Table 2.

Characteristics of 43 RCTs

Study	Population and sample	Type of MHPSS/Control group and the ISAC intervention pyramid	Implementation	Follow ups	Outcomes reported
(Ahmadi et al., 2023) Afghanistan Armed conflict RCT ROB: High	Young girls 11–19 years old, mean age 15.96 (1.97) years N = 125	NET: Memory Training for Recovery Adolescent (METRA)/TAU Tier 3: Focused, non-specialised support	Group Private room rent property in Kabul 10 sessions, 60 min over two weeks	3 months	PTSD* Depression Anxiety Psychological distress
(Annan et al., 2017) Thailand Armed conflict RCT ROB: Some concern	Burmese migrant and displaced children Female = 51% N = 479 children and 513 caregivers	Psychosocial: Parent and Family Skills interventions adapted from the Strengthening Families Programme (SFP) originally developed in USA for substance abusing parents and their children /Waitlist Tier 2: Strengthening community and family supports	Group Community spaces such as school and community halls 12 weekly, 2-h, sessions	1, 6 months	Emotional problems Conduct problems Attention problems Child psychosocial protective factor
(Barron et al., 2016) Palestine Armed conflict and political violence RCT ROB: Low	School students; age 11–15 years (mean age = 13.57 years (0.82); Female = 59.7% N = 154	CBT: The Teaching Recovery Techniques (TRT). The group-delivered programme, based on CBT, focuses specifically on children’s symptoms of PTSD/ Waitlist Tier 3: Focused, non-specialised support	Group School 5 weekly, 90 min, session, over 5 weeks	2 Weeks	PTSD Depression Disassociation
(Berger et al., 2018) Tanzania Armed conflict cRCT ROB: High	School children, mean age: INT = 12.44 years (0.89); CON = 12.48 years (0.93); Females = 50.8% N = 183	CBT: Erase Stress Prosocial (ESPS) is a universal school-based programme divided into two sets of strategies: stress-reduction interventions and pro-social interventions (i.e., perspective-taking, empathy training, mindfulness and compassion-cultivating practices) / No intervention Tier 2: Community and family support	Group School 16 sessions, 90 min weekly	One week, 8 months	Functioning impairment Somatic symptoms Anxiety Prosocial behaviour Conduct problems Academic achievement Social relationship
(Berger and Gelkopf, 2009) Sri Lanka Tsunami Quasi-cRCT ROB: Some concerns	Elementary school students; age 9–14 years Female = 41.7% N = 166	CBT: ERASE Stress Sri Lanka (ES-SL) – a classroom-based programme designed to help children cope with the threat and the exposure to disaster and trauma. The programme involved children’s caregivers with home assignments/Waitlist Tier 2: Community and family support	Group School/classroom 12, 90 min, weekly	3 months	PTSD Depression Somatic symptoms Function impairment Hope
(Betancourt et al., 2014) Sierra Leone Armed conflict RCT ROB: Low	Youth; mean age = 18 years; Female 45.6% N = 436	CBT: The Youth Readiness Intervention combines elements drawn primarily from CBT and Interpersonal therapy, both evidence-based therapies with demonstrated effectiveness in treating depression, anxiety, and interpersonal deficits due to trauma/Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group Community sites 10–12, 90 min sessions, over 10 weeks	Post and 6 months	PTSD Emotional problems Psychological distress Functional impairment Prosocial Social support School performance and attendance
(Bolton et al., 2007) Uganda Armed conflict RCT ROB: Low	Acholi adolescent aged 14–17 years from 2 IDP camps: Female 57.3% N = 314	Group Interpersonal Psychotherapy, psychosocial: Creative play – aiming to strengthening youth’s resilience by verbal and non-verbal expression of thoughts and feelings through activities such as songs, art, role plays, music, sports, games/Waitlist Tier 3: Focused, non-specialised support	Group Camps 16, 90–120 min, sessions	One month	Depression Function impairment
