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Open Access

Peer-reviewed

Research Article

The power of the social: A systematic review and meta-analysis of social interventions in Global Mental Health

  • Alma Ionescu,

    Roles Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

    Affiliations Institute for Global Health, University College London, London, United Kingdom, Centre for Socio-Legal Studies, University of Oxford, Oxford, United Kingdom

    ⨯
  • William Byansi,

    Roles Conceptualization, Investigation, Methodology, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Boston College, School of Social Work, Chestnut Hill, Massachusetts, United states of America

    ⨯
  • Farah Sheibani,

    Roles Formal analysis, Investigation, Writing – review & editing

    Affiliation UCL Institute for Global Health, University College London, London, United Kingdom

    ⨯
  • Ishrat Pabla,

    Roles Formal analysis, Investigation, Writing – review & editing

    Affiliation Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom

    ⨯
  • Abbie McDonogh,

    Roles Formal analysis, Investigation, Writing – review & editing

    Affiliation Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom

    ⨯
  • Eric Frasco,

    Roles Investigation, Writing – review & editing, Formal analysis

    Affiliation Institute for Global Health, University College London, London, United Kingdom

    ⨯
  • Rochelle A. Burgess

    Roles Formal analysis, Investigation, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing, Conceptualization

    r.burgess@ucl.ac.uk

    Affiliations Institute for Global Health, University College London, London, United Kingdom, Senior Research associate, University of Johannesburg, Johannesburg, South Africa

    ⨯

Abstract

Recent scholarship has emphasised the importance of social interventions in mental health, broadly defined as interventions designed to deliver social benefits that drive positive mental health consequences to their beneficiaries. While more is understood about the impact of some types (i.e., social-relational interventions) globally, impacts of social interventions addressing broader systemic and material conditions linked to mental health, such as poverty and access to welfare systems, are less understood. Addressing this evidence gap is critical for advancing a holistic agenda in the global mental health field that reflects the social realities and mental health needs of communities. We conducted a systematic review in accordance with PRISMA guidelines to advance understandings of social interventions and their role in addressing mental ill-health in low resource settings. We focused on interventions targeting conditions within the WHO MHGAP (version 2.0) guidelines, delivered in LMIC countries defined by World Bank criteria. Our protocol was registered with Prospero (CRD42022357660). Searches were conducted in October 2022 and updated in June 2025. 22,553 records were identified and independently double-screened, with 83 studies meeting inclusion criteria. We structured our discussion of findings, by level of intervention delivery: Individual and family level; Household and working life level; community level; and population level. We report on findings from 36 countries, with studies from the African continent being most represented. Meta-analysis of our most commonly explored mental health condition (depression) identified a moderate effect size (Cohen’s d = 0.42, P = 0.005) for social interventions, with a high level of heterogeneity. Service level interventions (primarily school-based), were most common, followed by community-level interventions. Overall, our findings indicate that the primary level of delivery did not preclude actions and impact across other levels, as many social interventions were flexible in responding directly to local needs. Implications for intervention programming in LMIC landscapes are discussed.

Citation: Ionescu A, Byansi W, Sheibani F, Pabla I, McDonogh A, Frasco E, et al. (2026) The power of the social: A systematic review and meta-analysis of social interventions in Global Mental Health. PLOS Ment Health 3(7): e0000625. https://doi.org/10.1371/journal.pmen.0000625

Editor: Karli Montague-Cardoso, PLOS: Public Library of Science, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND

Received: December 2, 2025; Accepted: April 30, 2026; Published: July 1, 2026

Copyright: © 2026 Ionescu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: RAB is the co-editor in chief of PLOS Mental Health. The authors have no further competing interests to declare.

Introduction

How should we best respond to the social, cultural, and political framings of mental ill-health? And how may we do so in contexts where social adversity is inextricably linked to the development and experience of mental health conditions? Since its inception, the Movement for Global Mental Health (GMH), which prioritises the reduction of inequalities in mental health services access between high and low-resource settings, has faced critique regarding its engagement with the complexities of the social landscapes shaping individual and community mental health experiences in the Global South [1–3].

