​​Youth psychotherapies in lower- and middle-income countries found to be particularly effective, but rarely studied​

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that psychotherapies (i.e., talk therapies such as cognitive behavioral therapy) appear to be about twice as effective for children and adolescents living in low- and middle-income countries (LMICs) as for children and adolescents living in high-income countries. Importantly, despite 90% of the world’s youth residing in lower- and middle-income countries, only 34 randomized controlled trials (or RCTs, a gold-standard effectiveness test) of youth psychotherapies have been conducted in LMIC, out of over 500 conducted worldwide.

This meta-analytic review, led by Katherine Venturo-Conerly, M.A., a PhD student in the Lab for Youth Mental Health at Harvard University, is the first to comprehensively analyze available RCTs of child and adolescent psychotherapies across nine different scientific databases and across the most common youth mental health concerns (i.e., anxiety including traumatic stress and OCD, depression, disruptive conduct, and ADHD problems). The average treatment effect of these youth psychotherapies delivered in LMICs is large –over twice as large as in comparable youth psychotherapy meta-analyses in which over 95% of studies were conducted in high-income countries. This surprising discrepancy is consistent with findings from the adult psychotherapy literature.

It is not clear why the effects of youth psychotherapies may be so much greater in LMIC than in high-income countries. The study authors analyzed many variables that may help explain this difference, including the income level and per capita income of each country, whether therapists were mental health professionals or lay-providers, the type of mental health problem, therapy duration, study risk of bias, whether the study authors worked in the country of implementation, and several other variables.

Katherine Venturo-Conerly explained, “To our surprise, almost all these variables were not significantly associated with the effectiveness of youth psychotherapies in LMIC. And even those that were significantly associated with effectiveness typically did not hold up in sensitivity analyses. Certainly, these findings will require further study and replication once more research is available on youth psychotherapy effectiveness in LMICs.” For now, the large effects of youth psychotherapies in LMICs remain largely a mystery.

In describing the most important take aways from this study, Katherine Venturo-Conerly emphasized, “90% of the world’s children and adolescents live in LMICs, yet only about five percent of youth psychotherapies tested to date have been implemented in these countries. This stark disparity points to the need for more funding and research efforts focused on testing and disseminating youth psychotherapies in LMICs. She added, “Clearly, there is great potential for youth psychotherapies to help many young people in LMICs. In order to meet the global demand for mental healthcare, researchers, funders, and front-line workers will need to collaborate to develop and implement effective and scalable psychotherapies worldwide.”

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Notes 
The article is "​Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries​" by ​Katherine E. Venturo-Conerly, AB  Danielle Eisenman, HSD Akash R. Wasil, MA Daisy R. Singla, PhD John R. Weisz, PhD, ABPP​ (​https://doi.org/10.1016/j.jaac.2022.12.005​). It appears in the ​​Journal of the American Academy of Child and Adolescent Psychiatry​​, volume ​62​, issue ​8​ (​August 2023​), published by Elsevier.

About ​JAACAP​

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today’s psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal’s purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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