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Table 3 Outline of mechanisms of change for interventions aimed at improving the wellbeing, mental health and resilience of children and adolescents affected by war and armed conflict

From: Mechanisms of change for interventions aimed at improving the wellbeing, mental health and resilience of children and adolescents affected by war and armed conflict: a systematic review of reviews

Mechanisms

Cited reviews

Outcomes

Evidence Quality

Basic services and security

1

Creating safety and protection from harm

Ager et al. [17]

Protection outcomes (sense of safety, exual exploitation and rape, physical injuries, referrals, reporting); social and emotional wellbeing

Low: Program evaluations

2

Playing

Apfel and Simon [1]; Betancourt et al. [14]

Resilience; wellbeing; self-confidence; emotional regulation

Low: Case or cross-sectional studies

Strengthening family and community support

3

Community capacity building

Apfel and Simon [1]; Ager et al. [17]; Peltonen & Punamäki [6]

Knowledge of protection systems; sense of order and sanity; PTSD; improved psychosocial wellbeing

Low: Program evaluations

4

Increasing social support

Apfel and Simon [1]; Peltonen & Punamäki [6]

Resilience; PTSD; improved psychosocial wellbeing

Low: Program evaluation and clinical experience

5

Family and caregiver capacity building

Apfel and Simon [1]; Jordans, Pigott and Tol [36]

Ability of caregivers to provide consistent and reliable care; depression; PTSD; anxiety symptoms; hope

High: Statistical testing of mechanism

6

Family and caregiver relationship strengthening.

Apfel and Simon [1]; Betancourt et al. [14]; Jordans, Pigott and Tol [36]

Further traumatic experience; psychosocial functioning; mental health; maternal mental health; depression; PTSD; anxiety symptoms; hope

High: Statistical testing of mechanism

7

Engaging with values, traditions, religious and non-religious beliefs, and ideologies

Apfel and Simon [1]; Betancourt et al. [14]; Tol, Song and Jordans [11]

Morale and healing; maintaining the right to be alive despite suicidal despair; drive to survive; community and personal restitution; empowerment; reintegration into communities; wellbeing

Low: Qualitative studies or clinical experience

Focused non-specialist support

8

Learning about the presenting problem, medication, and how to access services (psychoeducation)

Betancourt et al. [14]

Medication compliance; access to services; distress

Moderate: Statistic testing but of intervention not mechanism

9

Learning stress management skills

Peltonen & Punamäki [6]

PTSD; psychosocial wellbeing

Moderate: Statistic testing but of intervention not mechanism

10

Emotional regulation and bearing negative emotions

Apfel and Simon [1]; Peltonen & Punamäki [6]

Chances of survival; resilience

Low: Program evaluation and clinical experience

11

Problem solving

Jordans, Pigott and Tol [36]

Depression; PTSD; anxiety symptoms; hope

High: Statistical testing of mechanism

 12

Learned helpfulness

Apfel and Simon [1]; Betancourt et al. [14]

Helplessness; wellbeing

Moderate: Statistical testing but of intervention not mechanism

Specialist support

13

Adverse mechanism: Pathologising normal reactions

Apfel and Simon [1]

Alienating participants

Low: Clinical experience

14

Trauma processing through narratives, exposure, dreaming or play

Apfel and Simon [1]; Betancourt et al. [14]; Jordans, Pigott and Tol [36]; Peltonen & Punamäki [6]

Memory integration; PTSD; depression; PTSD; anxiety symptoms; hope; psychosocial wellbeing

Moderate: Statistical testing but of intervention not mechanism

15

Restructuring unhelpful cognitions and appraisals

Peltonen & Punamäki [6]

PTSD; psychosocial wellbeing

Moderate: Statistical testing but of intervention not mechanism

16

Therapeutic rapport

Jordans, Pigott and Tol. [36]

PTSD; anxiety symptoms; hope

High: Statistical testing of mechanism