The Effectiveness of Interpersonal Psychotherapy (IPT) Among War-Affected Children with Depressive Symptoms: A Systematic Review

Background and purpose: As of 2021, United Nations Children's Education Fund (UNICEF) reported nearly 13 million children are displaced by war, persecution, and other forms of violence. Children make up 50% of the displaced persons at risk of mental health problems, including PTSD, anxiety, and depression that emanate from traumatic experiences before and after resettlement in refugee camps in another country or internally displaced camps (IDP). Although depression can be devastating among war-affected or displaced children, few evidence-based interventions have been tested to decrease depressive symptoms for children impacted by war. Interpersonal psychotherapy (IPT) is one of the promising and empirically-based interventions that has proven effective in treating depressive symptoms in children. Despite this, no review has been done to determine the effectiveness of IPT for displaced children with depression. Henceforth, this review examines whether IPT effectively reduces depressive symptoms among war-affected or displaced children living in either refugee camps or internally displaced camps (IDP).

Methods: Six electronic databases were searched: PsycINFO, Web of Science, PubMed, Medline via Ovid, Social Sciences Index, and Cochrane Database of Controlled Clinical Trials (CENTRAL). The Boolean strategy was employed to access studies that met inclusion criteria. The search terms included "displaced children" or "refugee children" AND/OR "child soldiers" and "efficacy" OR effectiveness OR "decreasing/reducing" and "Interpersonal psychotherapy" OR interventions." The quality of the studies and risk of bias was assessed by triangulating three measurement tools: Cochrane Risk of Bias Assessment Tool (CRBAT), The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I), and Mixed Methods Appraisal Tool (MMAT)

Results: The search yielded 375 articles, and three studies met the inclusion criteria based on high quality checklists (CRBAT, ROBINS-I, and MMAT). The total sample size was 723 internally displaced children between 14 to 17 years old living in Northern Uganda. The final three studies were all randomized controlled trials (RCT) that examined the effectiveness of IPT for internally displaced children with depressive symptoms. Studies indicated mixed results that varied across gender and contexts. IPT substantially lowered depressive symptoms for girls than boys. Although gender differences were observed in depressive symptoms, significant improvements in decreased depressive symptoms were observed for all groups in the intervention groups when compared to the control group. However, there is still limited evidence to suggest that IPT is effective for all displaced children from different cultural backgrounds due to a lack of studies targeting these vulnerable populations.

Conclusion and implications: Although IPT is still underutilized among displaced children, IPT was locally feasible and effective for reducing depressive symptoms among displaced children affected by war and forced displacement. IPT should also be implemented for other displaced or war-affected children living in either refugee or IDP camps in other countries to widen the scope of evidence on its effectiveness in reducing depressive symptoms. The cross-national focus would strengthen the sustainability and adaptability of IPT intervention to children from different cultural backgrounds.