A Systematic Review and Network Meta-Analysis of the Efficacy of Psychological Interventions for Reducing Posttraumatic Stress, Anxiety, or Depression Among Forcibly Displaced Children

Background and Purpose:
Forcibly displaced children and youth face elevated risks of posttraumatic stress disorder (PTSD), anxiety, and depression due to exposure to conflict, violence, and ongoing instability. Although a range of psychosocial interventions has been developed to address these mental health challenges, the comparative effectiveness of these approaches remains unclear. Existing studies vary widely in design, population, and intervention type, making it difficult for practitioners and policymakers to identify which treatments are most effective across contexts. To address this gap, this study conducts a systematic review and network meta-analysis (NMA) to evaluate and rank the effectiveness of psychosocial interventions in reducing PTSD, anxiety, and depression among forcibly displaced children and youth.

Methods:
This study followed PRISMA guidelines and was prospectively registered. A comprehensive search of major databases identified randomized and nonrandomized trials evaluating psychosocial interventions for forcibly displaced children under age 18. Thirty-five studies met inclusion criteria, representing diverse geographic regions and settings, including schools, community programs, and clinical environments. Interventions were grouped into 12 categories based on theoretical orientation, including cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy (NET), integrative approaches, and others. Random-effects network meta-analyses were conducted using standardized mean differences to compare intervention effectiveness across outcomes (PTSD, anxiety, and depression). Sensitivity analyses, publication bias assessments, and inconsistency checks were performed to evaluate robustness.

Results:
Findings indicate that trauma-focused interventions consistently demonstrated the strongest effects for reducing PTSD and anxiety symptoms. NET (SMD = 1.72), EMDR (SMD = 1.65), and CBT (SMD = 1.27) were significantly more effective than inactive control conditions, with relatively similar levels of effectiveness among these approaches. For anxiety, NET showed the largest effect, followed by EMDR and CBT. In contrast, no intervention demonstrated statistically significant superiority for reducing depression symptoms. Although several interventions showed small to moderate positive effects, results were highly heterogeneous, and confidence intervals consistently crossed zero. Across outcomes, between-study variability was substantial, reflecting differences in intervention delivery, context, and population characteristics. Evidence of publication bias and small-study effects was detected for some outcomes; however, sensitivity analyses confirmed the overall stability of the main findings.

Implications for Practice and Policy:
These findings highlight the importance of trauma-focused interventions in addressing PTSD and anxiety among forcibly displaced youth, supporting their prioritization in both clinical and community-based settings. However, the lack of consistent effects for depression underscores a critical gap in current intervention approaches. Depression among displaced youth may be more strongly influenced by ongoing post-migration stressors such as poverty, family separation, and social instability, suggesting that individual-level interventions alone may be insufficient. Future research should prioritize the development of interventions that integrate trauma-focused treatment with broader social and structural supports. Policymakers and practitioners should also consider culturally grounded adaptations and longer-term implementation strategies to improve sustained mental health outcomes in this population.