(Brown et al., 2023) Lebanon Armed conflict RCT ROB: Some concerns	Children aged 10–14; Female 45% and the average age was 11.7 (SD = 1.3) N = 67 children and 67 caregivers	Early Adolescent Skills for Emotions (EASE)/TAU Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group 7, weekly 90 min, sessions	Post and 3 months	PTSD Depression Psychological distress* Functioning Well-being
(Bryant et al., 2022) Jordan Armed conflict RCT ROB: Low	Young Syrian adolescents; females = 49.5%; mean age = 11.6. years (1.3) N = 471	Early Adolescent Skills for Emotions (EASE) – focus on arousal reduction, behavioural activation and problem management as these strategies have been shown to be key for reducing internalising problems in adolescents/TAU Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group 7, weekly 90 min, sessions	9 weeks and 3 months	PTSD Depression Functioning Emotional problems* School outcome Conduct problems* Attention* Well being
(Catani et al., 2009) Sri Lanka Tsunami and war RCT ROB: Some concerns	Children aged 8–14 years, Female 45.16% N = 31	KIDNET – the participants constructed a detailed chronological account of his or her own biography/ Active Intervention Tier 3: Focused, non-specialised support	Individual Camps 6, 60–90 min, sessions over two weeks	4–5 weeks and 6 months	PTSD Somatic symptoms Function impairment
(Chen et al., 2014) China Earthquake RCT ROB: High	Children, Female 68% N = 40	CBT, Interpersonal and body psychotherapy / No intervention Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group Home 6, 60 min, sessions, weekly	Post and 3 months	PTSD Depression Psychological resilience
(Cluver, 2015) Haiti Earthquake RCT and Non-RCT ROB: High	Children living in orphanages; mean age = 11.23 years; Female 42% N = 61	Interpersonal and body psychotherapy (Yoga) /Active intervention (Dance) Tier 3: Focused, non-specialised support	Group School 8 weeks, twice, 45 min, weekly	Post	PTSD Psychological distress
(Dawson et al., 2018) Indonesia Civil war RCT ROB: Low	Children aged between 7–14; mean age: INT = 10.50 years (0.93); CON = 10.25 years (1.16) N = 64	Trauma-focused CBT with children and caregivers/Active intervention Tier 2: Community and family support Tier 3: Focused, non-specialised support	Individual , 1 h session over 5 weeks	3 months	PTSD Depression Anger
(Dhital et al., 2019) Nepal Natural disaster cRC ROB: High	Students grade 6–8; mean age INT = 12.9 years (1.3); CON = 12.9 years (1.4) N = 1,220	Psychosocial: Teacher-mediated school-based intervention/No intervention Tier 2: Community and family support	Group School 2 days training, eight sessions, 1–2 h	6 months	PTSD Depression Grief
(Dybdahl, 2001) Bosnia and Herzegovina Armed conflict RCT ROB: High	Bosnian-displaced mothers; Female only (Mothers) – Child (mean age = 5.5 years; Female =55.17%) N = 87	Psychosocial intervention aiming to promote the development and well-being of young children through parental involvement, support and education, and parent–child relationships/ TAU Tier 2: Community and family support	Group Weekly group meeting for five months; 60 min, home visit	Post	Depression Psychological distress Well-being Cognitive performance Physical health
(El-Khani et al., 2021) Lebanon Armed conflict RCT ROB: Some concerns	Children and their caregivers: Child aged 9–12 years; N = 119 children and caregivers	CBT: Teaching Recovery Techniques (TRT) with Parenting skills (TRT + P)/TRT/Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group Five weekly sessions; 120 min for each session 2 parent sessions	2 weeks and 12 weeks	Depression Anxiety Conduct behaviour