The moral necessity of expanding access to basic mental health services in under-resourced settings is undeniable [4–6]. Yet to date, these efforts have primarily prioritized clinical interventions, applying task-sharing models to deliver treatments for depression [7,8], substance misuse [9] and severe mental health conditions including schizophrenia [10,11]. Implemented mainly through community-based, peer-delivered programs, such approaches have demonstrated success, with some approaches now being scaled across regions, including in Africa [12,13], South Asia [14–16], and Latin America [17,18].

Despite these successes, critiques persist regarding the limited ‘fit’ of such interventions to complex social contexts. Specifically, scholars argue that while scaling up mental health services has narrowed the treatment gap, these services often fail to sufficiently address the structural and relational realities widely recognised as drivers of poor mental health care. For example, Roberts and colleagues [19] show how tensions emerge between externally designed services and the lived realities and everyday narratives of need presented by community members. In these settings, the treatment gap as a rallying point risks oversimplifying the problem by prioritizing biomedical services over social responses. Instead, they argue that more appropriate pathways forward involve approaches that explicitly centre the social concerns shaping daily life and well-being.

In response to these critiques, recent scholarship has emphasized the importance of social interventions in the global mental health space [20]. Social interventions are broadly defined as interventions designed to deliver social benefits to their beneficiaries [21]. Burgess and colleagues [20] identify two primary orientations of social interventions for consideration in mental health: Socio-structural and Socio-relational. Socio-structurally oriented interventions address broader systemic and material conditions, such as poverty, education, and access to welfare systems. Examples increasingly present in global mental health literature include cash transfers [22], social welfare interventions [23–25]. By contrast, Socio-relational oriented interventions focus on the interpersonal and relational dimensions of well-being. These include interventions designed to reduce loneliness [26,27], befriending schemes [28,29], and parenting and peer group programs [30–32]. While socio-relational approaches are more common in high-income contexts, they are increasingly recognized as relevant to low-resource settings.

Although social interventions vary in scope, they share the common trait of being situated outside the formal health sector, and require collaboration and integration of welfare, education, and community sectors. This presents challenges but also significant opportunities in settings where health and mental health systems are underdeveloped and under resourced. By involving multiple sectors, social interventions can target the root causes of mental ill-health and complement biomedical services, as they addresses dimensions of distress rooted within the broader socio-political economy of mental health, which structure people’s everyday life and opportunities for wellbeing [33].

Moreover, there are increasing calls to incorporate social interventions into the global mental health framework and ecosystem [34,35], but a systematic synthesis of their effectiveness remains limited. Existing reviews have often focused on high-income settings or on single intervention types, such as cash transfers or social protection programs [21,36], without mapping the broader spectrum of social interventions relevant to global mental health.

This systematic review and meta-analysis aims to provide a foundation for understanding the current state of evidence in relation to social interventions in global mental health. With this as our starting point, this review explores the following broad questions:

  1. (1) What types of social interventions exist and how are they used? (i.e., Which populations and key mental health outcomes they target?), and
  2. (2) What is the effectiveness of social interventions in reducing poor mental health symptoms?

Addressing this evidence gap is critical for advancing a more holistic global mental health agenda and expansion of interventions that reflect the social realities of affected communities. Thus, this review will advance understandings of the role that social interventions can play in addressing mental ill-health globally, and highlight implications for research, policy, and practice, with an emphasis on LMIC settings.

Concepts and terminology

Across contexts studied in GMH, poverty, inequality, conflict, and violence are commonplace social conditions that shape both the development and treatment of mental health conditions, as well as the broader social opportunities available to individuals and communities [37]. Conversely, our conceptual framework for this review builds on Wahlbeck and colleagues’ [38] review of interventions aimed at mitigating the effects of poverty and inequality on mental health. Table 1 outlines the different intervention levels outlined Wahlbeck and colleagues’ [38], accompanied by examples of the most common types of social interventions identified at each level. While their work is primarily focused on high-income settings, we adapt their categorisation of intervention levels to guide our search strategy, as they provide a useful starting point, with a clear articulation of the different domains at which social interventions may operate to improve the social conditions of individuals and communities in the Global South.

