|Year : 2022 | Volume
| Issue : 1 | Page : 81-97
Supporting adolescent mental health in humanitarian settings: To what extent do interventions consider climate change and its intersectional impacts?
Megan Devonald1, Joost Vintges2, Nicola Jones3
1 MSc, Gender and Adolescence: Global Evidence (GAGE), ODI, London, UK
2 MA, Gender and Adolescence: Global Evidence (GAGE), ODI, London, UK
3 PhD, Gender and Adolescence: Global Evidence (GAGE), ODI, London, UK
|Date of Submission||29-Nov-2021|
|Date of Decision||15-Jan-2022|
|Date of Acceptance||21-Mar-2022|
|Date of Web Publication||31-May-2022|
Overseas Development Institute, 203 Blackfriars Road, London, SE1 8NJ
Source of Support: None, Conflict of Interest: None
Research suggests that adolescents in humanitarian settings are particularly vulnerable to mental health challenges, but there is less attention to how mental health and psychosocial support (MHPSS) in these settings considers climate-related factors. This article aims to bridge this gap by reviewing studies on the impact of MHPSS interventions in humanitarian settings for adolescents in low- and middle-income countries. Our findings indicate there is a lack of attention to climate change; none of the 25 studies identified mentioned climate change or considered it in the intervention design. Given the urgency of the climate crisis, it is vital that MHPSS interventions for adolescents in humanitarian settings are adapted to respond to climate change-related factors. We also found that the data from such studies are rarely disaggregated by sex or disability. This is vital in order to deepen our understanding of the intersectional impacts of MHPSS on adolescents.
Keywords: adolescents, climate change, humanitarian settings, mental health
|How to cite this article:|
Devonald M, Vintges J, Jones N. Supporting adolescent mental health in humanitarian settings: To what extent do interventions consider climate change and its intersectional impacts?. Intervention 2022;20:81-97
|How to cite this URL:|
Devonald M, Vintges J, Jones N. Supporting adolescent mental health in humanitarian settings: To what extent do interventions consider climate change and its intersectional impacts?. Intervention [serial online] 2022 [cited 2023 Mar 28];20:81-97. Available from: http://www.interventionjournal.org//text.asp?2022/20/1/81/346328
Key implications for practice
- There is a lack of attention to climate change in recent mental health and psychosocial support (MHPSS) interventions in low- and middle-income countries.
- MHPSS interventions for adolescents in humanitarian settings generally have small but positive impacts on adolescents’ mental health; however, further research with control groups and randomisation is needed to confirm these impacts.
- Data should be disaggregated by sex and disability status to fully understand the differential effects of MHPSS interventions on adolescents, and ensure that no one is left behind.
| Introduction|| |
Recently, there has been increasing attention to the psychological impacts of climate change, and evidence suggests that climate change has both direct and indirect impacts on adolescents' mental health. Studies have shown that adolescents experience an increase in anxiety disorders, depression and post-traumatic stress disorder (PTSD) after climate-related disasters (Burke et al., 2018). These climate-related disasters can be broken down into rapid-onset climate events, such as cyclones, landslides and flooding, and slow-onset climate events, such as droughts, increasing temperatures and rising sea levels (UNHCR, n.d.). Climate change may also exacerbate existing social and economic challenges, such as poverty, malnutrition and forced migration, and can hinder access to education – all of which impact on adolescent mental health (Cianconi et al., 2020; Devonald et al., 2020). Adolescents in humanitarian settings are particularly at risk of psychosocial problems (Abu Hamad et al., 2021; Itani et al., 2017; Samuels et al., 2015), and are highly vulnerable to the impacts of climate change (Devonald et al., 2020). Mental health and psychosocial support (MHPSS) interventions in humanitarian settings have shown benefits such as reducing PTSD and improved functioning (Bangpan et al., 2019; Jordans et al., 2016; UNICEF, 2020). However, there is less research on whether MHPSS interventions consider climate-related causes of mental health issues in their programme design. With the increased chance of humanitarian catastrophes in low- and middle-income countries (LMICs) due to the impact of climate change, this constitutes a significant gap in the literature. This article aims to bridge this gap by reviewing MHPSS interventions in humanitarian settings to see how far they include climate change either as a driver of humanitarian crises and/or a contributing factor in adolescents' psychosocial status. We also discuss whether MHPSS interventions address gender and disability status, due to the way these characteristics intersect with climate change and cause heightened vulnerabilities for mental health challenges (Stein & Stein, 2022). We start with a review of adolescent mental health in humanitarian settings, before going on to explore the links between humanitarian settings, climate change and mental health. We then describe the methodology used for the review and present the results. Finally, we put these results into the context of climate change and discuss research gaps. Then we outline the implications for MHPSS policy and programming in humanitarian settings.
