensity Exclusion criteria: 1) date: not published after 1980; 2) participants: investigating populations who are a)military personnel or b) those working in HM contexts; 3) intervention: not delivering MHPSS interventions in the context of humanitarian emergencies or for populations affected by humanitarian emergencies; 4) study design: not conducting a process evaluation or an outcome evaluation using quasi/experimental designs with control groups; 5) reporting data: not collecting and reporting quantitative data on the impact of an MHPSS intervention; 6) language: not written in English.Further exclusion criteria were applied to full texts that met criteria 1-6 but were 7) not primary research (e.g., systematic reviews) 8) conducted in a high-income country 9) Linked studies 10) not focusing on children and young people 11) on-going studies  and duration.Nevertheless, MHPSS programmes designed for children and young people in low-resource, humanitarian settings were typically delivered between four to 15 sessions (n = 37), each lasting approximately 60-120 min (n = 31).Five MHPSS programmes were delivered in multiple sessions, spanning one school year or more (Layne Christopher et al., 2008;Peltonen et al., 2012;Nopembri et al., 2019;Torrente et al., 2019;Yankey and Biswas Urmi, 2019).A wide range of outcomes was used to assess the impact of MHPSS programmes (see Figure 2).The most commonly reported mental health measures were PTSD (n = 41 studies, 68%) and depression (n = 31 studies, 51.67%).Other traumatic stress reactions and emotional well-being measures reported in more than ten studies included psychological distress, conduct problems, functioning, anxiety and prosocial behaviours.Other coping resources, such as family and social support outcomes, were reported in 13 studies.Less commonly reported outcome measures were emotional problems (n = 8), educational outcomes (n = 8), hopefulness (n = 7), guilt (n = 3) and grief (n = 4).We identified various tools used to measure the impact of MHPSS programmes.Nearly half of the included studies clearly explained whether and how the standardised instruments were translated into local languages or piloted for use in local settings.(the key characteristics of 60 studies are summarised in file S3).
Due to a substantive amount of heterogeneity, we were able to perform a meta-analysis and found a significant positive impact of MHPSS on grief (2 studies; pooled ES = À0.55*,95% CI (À0.91,À0.19),I 2 = 0%), and guilt (2 studies; pooled ES = À0.51*,95% CI (À0.83,À0.19),I 2 = 0%).In other outcomes, we reported a range of effect sizes, presenting mixed results across studies (see S4).  Cambridge Prisms: Global Mental Health Cambridge Prisms: Global Mental Health We performed an explorative analysis to assess the impact of MHPSS programmes by programme type.CBTs were evaluated in 20 studies (six low risk of bias, ten some concerns, four high risk of bias).All but two CBT programmes were delivered in a group format (Chen et al., 2014;Dawson et al., 2018).The majority of the studies evaluated the impact of CBT delivered to children in conflict-affected settings, with three studies assessed its effects on children affected by earthquakes and tsunamis (Berger and Gelkopf, 2009;Chen et al., 2014;Pityaratstian et al., 2015).These CBT programmes were primarily delivered in school settings, with two conducted in refugee camps (Khamis and Coignez, 2004;Fine et al., 2021), and one delivered at home (Chen et al., 2014).In three studies, the effect of culturally adapted, school-based trauma-based CBT designed for war-affected youth in Democratic Republic of the Congo (DRC) was examined, showing a significant reduction in PTSD, conduct and emotional problems (McMullen et al., 2013; O 'callaghan et al., 2013; O'callaghan et al., 2015).The finding from the meta-analysis suggested that CBT programmes have a potential to improve depression symptoms (pooled SMD = À0.15;95% CI (À0.29,À0.01,I 2 = 51.86%%)(Figure 3).We did not perform a meta-analysis of the effects of CBT on other outcomes due to heterogeneity.