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Table 1. Adaptation from Wahlbeck et al (2017) of intervention levels where social interventions may operate.

https://doi.org/10.1371/journal.pmen.0000625.t001

Methods

Literature search

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [39]. The protocol was prospectively registered with Prospero (CRD42022357660). No amendments were made to the search terms. Our Prisma checklist can be found in supporting information files (see S1 Checklist).

The primary search was conducted in four major databases: Medline, PsycINFO, Embase, and Global Health. The search strategy (see Table 2) included a string of terms related to social interventions. To capture studies in low- and middle-income countries (LMICs), we applied an adaptation of the Cochrane EPOC LMIC geographical filter. The initial search was conducted in October 2022 and further updated in June 2025. In total, 22,553 records were identified and independently double-screened by a team of five trained reviewers (AI, FS, IP; AM; EF), supervised by the first and senior author. The screening process is presented in Fig 1.

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Table 2. Search strategy.

https://doi.org/10.1371/journal.pmen.0000625.t002

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Fig 1. PRISMA flow chart outlining screening process.

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Before screening began, 30 studies were randomly selected and reviewed by all screeners. We compared individual screening decisions and discussed discrepancies to ensure consistency and reliability across the team before starting the main screening phase, as is recommended for best practice [40]. The first-round screening of titles and abstracts excluded duplicates and studies falling outside the inclusion criteria. Full text screening was preceded by a similar phase of validation. To complement the database search, we manually screened reference lists of eligible studies and performed targeted searches in Google Scholar using the same key terms applied in the primary search. Backward and forwards citation searches were needed given that the terminology relating to ‘social interventions’ is sometimes inconsistent and therefore may miss potentially relevant studies in keyword-based database searches [41]. This process identified an additional 11 studies included in the final dataset.

Inclusion criteria

Our inclusion criteria for mental health conditions was informed by the mhGAP version 2.0 priority conditions [42], focusing on depression, schizophrenia, suicide, substance-use disorders, and child mental health conditions. We did not include dementia or epilepsy in our review, seeking to focus on mental health conditions that currently contributed to the greatest burden of disease.

We did not set any date limits. Geographical limits were set to low- and middle-income countries, as per the World Bank classification. We included peer-reviewed studies published between 2012–2025 and limited our inclusion to studies published in English. We excluded studies based on secondary data, pilot studies or those that did not explore the intervention impact on mental health outcomes (i.e., cost-effectiveness analyses; meta-analyses).

We also included studies that focused around the general category of mental health, if they were assessed by standardised scales, as this aligns with the ethos of social interventions that are concerned with wellbeing at multiple levels rather than being limited to clinical settings [38,43].

Data extraction and analysis

Data was extracted using a customised extraction table in Excel. Details included study design, description of intervention, aims of the study, intended beneficiaries, type of social intervention, and level of operation. A separate extraction table for the meta-analysis was created, including country, geographical region, population, sample size, outcome measure, and results. Our data extraction table can be found infile (See S1 Data)

Quality assessment

Quality appraisal was performed on eligible papers using Joana Briggs critical appraisal tools [44], which is available in the supporting information files (see S2 Data). We did not exclude any papers based on quality.

Meta-analysis

We completed a meta-analysis based on the most commonly occurring mental health condition in our sample (depression). Following established meta-analytic procedures [45,46], we first calculated study-level effect sizes for depression. For each included study, the standardized mean difference (SMD) was estimated using group means, standard deviation, and sample sizes for intervention and control groups. Effect sizes were expressed as Cohen’s d for the depressive symptoms [47]. The pooled effect of the interventions on depression was then estimated using STATA 17.0. STATA provides a z-test in its meta-analysis output, which was used to determine whether the aggregated effect size significantly differed from zero. A statistically significant z-test (P < .05) indicated that interventions had a meaningful impact on depression across studies.

To evaluate variability across studies, we assessed heterogeneity using the I² statistic and the Cochran’s Q-statistic [48]. I² values of 25%, 50%, and 75% were interpreted as low, moderate, and high heterogeneity, respectively [49]. Given that our analyses evidenced high heterogeneity, we analysed the results using random effects models. A significant Q-statistic (P < .001) further indicated that the observed variation in effect sizes was greater than zero.