(Ertl et al., 2011) Uganda Civil war RCT ROB: Some concerns	Child soldiers; Female 67.1% N = 1,113	Narrative Exposure Therapy (NET) -a short term, trauma-focused treatment, Psychosocial/ Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	Individual Camp 8 sessions, 90–120 min, 3 times a week	3, 6, 12 months	PTSD* Depression Guilt Suicide risks Function impairment Stigmatisation
(Fine et al., 2021) Tanzania Armed conflict cRCT ROB: Some concerns	Young adolescents in refugee camp Female 49%; mean age = 12.3(1.5) N = 82 children, N = 64 caregivers	The Early Adolescent Skills for Emotions (EASE) intervention aiming to reduce symptoms of internalising disorders, including depression and anxiety/TAU Tier 2: Community and family support Tier 3: Focused, non-specialised support	7 weekly, 90 min, sessions	1 week	PTSD Psychological Distress* Functioning Prosocial Somatic symptoms Well being
(Getanda and Vostanis, 2020) Kenya Displacement RCT ROB: Some concerns	Youth aged 14–17 years; N = 54	NET: Writing for Recovery – focusing on sensory aspects of traumatic events leading to PTSD and other symptoms of distress/Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	6 sessions over 3 days	Post	PTSD Depression Anxiety Quality of life
(Gordon et al., 2008) Kosovo Armed conflict RCT ROB: High	Children; mean age = 16.3 years; Female = 75.60% N = 82	Interpersonal and body psychotherapy: Mind–body technique model – a combination of a number of mind–body modalities with self-expression (spoken, written words, drawings, movement)/ Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group School 12, 120 min, session, twice weekly for 6 weeks	Post	PTSD
(Jordans et al., 2010) Nepal Armed conflict cRCT ROB: Some concerns	School children; mean age = 12.7 years; girls 48.6% N = 325	CBT: A school-based psychosocial intervention – the Classroom-Based Intervention (CBI) – an eclectic intervention based on concepts from creative-expressive and experimental therapy, cooperative play and CBT/ Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group Classroom 15, 60 min, sessions over 5 weeks	Post	PTSD* Depression* Anxiety* Psychological distress* Conduct problems* Functional impairment* Prosocial Hope
(Kalantari et al., 2012) Iran Armed conflict RCT ROB: High	Afghan refugees in school; mean age INT = 14.58 years; CON = 15.03 years; Females 55% N = 64	NET: Writing For Recovery – the writing sessions developed for adolescents who have experienced a trauma/ No intervention Tier 3: Focused, non-specialised support	Group School 3 consecutive days: two, 15 min, sessions, a 1 day	Post	Grief
(Khamis and Coignez, 2004) Palestine Armed conflict RCT ROB: High	Children aged 6–16 years, Female 43.37% N = 664	CBT: Classroom-based intervention-a psychosocial integration and recovery programme for children and adolescents and their adult caregivers who are exposed to psychological trauma/ Waitlist Tier 2: Community and family support	Group School/camp 15 sessions over 5 weeks	Post	Emotional problems Anxiety Conduct problems Prosocial Coping Hope Family relationship Peer and sibling relationship School performance Self-esteem
(Lange-Nielsen et al., 2012) Gaza Armed conflict RCT ROB: High	Adolescents; 12–17 years mean age = 14.54 years (1.47); Female 50% N = 124	NET: Writing For Recovery-a manual-based group intervention aimed at adolescents who have a history of trauma through short writing sessions/Waitlist Tier 3: Focused, non-specialised support	Group School 2, 15 min, sessions per day for 3 days	Post, one mo,5 months	PTSD Depression Anxiety
(Layne Christopher et al., 2008) Indonesia Terrorist attack RCT ROB: High	Children (Female 52.7%) mean age = 9.83 years (1.53) N = 127	Interpersonal and body psychotherapy: A spiritual-hypnosis assisted therapy/ Active intervention Tier 3: Focused, non-specialised support	Group School 17–20 weekly group sessions for 7 months (school year), between 60 to 90 min	Post and 4 months	PTSD Depression Grief