Eight studies (four some concerns, four high risk of bias) evaluating the impact of narrative exposure therapy (NET) were included in the review.(Schauer von, 2008;Catani et al., 2009;Ertl et al., 2011;Kalantari et al., 2012;Lange-Nielsen et al., 2012;Robjant et al., 2019;Getanda and Vostanis, 2020;Ahmadi et al., 2023).Six NET programmes were delivered in a group format (Schauer von, 2008, Kalantari et al., 2012, Lange-Nielsen et al., 2012, Robjant et al., 2019, Getanda and Vostanis, 2020, Ahmadi et al., 2023), with three delivered to individual participants.(Catani et al., 2009;Ertl et al., 2011;Robjant et al., 2019).Two studies were carried out in Sri Lanka: one with children affected by civil war (Schauer von, 2008) and the other one was carried out immediately after the 2004 tsunami (Catani et al., 2009).Two were carried out in camps for internally displaced persons (IDPs): one in Palestine (Lange-Nielsen et al., 2012) and the other in Uganda (Ertl et al., 2011).One study was conducted in a refugee camp in Iran (Kalantari et al., 2012).One study evaluated the NET programme delivered to female former child soldiers in DRC (Robjant et al., 2019).Another study evaluated the Memory Training for Recovery-Adolescent Intervention delivered to Afghan adolescent girls.The findings from the meta-analysis indicate that NET may have a significant impact in reducing the feelings of guilt (n = 2 studies; pooled SMD = -0.43,95% CI (À0.79,À 0.07), I 2 = 0%).However, NET may have no Cambridge Prisms: Global Mental Health statistically significant impact on other internalised symptoms or functioning.One randomised study assessing the impact of the Writing for Recovery (WfR) programme in Gaza found that the children in the intervention group experienced an increase in depression and anxiety symptoms compared to the wait-list control group (Lange-Nielsen et al., 2012).
In addition, we identified six studies (one low risk of bias, five high risk of bias) evaluating six interpersonal and body psychotherapy programmes including Group Interpersonal Psychotherapy (IPT-G) (Bolton et al., 2007), counselling (Chen et al., 2014), yoga (Cluver, 2015), mind and body technique (Gordon et al., 2008), logotherapy (SHoaakazemi et al., 2012) and school-based psychotherapy (Layne Christopher et al., 2008).The studies were carried out in five different countries (Bosnia and Herzegovina, China, Haiti, Uganda and Kosovo) affected by armed conflict (Bolton et al., 2007;Gordon et al., 2008;Layne Christopher et al., 2008) or natural disaster (SHoaakazemi et al., 2012;Chen et al., 2014).The most common outcomes reported in this group of programmes were PTSD and depression.We did not carry out statistical syntheses on these outcome measures because of differences and variations in psychotherapeutic programme modalities and intervention approaches.Four studies reported unadjusted mean scores and standard deviations of PTSD (Gordon et al., 2008;Layne Christopher et al., 2008;Chen et al., 2014;Cluver, 2015).One study evaluating a mind-body skills group in Kosovo found a significant impact of the intervention on PTSD (Gordon et al., 2008).The other studies suggested mixed findings for the interventions.Chen et al. (2014) found that support group counselling may have had little impact on PTSD in children and young people affected by the earthquake in China compared with those who received no intervention.The findings from the Layne Christopher et al. ( 2008) study also suggested that there might be little impact from a school-based psychotherapy intervention on schoolchildren in Bosnia.However, Cluver (2015) found that yoga may increase PTSD in children and young people compared with those in an aerobic dance group.
Three studies assessed the impact of other psychotherapy interventions on depression (Bolton et al., 2007;Layne Christopher et al., 2008;Chen et al., 2014).Only Bolton et al.'s (2007) study evaluating an IPT-G programme reported a significant positive impact of the intervention on depression.In this study, 314 Acholi children aged 14-17 from two internally displaced person camps in Northern Uganda were randomly assigned to IPT-G, creative play, or a wait-list control group.At post-intervention, the IPT-G participants showed a greater reduction in depression symptoms than those in the wait-list control group.

Conclusions and discussion
In the last decade, considerable attempts have been made to support children and young people's mental and psychosocial health in humanitarian emergencies (Barbui et al., 2020).Delivering CBT programmes has been suggested as a suitable choice of MHPSS programmes to reduce the symptoms of PTSD in adults across various humanitarian contexts (Bangpan et al., 2019).However, the findings from this systematic review suggest inconclusive evidence regarding the effectiveness of other MHPSS modalities, such as NET or other psychotherapies, in improving internalising symptoms in children and young people.Similar results found in recent systematic reviews evaluating psychological therapies and social interventions suggest limited evidence of the programme impact on mental health of children and young people affected by humanitarian settings (Purgato et al., 2018a;Papola et al., 2020).In addition, we found that studies evaluating psychosocial programmes incorporating components such as social support, child-friendly spaces, creative play, sports, games or academic catch ups reported potential unintended consequences.Future research should employ rigorous evaluation designs considering contextual and structural influences to better understand how these types of programming can be safely and effectively delivered to this specific population group in humanitarian settings.