Results

We identified 83 studies examining social interventions for mental health across low- and middle-income settings, with insights from 36 countries. The regional representation consisted of 38 studies from Africa, 14 from South Asia, 11 from Latin America and Caribbean, 10 from East Asia and Pacific, and eight from the Middle East. The countries with the most studies were Uganda (n = 8), India (n = 8), and Kenya (n = 6). Geographical distribution of studies is summarised in Fig 2, which indicates the geographical location of identified studies and the number of interventions in each country. As we high income countries were excluded from our criteria, they are labelled as N/A, and coloured in grey.

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Fig 2. Geographical distribution and frequency of included studies.

Base map and data from OpenStreetMap and OpenStreetMap Foundation. © OpenStreetMap Base map tiles © OpenStreetMap contributors (https://www.openstreetmap.org), ODbL license (https://www.openstreetmap.org/copyright). Country border shapefiles from datasets/geo-countries (https://github.com/datasets/geo-countries), derived from Natural Earth public domain data (https://www.naturalearthdata.com/about/terms-of-use/).

https://doi.org/10.1371/journal.pmen.0000625.g002

Almost all studies focused on common mental disorders (CMD), with only 6.1% (n = 5) of studies focusing on serious mental disorders (SMD), all of which centred on schizophrenia. The most common condition of focus was depression, which made up 69.5% (n = 57) of the studies, followed by 8.5% (n = 7) on general mental health, 7.5% (n = 6) on child mental health, 6.1% (n = 5) on schizophrenia, 4.9% (n = 4) on suicide and 4.9% (n = 4) on substance use. In terms of demography, 69 studies were targeted at all genders, while 13 studies were specifically targeted at women. 39 studies were specifically aimed at young people, 37 at adults, five were aimed at families specifically (including young people and adults), and one study included all.

91.5% (n = 75) of identified studies were quantitative. 6.1% (n = 5) studies used mixed methods. Similarly, only 2.4% (n = 2) of the studies were qualitative in nature. Randomised control trials (RCT) were the most common methodological design, making up 67.1% (n = 55) of the studies. Regarding the remaining quantitative studies, eight were quasi-experimental, four were non-randomised, three were cohort studies, and one was a case control study.

How effective are social interventions? Meta-Analysis Results on depression

Due to the diversity of the mental health conditions of focus and the heterogeneity of measures used to assess effectiveness, we could not conclude a meta-analysis for all papers in our final sample. Our meta-analysis began with 53 studies that examined social interventions on depressive symptoms. Of these, 14 papers provided sufficient statistical information (e.g., means, standard deviations, sample sizes) to be considered for quantitative synthesis. A further 39 were excluded due to inconsistencies in outcome measurement across studies and a lack of statistical details.

14 studies reported data that allowed for the calculation of standardized mean differences. Using a common outcome of depression, the pooled analysis demonstrated a significant medium effect size (Cohen’s d = 0.42; Effect size = -0.42, 95% CI = -0.75 to -0.09, p = 0.005), indicating that social interventions were associated with a meaningful reduction in depressive symptoms. However, heterogeneity across studies was high (I² = 97.6% and Cochran’s Q = 546.12 (df = 13, p < 0.001), suggesting substantial variability in effect sizes. Fig 3 presents the forest plot summarizing the pooled effect sizes for depression across the included studies.

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Fig 3. Pooled effect sizes of social interventions for depression in LMICs.

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As indicated in the forest plot, effect sizes across individual studies varied widely, ranging from strong negative effects (e.g., [50]) to positive or null results (e.g., [51]). This wide variability highlights differences in intervention effects across settings and study designs. Taken together, these findings suggest that interventions are associated with a moderate reduction in depressive symptoms overall. However, the extremely high heterogeneity warrants caution in interpretation and indicates a need for further analyses to explore potential moderators such as study setting, intervention type, or population characteristics.

How are social interventions used to impact mental health? Findings from the full dataset

We present our findings responding to our first research question, in line with the framework used to structure our search, outlined previously. It is worth noting however, that due to the nature of social interventions, many were multi-dimensional, and engaged with multiple levels of action. We organised our analysis based on the primary level of delivery described by authors themselves, to provide clarity in discussions of findings.

Individual and family level.

