Publications

Mental Health in Displaced Child and Youth Populations: A Developmental and Family Systems Lens addresses the mental health of children who are displaced due to crises. Children who are displaced experience an array of adverse situations prior to, during and after their displacement that impact their well-being, health, adjustment and developmental trajectories. However, research remains limited with respect to understanding the impact of displacement on mental health and addressing the roles of children’s ecological contexts (in particular the family). In this working paper, the authors summarize the knowledge base of mental health in displaced populations from peer-reviewed journal articles with a focus on the last 10 years and using meta-analyses of mental health research. Based on this evidence (as well as gaps and limitations), we present a framework and recommendations for guiding future research.

Mental disorders affect about 1 in 7 children and adolescents worldwide, with 50% arising before the age of 14. Despite the high burden and early onset, most conditions remain unrecognized and untreated. We mapped evidence on the effectiveness of child and adolescent (ages 0-19) mental health and psychosocial support interventions in low- and middle-income countries within the last 12 years and identified 697 records from 78 countries.

The field is reactive rather than proactive, with most interventions focusing on treatment rather than promotion or prevention. Most mental health research is conducted in educational settings and focuses on early and late adolescence. Research on early childhood interventions as well as evidence to address the mental health and psychosocial needs of children in humanitarian settings are scarce.

Mental health intervention research lacks diversity: less than one third of studies and reviews focused on specific population groups. Despite the known potential for digital interventions to overcome a range of barriers, the field is understudied with very limited evidence across all outcomes. In 60 countries, no research was identified. There were also important geographical disparities and research gaps in West and Central Africa.

Mental health conditions affect about 1 in 7 adolescents globally. In the context of COVID-19, the importance of mental health and psychosocial support for all has been undoubtedly confirmed. Despite the increased attention to mental health issues, there is a dearth of evidence on what determines child and adolescent mental health, who is most at risk, and what works to foster mental health across contexts, cultures and distinct population groups.

This conceptual framework aims to inform research on child and adolescent mental health. It incorporates children’s developmental stages and the dynamic environment in which they live and grow. Informed by a review of existing theoretical frameworks on mental health and child development, this framework integrates elements of the socio-ecological model; the life course approach; the social determinants of health approach; and Innocenti Report Card’s Worlds of Influence Framework. Combining diverse aspects of these frameworks and approaches, we propose an integrated model to guide UNICEF’s research in this area. 

COVID-19 lockdowns have significantly disrupted the daily lives of children and adolescents, with increased time at home, online learning and limited physical social interaction. This report seeks to understand the immediate effects on their mental health. Covering more than 130,000 children and adolescents across 22 countries, the evidence shows increased stress, anxiety and depressive symptoms, as well as increased alcohol and substance use, and  externalizing behavioural problems.

Children and adolescents also reported positive coping strategies, resilience, social connectedness through digital media, more family time, and relief from academic stress. Factors such as demographics, relationships and pre-existing conditions are critical.

 To ensure children and adolescents are supported, the report recommends building the evidence on the longer-term impact of the pandemic on child and adolescent mental health in low- and middle-income countries, including vulnerable populations.

COVID-19 is a crisis like no other in modern times. It has reached every population and community. While the evidence base is still nascent, this report looks at the impacts of disasters and past epidemics – such as Ebola, HIV, SARS/MERS and Zika – on child and adolescent mental health and psychosocial wellbeing, and examines how these insights can guide policies and progammes to support children, their families and communities during the current pandemic.

COVID-19 – its associated public health responses and social and economic impacts – is likely to have multiple deleterious effects on mental health, including elevated risks of anxiety and depression, trauma, loss of family and friends, violence, loneliness and social isolation. However, this pandemic also offers opportunities for positive coping and resilience.

While there is no magic formula to address the mental health and psychosocial impacts of crises, there are proven and promising interventions from past experiences to mitigate the impact today – especially for the most vulnerable children and adolescents. These include social protection, caregiver skills and support, community and social support, life skills and school based programmes, and specialized care, to name a few.

While there has been a global rush to generate rapid evidence on COVID-19 mental health impacts among adults, limited evidence exists on the potential impacts on children.

This is the protocol for our rapid review that seeks to (i) understand the immediate impact of COVID-19’s first wave on the mental health of children and adolescents (0–19 years); and (ii) apply lessons learned from this pandemic to mitigate the impacts of future health crises.

The key research questions of this review are: 

• What has been the immediate impact of COVID-19 and associated containment measures on the mental health and psychosocial well-being of children and adolescents?
• How and which risk and protective factors have affected mental health during COVID-19 and have they varied across subgroups of children and adolescents?