| Background|| |
Adolescent Mental Health in Humanitarian Settings
Adolescents in humanitarian settings are at high risk of experiencing poor mental health outcomes, as complex emergencies such as conflict and war can cause them significant mental health problems. The study by Abbo et al. (2013) in post-conflict Northern Uganda found that prevalence of anxiety disorders among children and adolescents was 26.6%. Similarly, among Palestinian youth in Gaza and the West Bank, prevalence of suicidality was estimated at 25.6% (Itani et al., 2017). Adolescents in humanitarian settings are also at high risk of experiencing or witnessing violence and trauma, which can lead to PTSD (Dubow et al., 2012; O'Connor & Seager, 2021) and anxiety (Abbo et al., 2013).
Extreme weather events and seismic hazards are linked to similar levels of trauma and risks to adolescents' mental health. A meta-analysis of the impact of disasters on the mental health of children and adolescents found that exposure to disasters was significantly associated with mental health problems, other than post-traumatic stress symptoms (Rubens et al., 2018). Tang et al. (2014) also found high levels of depression among children after a disaster (ranging from 7.5% to 44.8%) due to a range of factors, from experiencing injury or being trapped during the disaster to witnessing injury or death and having little social support.
Adolescents' own levels of self-esteem and self-worth can moderate their experiences of mental health symptoms. Dubow et al. (2012) found that for Israeli and Palestinian youth, exposure to violence was a predictor for PTSD symptoms, and that youth with lower levels of self-esteem were more likely to experience PTSD symptoms that occurred due to exposure to violence. Additionally, the qualitative study by Samuels et al. (2015) with adolescents in Gaza, Liberia and Sri Lanka suggests that inadequate sense of self-worth is a risk factor for poor mental health outcomes.
Adolescents in humanitarian settings also face disruptions to their everyday lives such as limited access to education and healthcare facilities (including for mental health services) that can further affect their psychosocial wellbeing. In post-conflict Sri Lanka, Emmanuel et al. (2014) found that structural and socioeconomic stressors can result in a deprioritisation of education. Schools can be an important site of social connectedness for adolescents, enabling them to interact with their peers and establish friendships. They can also provide a site for provision of MHPSS through access to trusted nonfamily adults and school-based counselling. As such, the disruptions to schooling during humanitarian disasters can disrupt access both to social networks and to nonspecialist mental healthcare (Samuels et al., 2018).
Gender and Disability
In this review, we also consider gender and disability status as they are key factors that may shape coping repertoires to climate change-related stresses, and to apply an intersectional approach to the analysis of these complex dynamics in adolescents' experiences. We recognise that other vulnerabilities (such as socioeconomic status) also have an impact; however, they are outside the scope of this study. Adolescents with disabilities are especially vulnerable to mental health challenges in humanitarian contexts. A study in Jordan found that 50% of adolescents with disabilities had high levels of emotional distress compared to 30% of those without disabilities (Jones et al., 2019). Adolescents with disabilities in conflict-affected contexts can face stigma and exclusion from schooling, healthcare, and employment and training opportunities (Abu Hamad et al., 2021). Climate change also disproportionately impacts those with disabilities. The mortality rate during disasters is four times higher than for those without disabilities and climate-related hazards can disrupt healthcare services, personal support and medical devices (Stein & Stein, 2022).
Challenges facing adolescents in humanitarian contexts are often highly gendered: girls often face high risks of experiencing sexual violence, while boys are more at risk of physical violence (Pereznieto et al., 2020; Stark & Landis, 2016) – both of which can have major impacts on their mental health (Montgomery, 2008; Verelst et al., 2014). Rates of child marriage are also high in many humanitarian contexts (Presler-Marshall et al., 2020). Climate change also further exposes existing gendered inequalities, impacting girls' school attendance (Fry & Lei, 2021), increasing risk of violence and exploitation (Devonald et al., 2020) and disrupting access to sexual and reproductive health supplies and services (Women Deliver, 2021).