We identified six studies discussing social interventions delivered at the individual and family level. Five of the six studies at this intervention level were deemed effective by the respective authors. One intervention found no evidence of effectiveness [52]. Three studies focused on parenting skills and support, all targeting depression outcomes amongst parents. In Ghana, pregnant adolescents were paired with ‘model mothers’, part of the community, to support their transition into motherhood [52]. In Nigeria, a similar model of a ‘neighbourhood mother’ was used to support pregnant mothers with parenting skills, social support, behavioural activation and problem-solving [53]. In China, parents in poor rural areas received parenting skills training, as well as weekly group reading & play activities alongside access to free play space at the parenting centres [54].

Three interventions catered for individuals with specific social needs. In Iraq, an intervention consisted of a psychotherapy programme that incorporated skills training, social empowerment and strength-building for survivors of torture [55]. Another programme delivered in the Democratic Republic of Congo, Healing in Harmony, offered survivors of sexual violence and violence-related trauma music therapy, promoting cognitive restructuring and verbalisation of trauma, with the goal of positively changing how recipients engage with their social environment about their experiences [56]. In India, a lay counsellor intervention for older adults combined problem-solving therapy with support for accessing government-sponsored medical services and social support [57].

Households and working life level.

Nine studies explored interventions delivered at the household and working life levels. All the nine interventions were deemed to be effective. Five of the papers were produced by a research group researching family-based economic strengthening interventions in Uganda [58–62]. The studies looked at different iterations and implementations of this type of social intervention. Given the signification impact of HIV/AIDS in Uganda, the various studies had various target populations, included AIDS orphaned children, young girls living with HIV or HIV prevention amongst young people. Outcomes were intended to improve mental health of young people, but interventions included their households. For example, families were encouraged to open savings account for the children (Child Development Accounts) which would be matched by the project, caregivers and children were invited to family financial management and microenterprise workshops, as well as mentorship programmes. This suggests the need for intervention elements directly targeted at children, as opposed to general household-targeted interventions, in order to adequately address child mental health.

The other three papers exploring delivery at this level consisted of employment interventions for Malaysian manufacturing workers, directly engaging with socio-structural sources of distress, namely their work environment. In Ghana, as a response to professional and personal challenges that were found to negatively impact teacher mental health, a teacher training intervention was undertaken to strengthen their belonging in the school community [63]. In the Dominican Republic, a living wage intervention for apparel factory workers saw signification reductions in depression levels [64]. The Small Farmers Development Program (SFDP) in Nepal included agricultural loans and strengthening of social support structures which supported low-income farmers [65].

Community level.

We found 19 papers delivered at community-level interventions. 14 of those interventions were found to be effective, while four of them found no evidence of effectiveness [55,66–68]. One intervention in China found mixed evidence, as there was some effectiveness in terms of reduction of depressive symptoms, but this differed across gender and was not sustained over time [54]. These interventions were typically delivered by or with community members themselves, such as lay community health workers, peers or community volunteers. After initial training, community-members were placed in charge of delivering various intervention elements, often targeting both socio-structural and socio-relational aspects.

For example, in their study on a community psychosocial intervention called Atmiyata in Gujarat, India, Pathare and colleagues [69] describe various intervention elements which speak to either socio-structural or socio-relational dimensions. While facilitation to help recipients access social benefits addresses socio-structural dimensions of ill mental health, their broader community awareness elements of the intervention address socio-relational dimensions. This community awareness included engagement with broader community members, during short films screenings, exploring mental health, in social and economic context, linking these to experiences around unemployment, domestic violence or family conflict. Atmiyata includes problem-solving mechanisms too, which were also observed in other interventions.

Broström and colleagues [70] assessed a Youth Friendship Bench project in Zimbabwe, directed at adolescents experiencing depression, and particularly tailored to address problems relevant to them including sexuality, relationships and young parenthood.

Many interventions delivered at the community-level were peer-led, drawing on peer support mechanisms. In Ghana, Appiah and colleagues (2020) attributed the significant outcomes of the community-based multicomponent positive psychology intervention in part to the effect of the peer delivery of the intervention, indicating the positive social impacts of such interventions delivered at community rather than individual level. Adolescent mothers in an intervention in Malawi similarly included a peer support element, consisting of teenage mothers support groups, alongside other offerings such as health services and child monitoring [71]. In Pakistan, a longer-term peer-led psychosocial intervention consisting of problem-solving and behavioural activation for pregnant women with depression was delivered by other married women in the community [66].

