Authors: Mark J.D. Jordans, Wietse A. Tol, Ivan H. Komproe & Joop V.T.M. de Jong
In our 18th edition, we this paper by Mark Jordans and colleagues - a thorough, well conducted and systematic review of the literature on interventions related to the psychosocial well-being and mental health of children affected by violence. 66 peer reviewed publications, based on interventions in 18 low and middle income countries, are considered and the scope of the review ranges from systematic evidence based outcome studies to those encompassing multi-sectoral, holistic and ecological approaches. The breadth of interventions covered reflects the ongoing paradigmatic shift in this field from a narrow disorder specific focus to a greater concentration on general well-being, mild distress, and from tertiary to primary and secondary prevention.
Regardless of the type of intervention undertaken, the majority of studies present positive results. Yet, methodological limitations inhibit our ability to draw general conclusions about their effectiveness. With respect to traditional evidence based evaluation studies, the authors’ meta-analyses reveal that treatment effects were, at best, moderate, were largely confined to the field of trauma, and there was an absence of research on how treatments work. The authors indicate a need for more rigorous research in this area.
Reservations are also expressed with respect to publications in the larger field that focus on primary and secondary prevention interventions of various kinds. A tendency to rely on anecdotal information, limited attempts to adapt interventions to the local context, and a lack of methodological thoroughness is noted. It seems that while the current discourse in this field favours multi-levelled community-based approaches, culturally appropriate interventions and thorough evaluations of outcome, ‘actual adherence to these principles is not often reported or lacks depth’ (p12). In short, it seems that there is a gap between research, policy and practice that should alert us all to the difficulty of conducting rigorous, methodologically sound, culturally appropriate and effective interventions with children affected by violence.