Many people living in low- or middle-income countries are exposed to adversities, such as conflict and war. In developing countries, most people with PTSD do not receive adequate care. This is due to insufficient mental health services and challenges in implementing evidence-based interventions. Non-specialist health workers and other professionals such as teachers have an important role in delivering mental health care in these settings.

What is the evidence on effectiveness of psychotherapy for PTSD in low- and middle-income countries?

Moderate to low quality evidence found large improvements in PTSD symptoms, depression, and anxiety for up to four weeks following treatment with psychological therapies in adults exposed to humanitarian crises in low-resource settings.. Therapies included trauma-focussed or supportive therapies, eye movement desensitisation and reprocessing, cognitive behavioural therapy, and interpersonal psychotherapy. There were smaller, but significant improvements for up to six months.

There were also improvements in children in these settings following focussed psychological therapies, particularly in children aged 15-18 years, in non-displaced children, and in children living in small households (<6 members). Functioning, hope, coping, and social support also improved, although only improvements in functioning helped improve PTSD symptoms. There were no significant improvements in depression and anxiety immediately post-treatment and at short-term follow up (6 weeks).

Moderate quality evidence found a large improvement in PTSD symptoms with active psychological treatments immediately following treatment and at follow-up (up to 24 months) in child and adult survivors of mass violence in low- and middle-income countries. The effects were smaller, but remained significant, when compared to control conditions. Depression and functioning also improved.

For non-specialist, lay health worker interventions in low- and middle-income countries, moderate to low quality evidence found a small improvement in PTSD symptoms in adults, and a large improvement in PTSD symptoms in children and adolescents at around six months post-treatment. Children and adolescents also showed improvements in functioning and depression.

Moderate quality evidence found no differences in PTSD symptoms following psychological therapies for women exposed to intimate partner violence compared to women not exposed to intimate partner violence in low- and middle-income countries. Only anxiety improved in exposed women.

August 2021

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