Review: School-based interventions for child and adolescent survivors of natural disasters – a systematic review and meta-analysis of randomized controlled trials

Child Adolesc Ment Health. 2025 Sep 15. doi: 10.1111/camh.70029. Online ahead of print.

ABSTRACT

BACKGROUND: Although post-disaster interventions can reduce mental health problems in children and adolescents, no systematic review and meta-analysis has synthesized the effects of school-based randomized controlled trials (RCTs).

METHODS: This study assessed the effects of school-based RCTs on post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in children and adolescents (6-18 years of age) in post-natural disaster settings. Outcomes were evaluated immediately, and in the short term (<6 months) and long term (≥6 months) after the intervention. Eligible studies included RCTs. Seven databases and gray literature were searched through March 2025. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions vers. 6.2.

RESULTS: Thirteen studies (with 2418 participants) were included. School-based interventions showed significantly large effects on PTSD symptoms (g = -1.203, 95% confidence interval (CI) = -2.202 to -0.203), significant small effects on depression (g = -0.337, CI = -0.673 to -0.001) immediately after the intervention, with sustained medium effects at the short- and long-term follow-ups for PTSD symptoms, but not depression in the long term. Anxiety showed a significantly large immediate effect immediately after the intervention (g = -4.602, CI = -8.807 to 0.396). All tested moderator variables-including the intervention approach, control group type, intervention protocol (duration, length, total sessions), type of analysis, risk of bias, interventionist, country type, and publication time-significantly influenced immediate PTSD outcomes.

CONCLUSION: School-based interventions are effective in reducing PTSD symptoms, depression, and anxiety in children and adolescents following natural disasters. The intervention format and implementation context matter. Future research should strengthen the evidence base for depression and anxiety outcomes and assess long-term effectiveness and scalability.

PMID:40954040 | DOI:10.1111/camh.70029