Humanitarian Settings, Climate Change and MHPSS
Given the current climate emergency, there is increasing attention to how climate change impacts mental health. Climate change is increasing the incidence of climate-related hazards such as droughts, wildfires, flooding and cyclones (Diwakar et al., 2019; Sanson & Burke, 2019). These incidents can impact adolescents' mental health directly, by exposure to trauma, displacement and food insecurity and indirectly, by affecting adolescents' physical health, the wellbeing of their community, and disrupting social networks and normal routines (Berry et al., 2009; Devonald et al., 2020; Diwakar et al., 2019; Sanson & Burke, 2019). As mentioned above, exposure to these events can increase risk of PTSD and other mental health issues. Rapid-onset climate-related events generally result in symptoms of PTSD (Bryant et al., 2014; Clayton, 2020; Orengo-Aguayo et al., 2019), whereas slow-onset events tend to result in symptoms such as depression and anxiety (Vins et al., 2015). Climate change may also contribute to anxiety and stress about the looming climate crisis and its consequences, a phenomenon which is commonly termed “eco-anxiety” (Clayton, 2020; Gifford & Gifford, 2016).
Young people and future generations stand to be most affected by climate change. A birth cohort analysis of exposure to six climate-related extreme events found that individuals born in 2020 are between two and seven times more likely to experience such events (under current climate policy) than those born in 1960 (Thiery et al., 2021). Young people in low-income countries will face the greatest increase in lifetime exposure to extreme events (a five-fold increase for the 2020 cohort) (Thiery et al., 2021). Children and youth are also more at risk of developing mental health-related issues such as PTSD and anxiety as a result of climate change (Goldmann & Galea, 2014; Neria et al., 2007; Norris et al., 2002). For some children, exposure to trauma such as climate-related hazards can cause mental health symptoms that persist for many years. For example, 20 years on from the Ash Wednesday bushfires in Australia, detectable mental health impacts were still identified in the children of families who lived through the event (McFarlane & Van Hooff, 2009).
MHPSS programmes have increasingly been incorporated in the guidelines of humanitarian responses and with it, its evidence base (Tol & van Ommeren, 2012; UNICEF, 2020). Evidence shows that MHPSS in humanitarian settings can be beneficial in improving the psychosocial wellbeing of adolescents but some gaps need to be addressed (UNICEF, 2020). The increasing risk of emergencies triggered by climate change necessitates an adequate response by MHPSS practitioners. Many survivors of disasters (be they rapid-onset or slow-onset events) may be in need of MHPSS, and MHPSS providers need to be prepared for changing contexts (Palinkas et al., 2020). Slow-onset disasters are particularly complex phenomena and understanding the consequences for mental health is crucial for drawing up an adequate response (MacIntyre et al., 2019).
Currently, there is limited evidence available as to how adolescent-focused MHPSS responses in low-income humanitarian contexts have incorporated the effects of climate change into their programmes. This study reviews evaluations of adolescent-focused MHPSS programmes in low-income humanitarian contexts published in academic literature in order to understand how much attention current MHPSS programmes pay to climate change as a possible stressor. We aim to gain an understanding of the current gaps and/or promising practices in this area to inform future climate change-sensitive MHPSS programme design. In addition, we explore whether the studies disaggregate by gender and disability status, as these can be key compounding factors shaping vulnerabilities to climate change.
| Methods|| |
This article draws on findings from a literature review on the impact of MHPSS interventions in humanitarian settings for adolescents in LMICs, and the extent to which they pay attention to climate change, gender and/or disability. We defined a humanitarian setting as “a disaster requiring international support to meet the basic needs of the population” (Anderson & Gerber, 2018). However, we have moved away from the breakdown of disaster into “natural” and “man-made” as the term “natural” ignores the role that humans play in disasters and the links to climate change (Chmutina et al., 2017). Instead, we have broken down humanitarian settings into four categories: extreme weather events; seismic hazards; epidemic diseases and complex emergencies, including war and conflict due to the complex factors (e.g. extreme weather) that can underlie these crises (Hendrix & Salehyan, 2012; Hsiang et al., 2011; Peters et al., 2020). We began with a keyword search using bibliographic databases – MEDLINE, Cochrane Database of Systematic Reviews, Google Scholar, 3ie and grey literature (see [Table 1] for an overview of the databases and grey literature websites used). We subsequently refined our search to focus on studies presenting primary data and excluded systematic reviews; however, we used the systematic reviews for snowballing purposes. In September 2021, we refined the first search. We added new criteria to include only studies published since 2015 and only focused on MHPSS intervention studies (rather than also including studies on the impact of humanitarian disaster on adolescents' mental health). The inclusion and exclusion criteria are summarised in [Table 2]. We created a search strategy [Table 1] and used this in combination with synonyms, including truncation where appropriate.
