Karmaliani 2020.

Study characteristics
Methods	Study design: cluster‐RCT Duration of study: the study was conducted between December 2015 and January 2018. Country: Pakistan Income classification: low‐middle‐income country between 2015‐2018 Geographical scope: not specified Healthcare setting: 40 gender‐specific public schools
Participants	1. Age: 12‐13 years 2. Gender: both 3. Socioeconomic background: not specified 4. Educational background: 6th grade Inclusion criteria—schools: a. single‐sex, government schools; b. sufficiently large spaces for safe play; c. 35+ students in grade 6 where parental consent could be sought. Inclusion criteria—children: all 6th graders attending the selected schools. Exclusion criteria—schools: campus schools with a single administration responsible for multiple schools in the same area. Exclusion criteria—children: none reported. Note: considerations on baseline scores not applicable for this study Stated purpose: to determine the impact of the intervention on school‐based peer violence (victimization and perpetration) and depression amongst school children
Interventions	Name: The Positive Child and Youth Development Title/name of PW and number: coaches (20 adult coaches + 120 junior leaders) 1. Selection: criteria for coach selection include previous experience in working with children, a passion and willingness to participate in Right To Play’s training, a positive attitude toward child protection, and living in relatively close proximity to the school where the coaches will work. Junior leaders are given leadership training, and they participate as assistants to the coaches, for example, by leading warm‐up exercises. 2. Educational background: intermediate education 3. Training: training was done in accordance with Right To Play’s Junior Leader Facilitation Toolkit. 4. Supervision: the research team verified completion of the intended number of sessions and observed a session in each school each month to ensure compliance with the manual. 5. Incentives/remuneration: not specified Prevention type: universal – all 6th‐grade students were eligible for inclusion. Intervention details: the intervention in Pakistan was based on 103 play‐based learning activities, each with a specific goal as specified in the manual. These structured activities, designed to help children and adolescents improve their confidence, resilience, and critical thinking, were developed by a team of experts including educationists, athletes, teacher‐trainers, and psychologists. Coaches selected an activity for a session from the manual. After the game, they led a three‐step discussion following the formula Reflect‐Connect‐Apply, which involved reflection on the activity and how it made participants feel or what had been learned from it, discussion connecting this to daily life, and application more broadly to other circumstances. Over the 2 years of this study, 120 sessions were conducted in each class, with, on average, two sessions of 35 minutes per week, resulting in 60 sessions in a year. Control: waiting list – regular schooling programme; received intervention for 6 months after study completion.
Outcomes	Participants’outcomes of interest for this review Depressive symptoms – Child Depression Inventory (CDI‐2) Carers’ outcomes of interest for this review Nil Economic outcomes Nil Time points: baseline, post‐intervention (7‐24 months) Note: data were not included in the meta‐analysis because they were not provided in the right format or were not available even after attempted author contact.
Notes	Source of funding: this is an output from the What Works to Prevent Violence: A Global Programme, funded by the UK Aid from the UK Department for International Development (DFID) for the benefit of developing countries, managed by the South African Medical Research Council; Department for International Development, UK Government. Notes on validation of instruments (screening and outcomes): the CDI is a widely adopted and validated outcome measure. Additional information: none Handling the data: not applicable Prospective trial registration number: not reported