Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.
Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
BMJ Glob Health. 2020 Mar 15;5(3):e002014. doi: 10.1136/bmjgh-2019-002014. eCollection 2020.
Over 240 million children live in countries affected by conflict or fragility, and such settings are known to be linked to increased psychological distress and risk of mental disorders. While guidelines are in place, high-quality evidence to inform mental health and psychosocial support (MHPSS) interventions in conflict settings is lacking. This systematic review aimed to synthesise existing information on the delivery, coverage and effectiveness of MHPSS for conflict-affected women and children in low-income and middle-income countries (LMICs).
We searched Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO)databases for indexed literature published from January 1990 to March 2018. Grey literature was searched on the websites of 10 major humanitarian organisations. Eligible publications reported on an MHPSS intervention delivered to conflict-affected women or children in LMICs. We extracted and synthesised information on intervention delivery characteristics, including delivery site and personnel involved, as well as delivery barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.
The search yielded 37 854 unique records, of which 157 were included in the review. Most publications were situated in Sub-Saharan Africa (n=65) and Middle East and North Africa (n=36), and many reported on observational research studies (n=57) or were non-research reports (n=53). Almost half described MHPSS interventions targeted at children and adolescents (n=68). Psychosocial support was the most frequently reported intervention delivered, followed by training interventions and screening for referral or treatment. Only 19 publications reported on MHPSS intervention coverage or effectiveness.
Despite the growing literature, more efforts are needed to further establish and better document MHPSS intervention research and practice in conflict settings. Multisectoral collaboration and better use of existing social support networks are encouraged to increase reach and sustainability of MHPSS interventions.
CRD42019125221.
超过 2.4 亿儿童生活在受冲突或脆弱性影响的国家，这些环境与心理困扰加剧和精神障碍风险增加有关。尽管已有指导方针，但缺乏有关冲突环境中精神卫生和心理社会支持（MHPSS）干预措施的高质量证据。本系统评价旨在综合现有信息，了解中低收入国家（LMIC）中受冲突影响的妇女和儿童的 MHPSS 提供、覆盖和有效性。
我们检索了 Medline、Embase、护理与健康相关文献累积索引（CINAHL）和心理信息数据库（PsycINFO）数据库，以获取 1990 年 1 月至 2018 年 3 月发表的索引文献。在 10 个主要人道主义组织的网站上搜索灰色文献。符合条件的出版物报告了在 LMIC 中向受冲突影响的妇女或儿童提供的 MHPSS 干预措施。我们提取并综合了干预提供特征的信息，包括提供地点和参与人员，以及提供障碍和促进因素，并列出了报告的干预覆盖范围和效果数据。
搜索产生了 37854 个独特的记录，其中 157 个被纳入综述。大多数出版物位于撒哈拉以南非洲（n=65）和中东和北非（n=36），许多报告了观察性研究（n=57）或非研究报告（n=53）。近一半描述了针对儿童和青少年的 MHPSS 干预措施（n=68）。心理社会支持是最常报道的干预措施，其次是培训干预措施和筛查以转介或治疗。只有 19 篇出版物报告了 MHPSS 干预措施的覆盖范围或有效性。
尽管文献不断增加，但仍需要更多努力进一步建立和更好地记录冲突环境中的 MHPSS 干预措施研究和实践。鼓励多部门合作和更好地利用现有的社会支持网络，以提高 MHPSS 干预措施的覆盖面和可持续性。
PROSPERO 注册号：CRD42019125221。
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