Other interventions focused on creating sustainable support structures and systems within communities, which have the potential of addressing certain root causes of ill mental health and distress, in particular structural ones. In a Kenyan intervention named Kuja Pamoja (translating to ‘come together’) described by Goodman and colleagues [72], intervention elements included savings- and lending-groups, as well as skills and entrepreneurial training for women, in an effort address economic challenges and inequalities as drivers of adverse mental health outcomes. In Haiti, given the high likelihood of natural hazards, a disaster preparedness intervention was aimed at supporting mental health of recipients and ensuring they have necessary social support structures in place in case of a disaster [73].

Service level.

Social interventions delivered at the level of services, were the most commonly identified in our search, with a total of 31 studies. Amongst these studies, 19 focused on school-based interventions, which we present in the subsequent sub-section. Here we focus on the 12 service-level interventions. 11 out of the 12 non-school-based service-level interventions were found to be effective, and one intervention found no evidence of effectiveness [74].

Five studies delivered at service level targeted individualised offering blended therapeutic interventions with social components. In a comparative study in India and Pakistan, the peer-delivered adaptation of the Thinking Health Programme offered psychosocial support to pregnant women experiencing perinatal depression [75]. In Brazil, a task-shared and collaborative programme was delivered for older adults living in socio-economically deprived areas experiencing depression [76]. In Bangladesh, the intervention supplemented regular paediatric visits at the community clinics with psychosocial stimulation for mothers and food supplementation for their children, aimed at improving mothers’ depression [74]. In Indonesia, outpatients with schizophrenia received psychoeducation and social skills interventions in the community [77]. Overall, these interventions incorporated mechanisms such as problem-solving, behavioural activation, social support and psychoeducation in ways that engaged with the social dimensions of people’s distress and helped them devise strategies to address these.

Another two studies, both from Uganda, implemented group-based psychotherapy interventions, which similarly incorporated mechanisms addressing the social aspects of mental health. In an intervention aimed at perinatal depression, women were supported in group-settings to identify and name problems in their day to day life contributing to their distress, and encouraged to collectively support each other in identifying achievable solutions [78]. The other intervention was targeted at people with HIV/AIDS, and included sessions focusing on income-generating skills, to attain livelihood opportunities that foster dignity and independence [79]. Beyond the practical aspects of such interventions geared at providing solutions to socio-structural challenges, participants were encouraged to create groups for sustaining group-based livelihood generating enterprises (for example, growing and selling produce) that incorporates socio-relational elements to these solutions.

Two studies, from India and Brazil, looked at supported housing initiatives aimed to facilitate post-hospitalisation discharge and aid social reintegration into the community. In Brazil, the intervention supported transitions by offering housing and employment support to participants [80]. In India, the intervention focused on shifting paradigms of care towards ones that emphasize independence of people with severe mental health conditions, by promoting community-grounded care [81]. A similar study in Iran, provided intervention focused on community rehabilitation, though it did not include housing, focusing social function for people with chronic mental health concerns [82].

School level.

In Wahlbeck’s [38] framework, school-based interventions fall under the service-level category. School-based interventions comprised a quarter of all interventions (n = 19) we identified. The age ranges of young people included in school-based interventions varied, starting from as young as 8 years old to 19 years old. 11 studies were found to be effective and four interventions found no evidence of effectiveness in respect to mental health outcomes of interest in this review [51,83–85]. A further four interventions showed mixed outcomes, indicating some level of improvement on some indicators of interest but not all [86–89]. For example, the intervention by Qouta and colleagues [86], focusing on children in Palestine did not show overall effectiveness, but rather gender- and risk-specific effectiveness, given the complexity of the context within which the intervention was delivered.