Overview of All Studies
An initial search in 2019 generated 4750 items for screening. After removing duplicates, the remaining 4221 items were screened for inclusion based on their title and abstract, leaving 297 items remaining for full screen. Most studies were excluded because they did not focus on adolescents aged 10–19 years or they did not evaluate the impact on mental health. In total, 85 items were included in the initial review. After the second search, using the refined inclusion criteria, 25 items remained, and were used for the review. [Figure 1] summarises the flow of studies included in the review.
| Results|| |
We now turn to a discussion of the results of the review, beginning with an overview of the programmes covered, then turning to the extent to which they attend to climate change related issues, issues related to conflict and forced displacement, and gender and disability.
Overview of Programmes
[Table 3] summarises the key information about the articles included in the review, and the interventions they studied. The programmes took place in 16 countries, with most in the Middle East and North Africa region (11 interventions) and Asia (8 interventions). One programme targeted survivors of extreme weather events, six programmes targeted survivors of seismic hazards (one also focused on violence), and one targeted survivors of epidemics; the rest focused on complex emergencies. Of the extreme weather events/seismic hazards interventions studied, earthquakes (including tsunamis) were the most commonly studied, while ongoing conflicts in Gaza, Myanmar and Syria were the most common complex emergencies. Programmes varied in length between 5 and 16 sessions, with most implementing between 8 and 16 sessions, spanning a few weeks (on average). The number of participants varied greatly; most programmes were small-scale interventions. Twelve programmes reached fewer than 100 participants and 8 programmes involved between 100 and 500 participants. Five interventions involved more than 500 participants, with only two of them reaching 1000 adolescents. Most programmes were delivered through group settings in the community or in schools.
Twenty studies found positive outcomes of the intervention, while four interventions had no effect and one had a negative effect. The majority of positive effects were observed in reducing PTSD symptoms (11) and emotional problems (5). Other common positive outcomes were found in relation to depression, prosocial behaviour and social support.
Attention to Climate Change and Climate-Related Hazards
As outlined in [Table 4], none of the 25 studies mentioned climate change as a threat or multiplier of climate-related hazards, and none of the interventions appeared to take climate change into account in programme design. In general, there was a lack of interventions that focused on climate-related hazards. For example, there were no studies on interventions for communities affected by flooding, wildfires or landslides. Only one study looked at communities affected by a climate-related hazard (Akiyama et al., 2018; an intervention for students affected by Typhoon Haiyan) which found a positive (but small) impact of an in-school sports coaching programme on adolescents' self-esteem. The majority of studies focused on seismic hazard such as earthquakes. In general, our review indicates that the extreme weather events/seismic hazards interventions had positive impacts on a range of adolescent mental health problems, with only one study (Dhital et al., 2019), suggesting the intervention did not have an effect.1 Two studies (Mattheß et al., 2020; Pityaratstian et al., 2015) focused on more traditional psychotherapy approaches, both of which showed positive impacts on levels of PTSD. Most studies examined interventions that took a wider psychosocial approach, including yoga classes (Culver et al., 2015), sports interventions (Akiyama et al., 2018), life skills (Kaligis et al., 2017) and/or resilience building (Niu et al., 2021), which had impacts on self-esteem, resilience and prosocial behaviours.
Most of the studies on extreme weather events/seismic hazards in this review were of rapid-onset disasters such as earthquakes, tsunamis and typhoons. We did not find any studies that focused on slow-onset climate-related disasters in this review such as drought. Only one study (Niu et al., 2021) examined an intervention that focused on more direct disaster resilience training; this had a positive but insignificant effect on resilience (although significant effects on other aspects such as learning competency and coping styles).
