The Effect of Psychotherapies on Youth in Low- and Middle-Income Countries

The effect of psychotherapies on youth may differ among those living in low- and middle-income countries (LMICs), according to results of a systematic review and meta-analysis published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Investigators from Harvard University searched publication databases through January 2021 for randomly assigned controlled trials of psychotherapy treatment among youth living in LMICs. A total of 34 articles were included in this analysis.

The study population comprised 4176 individuals among whom 65.11% were girls who were aged 13.38 (SD, 2.66) years.

The studies were designed to treat anxiety (48.83%), conduct problems (23.26%), depression (13.95%), multiple internalizing problems (11.63%), and multiple internalizing and externalizing problems (2.33%). Treatments were administered for an average of 8.71 (SD, 5.11) weeks.

Overall, treatment had a significant effect on symptoms at posttreatment (effect size [ES], 1.01; 95% CI, 0.72-1.29; I², 91.22%; P <.001) and follow-up (ES, 0.68; 95% CI, 0.29-1.07; I², 83.11%; P =.003). Results were similar in the outlier sensitivity analyses.

Stratified by therapeutic target, significant effects were observed for the treatment of conduct problem (ES, 1.73; 95% CI, 0.85-2.62) and posttraumatic stress disorder (ES, 0.60; 95% CI, 0.30-1.49) but not for anxiety (ES, 0.76; 95% CI, -0.13 to 1.65).

In the moderation analysis, significant effects were observed for provider type and adaptation. In which, treatment had a greater effect when delivered by a professional mental health clinician (ES, 1.59; 95% CI, 0.75-2.43) compared with a lay-provider (ES, 0.53; 95% CI, 0.17-0.90) as did treatments that were not adapted to the local context (ES, 2.31; 95% CI, 1.01-3.60) compared with treatments that were adapted (ES, 0.66; 95% CI, -0.57 to 1.88).

Significant publication bias was detected in the posttreatment (β, 3.62; P <.001) and follow-up (β, 3.54; P <.001) comparisons. The findings in this analysis may have been biased by the significant study bias and heterogeneity.

“We found evidence that psychotherapies for youths in LMICs are effective across a variety of mental health problems, that treatment effects may be especially large in LMICs, and that a few study-level variables moderated the effectiveness of these interventions. Notably, although 90% of youths live in LMICs, only a disproportionately small fraction of youth psychotherapy trials have been conducted in these settings. We hope the present findings will encourage further research testing how to design, adapt, and implement effective psychosocial treatments for young people living in LMICs,” concluded the study authors.