(McMullen et al., 2013) Congo Armed conflict RCT ROB: Some concerns	39 former soldiers and 11 war-affected boys; mean age = 15.8 years N = 50	A manualised, Trauma-focused CBT/Waitlist Tier 3: Focused, non-specialised support	Group School 15 sessions	7 weeks and 3 months	PTSD Emotional problems Psychological distress Conduct problems Prosocial
(Nopembri et al., 2019) Indonesia Natural disaster cRCT ROB: High	Students: INT = mean age 10.4–10.39 years N = 810	Psychosocial: Physical Education and sports classes/TAU Tier 2: Community and family support	Group School 15, 2 h sessions, 3 days a week over five weeks	Post	Coping Problem solving skills
(O’callaghan et al., 2013) Congo Armed conflict RCT ROB: Low	Girls who had witnessed or had personal experience of rape of sexual abuse; mean age = 16 years N = 52	A manualised, culturally modified, trauma focused CBT/Waitlist Tier 3: Focused, non-specialised support	Group School 15, 120 min, sessions, 3 days a week over five weeks	7 weeks and 3 months	PTSD* Emotional problems Conduct problems Prosocial
(O’callaghan et al., 2014) Uganda Armed conflict RCT ROB: Some concerns	Children: mean age = 13.42 years; females 45% N = 159	A manualised, family-focused – psychosocial interventions/ Waitlist Tier 2: Community and family support	Group Church 3 times weekly, 8, 12o mins, sessions over 4 weeks	Post and 3 months	PTSD * Emotional problems* Conduct problems* Prosocial*
(O’callaghan et al., 2015) Congo Armed conflict RCT ROB: Low	War affected youth; mean age = 14.88 years N = 50	Trauma-focused CBT – a combination of cognitive therapy and behavioural therapy Psychosocial: Child Friendly Spaces – a psychosocial intervention aiming to improve resilience and well-being of youth through community-based, structured activities held in a safe, child friendly environment/ Active intervention Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group Field attached to local schools 9, 90 min, sessions, three sessions per week plus two, 90 min caregivers’ sessions in group sessions	Post and 6 months	PTSD Emotional problems Conduct problems Prosocial
(Panter-Brick et al., 2018) Syria Conflict RCT ROB = Low risk	Adolescents, mean age = 14.37 years (1.72), Female = 43% N = 603	Psychosocial: Advancing adolescents programme – consisting of structural activities that aimed to promote capacities for the mediation of extreme and prolonged stress/Waitlist Tier 2: Community and family support	Group community based (Youth centres, designed as ‘Adolescent Friendly Spaces) 16 sessions (twice per week) for 8 weeks	10 weeks, 11 months	PTSD Emotional problems Human distress* Stress* Prosocial Human insecurity*
(Pityaratstian et al., 2015) Thailand Tsunami RCT ROB: Some concerns	Children; mean age = 12.25 years: Female = 72.2% N = 36	CBT – a manual-based and adapted from the Teaching Recovery Techniques (TRT)/Waitlist Tier 3: Focused, non-specialised support	Group School and outdoor Daily, 120 min, sessions for 3 days	Post and 1 month	PTSD
(Qouta Samir et al., 2012) Palestine Armed conflict cRCT ROB: Some concerns	Children; mean age = 11.29 years; Female 49.4% N = 482	CBT: Extra curriculum sessions of the Teaching recovering techniques (TRT) / Waitlist Tier 2: Community and family support	Group School 2, weekly, 2 h session in total of 16 sessions, last for 4 weeks	Post and 6 months	PTSD Depression Psychological distress Prosocial Family factor Peer and sibling relation Well-being Maternal attachment Family atmosphere
(Richards et al., 2014) Uganda Armed conflict RCT and non-RCT ROB: Some concerns	Children; mean age = 9.83 years N = 1,462 Intervention boys =74, girls 81; waitlist boys = 72	Psychosocial: voluntary competitive sports for development football league/Waitlist and no intervention Tier 2: Community and family support	Group Sport field 11 weeks – 45 min per session	Post	Depression Anxiety Physical health
