For millions of young people growing up in low and middle income countries, anxiety, depression and trauma are part of daily life. War, displacement, poverty and natural disasters leave many children struggling in silence, often with little access to specialist care. New research suggests that group based psychosocial interventions may offer a practical and effective way to reduce mental health problems in these settings. The findings were published in PLOS Mental Health.
A large realist systematic review and meta analysis examined 38 randomised controlled trials involving 6,086 participants across 24 countries . The young people, with a mean age of 13 and just over half female, received group interventions targeting depression, anxiety or post traumatic stress disorder.
The pooled results show moderate to large improvements. Post intervention effect sizes were minus 0.72 for depression, minus 0.90 for anxiety and minus 0.71 for PTSD, all statistically significant . In practical terms, this means many participants experienced meaningful reductions in symptoms compared with those receiving usual care or waiting list support.
Most of the programmes were delivered in schools, community centres or refugee camps. Interventions ranged from cognitive behavioural therapy and trauma focused approaches to mindfulness and written exposure therapy. Many were led not by psychiatrists but by trained lay facilitators, teachers or school counsellors, highlighting their potential scalability.
Yet the study also found that results varied widely. Some trials reported strong benefits, while others showed little difference. To understand why, researchers used a realist approach, examining how context and mechanisms interact to shape outcomes.
Age emerged as an important factor. Interventions were more effective when content matched the young person’s cognitive level and included age appropriate activities. Older children showed larger improvements in depression symptoms in the meta regression analysis . Programmes that were too abstract or reliant on literacy risked disengaging younger participants.
Gender and social context also mattered. Some studies suggested that boys and girls respond differently depending on cultural expectations, exposure to violence and levels of social support. Interventions appeared to work best when they accounted for local gender specific pressures and community dynamics.
Conflict exposure was another key influence. For depression, larger effect sizes were found in populations not currently exposed to conflict . Ongoing insecurity and daily stressors may limit how much young people can benefit from structured group therapy, especially when adversity continues outside the classroom.
The authors argue that understanding what works for whom is essential. Simply exporting a manualised programme from a high income country is unlikely to succeed without careful cultural adaptation. Several trials highlighted the value of tailoring language, examples and activities to local realities, as well as engaging families and communities.
Mental health in teenagers is now recognised as a global public health priority. With 1 in 7 adolescents worldwide estimated to experience a mental disorder, scalable treatments are urgently needed. Group psychosocial interventions offer a cost effective option, particularly where specialist services are scarce.
But the review also points to limitations. Many trials were small or at risk of bias, and few included detailed analyses of which components drove change. The researchers call for more high quality studies that test how age, gender, trauma exposure and setting influence outcomes.
For policymakers and practitioners working in low resource settings, the message is cautious optimism. Group therapy can reduce anxiety, depression and PTSD in young people, but success depends on matching the intervention to the context in which children live.