Conflict Settings and Displacement
Of the 16 studies on complex emergencies in this review, 10 focused on refugee contexts (9 had positive impacts and one had negative impacts) and 6 were ongoing conflict contexts (3 had positive impacts and 3 had negative impacts). Among the studies focused on interventions with refugee populations, most had positive impacts (using psychosocial and psychotherapy approaches) on PTSD, anxiety, and externalising and internalising symptoms. The studies that reported no effects or negative effects concerned interventions that used either resilience methods (Miller et al., 2020; Shaheen & Oppenheim, 2016) or teaching recovery techniques (Diab et al., 2015; Kangaslampi et al., 2016). Most of the studies do not describe climate-related factors as playing a role in displacement. However, the study by Getanda and Vostanis (2020) of a writing for recovery intervention cites that drought is one of the possible explanations for internal displacement of adolescents in Kenya. Although the sample size was small, the intervention found positive impacts on PTSD but not on depression or anxiety.
Gender and Disability
All programmes had mixed sex participants but only six studies disaggregated outcomes by sex. Out of these six studies, five had positive results. Only one study (a myth-based intervention in China) looked at inclusion on the basis of physical disability and its effects on the intervention and found positive results.
| Discussion|| |
The purpose of this review was to summarise the current academic literature on adolescent-focused MHPSS programming in low-income humanitarian settings and to assess whether these interventions pay attention to climate change in their programme design. The lack of attention to climate change in recent MHPSS interventions in LMICs that our review revealed presents a significant gap, especially considering the increasing vulnerability of those in LMICs to climate change.
The review also highlights the lack of evidence in these settings on interventions aimed at climate-related hazards, with the majority instead focusing on seismic hazards. There is currently limited evidence that earthquakes are related to climate change. However, some evidence suggests there may be a link (McGuire, 2012). Even so, these types of disasters produce similar outcomes to more directly climate-related rapid-onset events (such as cyclones, landslides and flooding), causing destruction of homes and damage to livelihoods. Accordingly, there are lessons that can be learnt from these intervention studies as to how to improve the design of MHPSS programmes in the context of climate-related events.
Only one study (Akiyama et al., 2018) in our review focused on a climate-related hazard (Typhoon Haiyan) and it involved an in-school sports coaching programme for adolescents' self-esteem. It highlights the potential benefits of a broader package of psychosocial activities in boosting students' self-esteem, which can also moderate adolescents' experiences of mental health symptoms (Dubow et al., 2012) and help protect students from future mental health challenges due to the trauma of climate-related hazards.
Reinforcing the important role that MHPSS programmes can play in helping people adapt to and remain resilient during changing conditions due to climate change, Mah et al. (2020) point not only to the inherent interconnectedness between resilience to climate change and the individual but also the community and wider ecosystems. This is also echoed by Adams et al. (2021), whose study emphasised the low likelihood of individual transformations in resilience to climate change without social support. However, the interventions in our review were predominantly focused at the level of the individual adolescent and lacked a wider community component (with the exception of Annan et al., 2016, Bosqui et al., 2020 and Wang, 2016). This is surprising given that studies have shown that distress among adolescents in humanitarian contexts is strongly related to parenting and parental wellbeing (Eltanamly et al., 2019). The intervention described by Bosqui et al. (2020) found that most families highlighted the importance of family and relationships in supporting their adolescent child's mental health. Annan et al.'s (2016) study focused on a family skills training programme designed to increase resilience, which was also found to have a small but significant positive effect on externalising behaviour and attention problems among adolescents.
It has also been suggested that group-based coping mechanisms for climate change may be beneficial and reduce the burden on individuals (Mah et al., 2020) and indeed most of the studies in our review were group-based. Wang's (2016) study of a myth-based intervention for children in the aftermath of the Sichuan earthquake in China found a positive effect on children's resilience, and found that sharing and discussing experiences in group activities was very important in promoting the intervention effects. As was powerfully shown by the Climate Strike of 2019, it is important to remember that adolescents themselves are active participants in the climate debate and have shown engagement in efforts to build resilience and support climate change mitigation and adaptation (Han & Ahn, 2020; UNICEF, 2015).
