Improving child mental health and learning outcomes and reducing stigma and discrimination in conflict setting: findings from a cluster randomized controlled trial of a classroom-based psychosocial intervention in rural primary schools in Afghanistan.

BACKGROUND

Conflict and crises have long-lasting and dramatic consequences on the mental health of children. We aimed to investigate the effectiveness of a psychosocial intervention on child mental health in Afghanistan.

METHODS

A two-arm cluster-randomized controlled trial was conducted in 83 rural primary schools within three provinces of Afghanistan. Children in Grades 3-6, their teachers, and one adult family member were enrolled. Schools were randomly assigned (1:1) to one of two groups: a treatment group composed of entire classes receiving a week-long classroom-based teacher-and-child psychosocial training, a one-day family engagement component, and a community-based system dynamics workshop; and a control group. Primary outcomes were anxiety, depression, life skills, self-efficacy, and resilience of the child. Secondary outcomes included reading and mathematical literacy, mathematical problem-solving, and school-based discrimination and stigma. This trial is registered with the International Standard Randomized Controlled Trials Number registry (ISRCTN83632872).

RESULTS

In June 2021, 40 schools and n = 2,262 children were randomly assigned to the intervention group and 43 schools and n = 2,277 children to the control group. Preintervention survey started October 2, 2021 (first batch) and April 10th, 2023 (second batch). After a minimum of 4-month intervention, a postintervention survey took place. No treatment effects were found on anxiety, depression, resilience, self-efficacy, life skills, or stigma. Effects were found for academic outcomes and school-based discrimination. Shorter interventions displayed reductions in depression, anxiety, stigma, and discrimination, and an increase in life skills. Additional analyses showed significant effects on several outcomes for boys, on a few outcomes for girls, and in areas where the governmental did not disrupt the process.

CONCLUSIONS

Classroom-based interventions delivered by trained field-based educational staff can effectively promote child mental health, social-emotional skills, and academic outcomes, and reduce stigma and discrimination among subgroups of children in conflict and crisis settings and have viable potential for scalability.