People of low- and middle-income countries living through a humanitarian crisis experience one or more events such as wars, famine, and natural disasters that largely compromise their health and safety. Moreover, during these conditions, mental and physical well-being may often be involved. Several mental disorders including post-traumatic stress disorder (PTSD) and symptoms of depression or anxiety may occur. In this scenario, psychosocial interventions are strongly encouraged targeted to people of all ages. In particular, a prevention approach is often adopted, aimed at counteracting stressor factors and improving coping strategies, to reduce the risk of onset of mental disorders. 

This review is important for people living in low- and middle-income countries affected by humanitarian crises, health professionals, general practitioners, researchers, and policymakers. 

In this 2020 Cochrane systematic review, the authors compared the efficacy and acceptability of psychological and social interventions versus control conditions such as wait list, treatment as usual, attention placebo, psychological placebo, or no treatment in the prevention of onset of mental disorders in people of low- and middle-income countries living in a humanitarian-crisis setting. Seven randomized controlled trials with 2,398 participants (both children/adolescents and adults) were included. 

Results suggest there is a lack of data in terms of efficacy of psychological and social interventions to reduce the incidence of mental disorders. As for acceptability, psychological and social interventions may make no difference compared to control at endpoint for children/adolescents and adults (low- to very low-quality evidence).

For the secondary outcomes, it is uncertain if psychological and social intervention reduce depressive and anxiety symptoms in both children and adults and reduce PTSD in children compared with control conditions (all very low-certainty evidence).

No information on adverse events related to the interventions was available.

In conclusion, low- to very low-quality evidence was found for the acceptability of psychological and social interventions in both juvenile and adult populations in LMICs affected by humanitarian crises. The authors suggest further randomized control trials, with more rigorous outcomes measures, to assess the efficacy and the potential adverse effects of these interventions. 

Comment by Sara Liguori