Climate change effects can result in internal displacement initially, but may later lead to cross-border displacement (Peters et al., 2020). As such, it is estimated that by 2050, there will be 200 million climate migrants (Shultz et al., 2019). Although most of the refugee related studies do not describe climate-related factors as playing a role in displacement, these studies can be drawn upon when designing interventions for those experiencing climate-caused displacement. The studies found that in the context of humanitarian disasters, it is often the daily and present stressors experienced by adolescents that cause most concern, rather than their past experiences. In the study by O'Callaghan et al (2015) with war-affected Congolese youth, when asked about their most significant concern, a high proportion cited paying school fees, despite the fact that most had experienced significant war trauma. This finding was mirrored in Bosqui et al.'s (2020) study of Palestinian adolescents living in Lebanon, who were more likely to be troubled by daily stressors such as poverty, family discord and oppression. Thus, it is important to ensure that MHPSS interventions in humanitarian disasters are informed with a clear understanding of adolescents' key concerns, including climate-related factors.
In this review, of the intervention studies that did not show a positive effect, most were in contexts that had continual exposure to war and other stressors. Studies by Shaheen and Oppenheim (2016), Diab et al. (2015) and Kangaslampi et al. (2016) all took place in the State of Palestine, where participants are continually exposed to violence and war events during the course of the intervention, which can make it difficult to obtain positive results. For example, the Enhancing Resiliency Amongst Students Experiencing Stress intervention (Shaheen & Oppenheim, 2016) was not effective with Palestinian youth but has been shown to be effective in other contexts (for example, in Sri Lanka; Berger & Gelkopf, 2009). This highlights some of the divergent impacts of interventions and the importance of taking a context-specific approach. It also indicates some of the challenges for adolescent MHPSS that could be experienced in the face of the climate emergency, as climate change will similarly produce prolonged and continual exposure to stressors.
Our review also identified a number of important research gaps. Out of the 25 studies included in this review, only six studies disaggregated outcomes by sex. This represents a major gap in the light of growing evidence on the gender-specific mental health outcomes experienced by boys and girls in humanitarian contexts (Kapungu & Petroni, 2017). Research on interventions among war-affected children has shown significant gender differences in terms of effectiveness in relation to PTSD, depression, aggression and prosocial behaviour (Bolton et al., 2007; Jordans et al., 2010; Qouta et al., 2012). Of the studies in our review that did disaggregate by sex, some found no differences in outcomes (Dhital et al., 2019; Kangaslampi et al., 2016; Panter-Brick et al., 2017). However, Kazandjian et al.'s (2019) study of a cognitive behaviour therapy intervention with Syrian refugees found positive impacts for males and not females.2 It was suggested that this could be due to cultural differences (as women and girls in humanitarian contexts are often vulnerable to isolation and gender-based violence) or due to differences in how males and females respond to different types of intervention. McGovern et al. (2018) indicate that adolescent girls may be more suited to intervention strategies directed towards cognitive reframing and positive self-talk, whereas boys may be more suited to interventions that involve skill-building activities. Supporting this, El-Khodary and Samara's (2020) study of a school-based counselling programme found larger decreases in PTSD for girls than boys, even though boys had greater exposure to war events.
Additionally, the overwhelming majority of studies do not disaggregate by disability status. The exception to this is Wang's (2016) study of myth-based intervention, which found that “children who have been physically disabled by the earthquake showed more significant change in their resilience” (p. 189) possibly due to greater engagement in the programme for children who were more negatively affected by the disaster. Given the high rates of injury and disability during humanitarian crises (WHO, 2013), and the significant challenges facing adolescents with disabilities in humanitarian contexts (Abu Hamad et al., 2021; WHO, 2013), it is important that studies understand the deferential effects that disability status can have on MHPSS. Mental health interventions also often require significant adjustments to ensure that they are suitable to the needs of people with disabilities, which means that evidence on engagement and acceptability of interventions is vital. In the wider literature, there is a similar lack of evidence (Terry, 2021; Vereenoghe et al., 2018), highlighting that more research is urgently needed, both among people with disabilities in humanitarian context in general, and adolescents with disabilities in particular.
