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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