Mechanisms of Change for Child Mental Health and Psychosocial Support in Conflict Settings: A Systematic Review

There is a growing evidence-base for the effectiveness of mental health and psychosocial support (MHPSS) programmes for children affected by conflict for a range of mental health and wellbeing outcomes, but with limited evidence for how these interventions produce change. This study aimed to review the evidence for mechanisms of change of MHPSS interventions for children affected by conflict. Systematic review methodology was used to screen the PubMed, Published International Literature on Traumatic Stress (PILOTS) and PsycInfo databases for primary quantitative studies. Out of 3,903 records, seven studies were included, all evaluations of school-based preventative programmes. Results showed a mediation effect of peer relations on treatment change for wellbeing outcomes, while a predictable and cooperative learning environment partially mediated treatment change for academic outcomes, victimisation and mental health. One study found a small negative mediation effect of play-based social support for posttraumatic stress disorder. No evidence was found for any other mechanisms. The findings of this review highlight the role of social relationships as mechanisms of change in MHPSS programmes, but with limited studies to draw from. Future programme evaluations should include measures of proposed mechanisms to further our understanding of how MHPSS programmes work to continue to improve their relevance and scope and to do no harm.