Ten interventions were modelled after universal school interventions, aimed at supporting students to identify and work through their problems. In Tanzania, an intervention centred around promoting pro-social behaviours, supporting socio-relational dimensions of mental health for students in various social locations, including school and community [90]. Another intervention in India, the SEHER intervention, consisted of multiple components aimed at supporting students in actively engaging with their social problems, including setting up school-wide students committees listening, supporting and engaging concerns; peer-based support groups; and problem-solving counselling sessions with individual students [91]. RECAP-VN in Vietnam focused on social skills training in school [92]. In Nigeria, a school-based intervention trained teachers and school nurses on psycho-social wellbeing, with a focus on resiliency, and established peer support groups in order to create environments where students’ social worlds could be better understood, creating opportunities for them to more easily work through their problems [93]. Also in Nigeria, Bella-Awusah and colleagues [50] studied a school-based cognitive behavioural therapy (CBT) programme, which blended religious elements to better make sense of the social anchors in student’s lives.

Other studies (n = 9) were structured around preventing and addressing negative mental health outcomes that linked to specific contextual realities shaped by socio-structural factors. In Guatemala, Kulis and colleagues [94] highlight the particular social, political and economic context in the country that contribute to the vulnerability of young people in regard to substance abuse. As such, the intervention responded to these realities, by emphasising substance use prevention [94]. Similar interventions were observed in Brazil [88,89]. Two interventions in Gaza were aimed at Palestinian children who had lived through conflict and war, focusing on social relationships, peer protection, socio-emotional skills and cooperation with different social actors including schools and families [83,86]. A similar intervention was delivered to war-affected children in Burundi, which blended creative and artistic aspects [87]. In Nepal, school children in low-income settings received teacher-delivered psychosocial interventions focused around mental health and hope in earthquake affected districts [85]. In Rwanda, unstructured emotional writing interventions were delivered to orphan adolescents [51].

Country level.

We identified 13 studies reporting on social interventions delivered at country-level, all of which were financial in nature. Out of the 13 studies, 10 interventions were found to be effective and two interventions showed no evidence of effectiveness [95,96]. One intervention in Tanzania found mixed evidence in terms of outcomes, as depressive symptoms decreased amongst men but increased for women [97]. The majority of interventions were cash transfers, of which six were unconditional, three were conditional and two were hybrid. These cash transfers were sometimes delivered in tandem with other intervention elements, for example in Uganda the intervention included business training skills [95,96]. In Tanzania, the Adolescent Cash Plus intervention (which targeted adolescents) included similar livelihood and financial skills training, but also included linkages to health services and supported aspects socially relevant aspects for adolescence including sexual and reproductive health, as authors highlight the importance of multisectoral approaches to supporting the complex needs of adolescent mental health [98,99]. In Kenya, the intervention also included free health insurance alongside the unconditional cash transfer [100].

Eight studies investigated the impact of larger national-scale government-run cash transfer programmes on mental health outcomes specifically. Machado and colleagues [101] investigated the outcomes of Brazil’s programme Bolsa Familia, which they found to be associated with 56% lower suicide rates after adjusting for other variables. In India, Janani Suraksha Yojana (JSY) is a safe motherhood intervention aimed at supporting poor women, and involves cash assistance upon delivery and post-delivery care. The study found up to 36% reduction in moderate depression amongst recipient mothers in Uttar Pradesh, one of the most deprived states in the country [102,103]. In Malawi, the national unconditional cash transfer programme Social Cash Transfer Program (SCTP) directed at ultra-poor and labour-constrained household too was found to have positive effects on youth mental health, particularly amongst females [104]. Authors in particular highlight socio-relational mechanisms contributing to positive outcomes, such as increased sense of social support facilitated through greater opportunities for socialisation and decreased caregiver stress at the household level. Two studies also evaluated Kenya’s Cash Transfer for Orphan and Vulnerable Children (CT-OVC) governmental programme, found to not only considerably decrease depressive symptoms but also improve hope and outlook on future [104,105], similarly highlighting that the ability to meet basic needs opens up opportunities to strengthen socio-relational dynamics that support wellbeing.

