A Psychosocial Intervention to Improve Child Mental Wellbeing and Learning Outcomes in Afghanistan Schools

Background and Purpose: The change of regime in Afghanistan, replacing the Afghan Islamic Republic by an Islamic Emirate had an important impact on child mental health through multiple channels. Literature has shown negative effects of earlier crises, without remedial action. Negative effects such as high risk of school dropout, early marriage or pregnancy, displacement, child labor, and poor health were particularly elevated for vulnerable children. The country did not have enough remediation capacity: Mental health capacity outside the main cities was lacking as the basic package of health services did not include mental health in practice. Instead, schools offered multiple advantages for the implementation of a psychosocial intervention. Therefore, this study aimed to implement a culturally adapted and grounded participatory psychosocial intervention for primary school children in three provinces of Afghanistan and evaluated its impact on children's mental well-being and academic performance.

Methods: A multistage random sampling method was used to select 42 intervention and 39 control schools in Afghanistan to participate in this cluster randomized control trial. No significant difference was found at baseline between the children in intervention and control groups in any demographic and socioeconomic characteristics, psychosocial skills, or academic performances. Psychosocial skills were measured using the Multidimensional Scale Life Skills in Late Childhood, the Self-Efficacy Questionnaire, the Child and Youth Resilience Measure. We also measured depression and anxiety using the Revised Child Anxiety and Depression Scale (RCADS). Stigma, perceived prejudice, and experienced discrimination were gauged using an adapted and validated version of the Discrimination and Stigma Scale (DISC) developed for India and validated in Afghanistan. Cognitive skills were assessed using an adapted version of the Monitoring Education Development in Afghanistan (MED-A) framework developed by the Australian Council for Educational Research that included comprehensive and context-appropriate definitions of “literacy score” to evaluate reading and writing in Dari/Pashto, text comprehension as well as mathematics literacy and problem solving. The baseline data was collected in 2022, same respondents was interviewed again at endline in 2023. We used multilevel modeling (MLM) to analyze the rate of change in psychosocial and academic outcomes between intervention and control schools.

Results: Among the 4688 students at baseline, 3800 of them stayed in the study until endline. Results showed that, on average, students in intervention schools have 1.07 higher scores in self-efficacy and 0.28 lower scores in discrimination compared to children in control schools at endline. Students in intervention schools scored on average 0.25 points higher in mathematics literacy, 0.31 points higher in reading literacy, and 0.13 higher in mathematics problem solving compared to children in control schools at endline.

Conclusions and Implications: Our study shows that a participatory psychosocial school program had a significant impact on improving students' self-efficacy, reducing perceived discrimination, and enhancing academic achievements. This is especially important in Afghanistan, a conflict-affected country, where access to mental health resources is limited. The noticeable benefits from our study suggest the need for locally adapted psychosocial support in educational settings to ensure children’s emotional health. That allows them to focus on learning.