(Robjant et al., 2019) DRC Armed conflict RCT ROB: Some concerns	92 female former child soldiers, age range 11–25 years N = 92	Narrative Exposure Therapy adapted for offenders (FORNET)/TAU Tier 3: Focused, non-specialised support	Group and individual Community 6 individual sessions, 90–120 min; group therapy weekly for 60–90 min	3, 9 months	PTSD* Depression Conduct problem Violence behaviour Guilt Social acknowledgement
(Schauer von, 2008) Sri Lanka Armed conflict and Tsunami cRCT ROB: Some concerns	Children who suffered severe PTSD; mean age = 13.1 years N = 47	Manualised KIDNET – a trauma-focused, short-term therapy with exposure elements/TAU Tier 3: Focused, non-specialised support	Group School 6, 60–90 min, sessions	5 months post, and 13 months post-int.	PTSD School performance
(SHoaakazemi et al., 2012) Iran Earthquake RCT ROB: High	Girls with PTSD (15–18 years) N = 24	Interpersonal and body psychotherapy: Logo therapy/ No intervention Tier 3: Focused, non-specialised support	Individual 8,60 min, sessions	Post	Quality of life
(Sirin et al., 2018) Turkey Conflict RCT ROB: High	Children from five refugee camps N = 147	Psychoeducation: Project Hope: an online-game based learning intervention/ Waitlist Tier 2: Community and family support	Group Community 2 h, 5 days a week for 4 weeks	Post	Common mental health disorder School performance Cognitive skills
(Tol et al., 2008) Indonesia Political violence cRCT ROB: Some concerns	School children, mean age = 9.9 y, Girls 48.63% N = 403	CBT: School-based mental health including trauma-processing activities, cooperative play, and creative expressive elements/Waitlist Tier 3: Focused, non-specialised support	Group Classroom 15 sessions, over 5 weeks	Post and 6 months	PTSD Depression Anxiety Conduct problems Functional impairment Hope
(Tol et al., 2012) Sri Lanka Armed conflict cRCT ROB: Some concerns	Children; mean age 12.29 years; Girls 48% N = 399	CBT: School-based mental health – consisting of CBT and creative expressive elements/Waitlist Tier 3: Focused, non-specialised support	Group School 15 sessions, over 5 weeks	One week and 3 months	PTSD* Depression* Anxiety* Psychological distress Conduct problems Function impairment Prosocial Coping
(Tol et al., 2014) Burundi Armed conflict cRCT ROB: High	Children, mean age 12.29 years N = 329	CBT: The classroom-based intervention (CBI) including universal preventive activities and provision of mental health treatments/Waitlist Tier 2: Community and family support Tier 3: Focused, non-specialised support	Group School 15 sessions, over 5 weeks	Post and 3 months	PTSD* Depression* Anxiety* Function* impairment Social support Coping Hope
(Torrente et al., 2019) DRC Armed conflict cRCT ROB: High	76 clusters and 126 schools 47.5% females, mean age = 11.66 years (1.9) N = 8,813	Psychosocial: Learning in a Healing Classroom – a universal school-based intervention to support children’s social–emotional well-being and academic learning/ Waitlist Tier 2: Community and family support	Group School One to two academic years	One year	School performance Well-being Teacher and school-level outcomes
(Yankey and Biswas Urmi, 2019) India Political violence, refugees RCT ROB: High	Tibetan refugees, age 13–17 years N = 300	Psychosocial: school-based life skill training programme/No intervention Tier 2: Community and family support	Group School 30 sessions over 11 months	2 weeks post-intervention	Coping Self-confidence Emotional intelligence

Abbreviations: CBT, cognitive behavioural therapy; cRCT, cluster randomised controlled trial; DRC, democratic republic of the congo; N, sample size; NET, narrative exposure therapy; PTSD, post-traumatic stress disorder; RCT, randomised controlled trial; ROB, risk of bias; TAU, treatment as usual; *, primary outcome when reported.