We recognise that MHPSS programmes implemented in humanitarian settings may face several implementation challenges, and the observed unintended impact could arise from the interplay between programme delivery and socially and culturally sensitive contexts (Koch and Schulpen, 2018).Moreover, challenges in recruiting, retraining and training programme personnel in lowresource settings, coupled with ongoing risks and insecurity, may affect the fidelity of programme implementation (Dickson and Bangpan, 2018).Recent research highlights the possibilities of training lay community workers to deliver MHPPS programme in resource-limited settings.Future research should investigate the effectiveness of this task shifting approach to guide the advancement of the implementation of MHPSS programmes (Cohen and Yaeger, 2021).In addition, some point out that children and young people face daily threats and ongoing stressful events in humanitarian emergencies which may require access to a wide range of basic social services.Therefore, further consideration to the importance of socio-ecological and multi-sectoral programming, as part of MHPSS programme design and delivery, aiming to prevent, treat and promote mental health of populations affected by humanitarian crises, is warranted (Purgato et al., 2018a;Kamali et al., 2020;Papola et al., 2020;Tol et al., 2020;Raslan et al., 2021;Papola et al., 2022).Future research might also benefit from considering the social determinants of mental health and developing a theory of change to understand mechanisms that improve mental health outcomes and wellbeing throughout the life course (Allen et al., 2014).
The current systematic review offers an overview of the current state of evidence on the impact of MHPSS programmes on children and young people affected by humanitarian emergencies in LMICs.We assessed the impact of different types and modalities of MHPSS programmes, offering insights into their potential benefits and unintended consequences.Although our comprehensive search identified substantial evidence in the field, we noted some caveats when interpreting the findings.First, the quality of the studies included in the systematic review varied, with the majority judged to have some quality concerns or being at a high risk of bias.This limitation of the existing evidence is also expressed by recent systematic reviews highlighting a low quality of evidence on the impact of the programmes aiming to prevent and treat mental health in children and young people affected by humanitarian settings (Purgato et al., 2018a;Papola et al., 2020).Second, we included only studies published in English.Other high-quality studies published in other languages may provide further evidence on the impact of MHPSS programmes, especially studies from Central and South America.Third, we identified a wide range of outcomes using various scales, reflecting the attempt to adapt tools for measuring the mental health and wellbeing outcomes across socio-cultural settings.Finally, the studies included in the metaanalysis were heterogeneous, drawing on a broad evidence base that aims to evaluate the impact of multi-component, multi-level MHPSS programmes on various outcomes across humanitarian settings.Future development and evaluation of MHPSS programmes would benefit from engaging with key stakeholders and local communities to understand and theorise how interventions intend to work and how socio-cultural factors might influence their observed impact (Kneale et al., 2020;Miller et al., 2021).
We systematically reviewed research evaluating the impact of MHPSS programmes on children and young people affected by humanitarian emergencies in LMICs.Sixty studies met the inclusion criteria.We identified several research gaps.In sub-Saharan Africa, although more than one-fifth of global refugees and internally displaced persons are hosted in countries such as the Central African Republic (CAR), the Democratic Republic of the Congo (DRC), Somalia and South Sudan (UNHCR, 2018), our systematic review identifies the paucity of rigorous evidence to inform the design and implementation of MHPSS programmes in this region, in line with the recent meta-review focusing on vulnerable African children (Katsonga-Phiri et al., 2019).Secondly, there is increasing recognition of the need to develop MHPSS programmes that are tailored to girls' and boys' needs, considering the social determinants of their individual psychological health and well-being (Purgato et al., 2018b;Raslan et al., 2021;Lasater et al., 2022).Yet, we identified limited evidence examining the impact of genderspecific MHPSS programmes.Furthermore, we did not come across any studies explicitly targeting children with disabilities.There is a need to further develop inclusive MHPSS programmes that not only address the unique needs of children with disabilities but also consider the influence of intersectionality and factors, such as gender, culture and religion.Additional research gap identified from this systematic review includes evaluations of MHPSS programmes aiming to protect children and young people's well-being in humanitarian settings through basic service and security provision.Finally, future evaluative research should aim to capture the long-term impact and assess the cost-effectiveness of MHPSS programmes (Purgato et al., 2018a;Papola et al., 2022).
Open peer review.To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.17.Supplementary material.The supplementary material for this article can be found at http://doi.org/10.1017/gmh.2024.17.

Figure 2 .
Figure 2. Type of MHPSS programmes and outcomes*.*More than one types of the MHPSS programmes can be evaluated in one study.

Figure 3 .
Figure 3. Impact of CBT programmes on depression in children and young people (n = 12 studies).

Table 1 .
Types of MHPSS programmes