There is a larger evidence base on mental health interventions in climate-related disasters for adults (Crombach & Siehl, 2018; James et al., 2019; Kang & Choi, 2021), but there is limited evidence on adolescents and young people. Similarly, in high-income countries, there are a number of studies on mental health interventions for climate-related hazards (Ruggiero et al., 2015; Sirey et al., 2020; Yuen et al., 2016), but fewer in low-income countries. For example, a pilot of the Skills for Life Adjustment and Resilience programme – a skills-based intervention for survivors of Australian bushfires – showed a decrease in psychological distress, post-traumatic stress symptoms, and impairment (O'Donnell et al., 2020) and has also been adapted for cyclone-affected regions in Tuvalu (Gibson et al., 2021). Considering that people in low-income countries and youth are likely to be most impacted by climate change, there needs to be a greater focus on these contexts and populations in research, policy and programming. Programming for adolescents in humanitarian contexts could build on these broader interventions, with careful adaptation to cultural and context-specific needs, and taking into account that western concepts of mental health are often different from those found in other contexts (de Jong, 2002; Hinton & Lewis-Fernández, 2011).
Due to the specific challenges of conducting research in humanitarian contexts, many of the studies in the review did not include a randomised control trial design, and instead relied on a less robust pretest and post-test design, often with no control. Quite a few studies also had a small sample size, making disaggregation by different social characteristics more difficult. Most studies also only assessed the short-term effects of the intervention, and there was a lack of medium-term or long-term follow up. Furthermore, most studies were quantitative, and there was a lack of qualitative exploration of the interventions and the pathways through which they contributed (or not) to improvements in adolescents' mental health outcomes.
| Conclusions|| |
Overall, the interventions reviewed in this article generally had positive effects on adolescent mental health and psychosocial wellbeing outcomes, and could be adapted to tackle the effects of climate change stressors. However, there is a significant lack of attention to climate change in the recent MHPSS literature. Interventions should take into account the increased frequency of climate-related hazards (and particularly the impacts of slow-onset events such as drought) to understand how they can best support adolescents' mental health in the face of such crises. In addition, the knowledge of both the current and future impacts of climate change is understandably going to cause increasing levels of anxiety and other emotional reactions in adolescents. This should also be addressed in MHPSS interventions which can help provide adolescents with the skills that they need to cope and manage experiences of eco-anxiety. Furthermore, there is a pressing need for data to be disaggregated by sex and disability status in order to fully understand the differential effects of MHPSS interventions on adolescents, and ensure that they are meeting the needs of all adolescents at risk. Group-based interventions with a community component should also be considered for supporting adolescents' mental health in humanitarian settings. The climate crisis is going to have large and far-reaching impacts for the majority of world, with significant implications on the mental health of many young people. The scale of this challenge means that 1:1 therapy and small-scale interventions may not be feasible, especially in LMICs. Instead, culturally appropriate, community-based and action-oriented interventions are likely to be more effective.
Finally, there needs to be further research on MHPSS interventions for adolescents in humanitarian contexts in LMICs, with larger sample sizes and randomisation to confirm the positive impacts. Given the urgency of the climate crisis and the far-reaching impacts it is having, and will continue to have, on the mental health of adolescents in humanitarian crises, it is vital that MHPSS interventions are adapted to respond to climate change-related factors.
MD led on analysis and write-up of the article, JV conducted the search and supported writing of the results and NJ supervised the research. The manuscript has been read and approved by all the authors and the requirements for authorship stated by the journal have been met.
The authors thank Kathryn O'Neill and Anna Andreoli for their excellent editorial support. They also acknowledge Foreign, Commonwealth & Development Office for funding the GAGE programme.
Financial support and sponsorship
The GAGE programme is funded by the Foreign, Commonwealth & Development Office (FCDO). However, the views and information expressed in this article are not endorsed by FCDO, which accepts no responsibility for such views or information or any reliance placed on them.
Conflicts of interest
There are no conflicts of interest.
1This was a teacher training intervention and it is suggested that teacher-mediated interventions alone are not adequate to address adolescent mental health in schools.
2Studies in nonhumanitarian contexts showed a positive impact for both males and females (Hickman et al., 2015; Lusk & Melnyk, 2013; Melnyk et al., 2009, 2015).
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[Figure 1], [Figure 1]Intervention_2022_20_1_81_346328_f7.jpg
[Table 1], [Table 2], [Table 3], [Table 4]