Cash transfer interventions normally seek to address poverty, which we found to be the case for all cash transfer interventions included in our sample (n = 11). However, nine of these interventions were also explicit in expanding their efforts to address complex forms of social marginalisation and inequality. For example, four studies focused specifically on interventions targeted at orphaned and vulnerable children (OVA). A study by Haushofer and colleagues [100] directed their health insurance and cash transfer intervention towards informal workers in Nairobi, recognising the increased social and economic vulnerabilities experienced by informal sector workers. Angeles and colleagues [104] highlight the vulnerabilities linked to chronic illnesses and disabilities that is a reality for many of the beneficiaries of their intervention. In Syria, Falb and colleagues [96] highlighted the complex crisis context - involving civil conflict and ISIS occupation – experienced by the intended beneficiaries of the intervention. In their contextual grounding and attention to complex and intersectional forms of disadvantage, these cash transfer interventions highlight the importance of considering the interplay of socio-structural dimensions in relation to mental health.

Mixed levels.

Four studies were more distinctively ‘mixed’ in nature in terms of their level of delivery, which we describe here. All four interventions were found to be effective. In Mexico, Amador Buenabad and colleagues [106] studied a multicomponent programme at combined two streams of intervention: Leaving Traces on Your Life (Dejando Huellitas en tu Vida) and Raising Children with Love: Promoting Harmony and Self-Improvement in Mexico (CAPAS-Mx). The former delivered the intervention to children at school-level, focusing on social and emotional skills, while the latter delivered support to parents at the family level, focusing on parenting skills. An intervention aimed at Syrian refugees living in Lebanon similarly blended school and family level, by offering school-based psychosocial recovery intervention to children and parenting programmes at the family level [107]. Another study in Mexico integrated a life skills education programme delivered at the school-level, with a community-level youth patrol imitative [108]. In Burkina Faso, economic strengthening programmes for delivered to women at community level, which included livelihood training, savings group formations and seed-capital grants, was paired with family coaching sessions delivered at household level to family members [109].

Discussion

Our findings revealed a diversity of social interventions being used in low- and middle-income settings that, when used independently or in combination, had positive impacts on mental health outcomes. We identified a large amount of heterogeneity in the field, highlighting a diverse range of approaches to addressing social and structural determinants of poor mental health in LMIC settings. While all but four interventions identified had a primary level of delivery which we mapped across Whalbeck’s [38] categories, many also had some elements of heterogeneity: seeking to tackle numerous the social conditions linked to poor mental health in these settings. This finding is of particular relevance as it speaks to the power of social interventions in holding the complexity of people’s lives.

Our attempt to assess the effectiveness of interventions using a meta-analysis was limited by the wide heterogeneity in measures used to evaluate mental health outcomes. This finding reflects a broader challenge linked to capturing the true impact of social interventions. Heterogeneity is an expected outcome given the complexity of social landscapes targeted by these interventions. However, heterogenity of action does not negate the existence of shared conceptual principles that shape wellbeing. An absence of applying conceptual frameworks to the design and evaluation of social interventions causes challenges in measurement of impact, and points to the need for developing theory within the social intervention landscape. For example, recent work seeking to identify active ingredients in social prescribing in the UK had similar challenges in identifying a shared set of principles underpinning efficacy [110].

With better understandings of which types of social dynamics are targeted by specific interventions, studies could apply outcome measures in ways that lend themselves to generating shared understandings, and better understandings of complex impact. For example, condition specific measures of depression may capture different aspects of illness (i.e., social relationships, isolation, cognitive symptoms, physiological symptoms), but we struggle to identify which domains are engaged by approaches. By identifying the ‘active ingredients’ of social interventions such as improving social support, social relations, reducing stigma, or enhancing coping skills, repair and restoration of hope, or collective efficacy, would allow future evaluations to focus on the most relevant outcomes.

The importance of refining our object of measurement in GMH is underscored by funders who are increasingly requesting proposals that outline theories of change and suspected mechanisms that will be measured. This presents a significant challenge to those wanting to include social interventions in their work but lack the acceptable evidence to articulate their value, or impact to funders. Future research clarifying mechanisms in social intervention landscapes is crucial, and must engage with local definitions of wellbeing, and impact within such investigations. This will resist tendencies to build frameworks anchored exclusively to western perspectives of knowledge that minimise cross-cultural differences and variation. Some existing frameworks may offer good starting points to structure and evaluate social interventions more widely, without losing meaning cross-culturally. For example, Corey Keyes’ [111] well-established framework of social wellbeing identifies five domains that have been linked to a dual continuum model of mental health, which encapsulates social wellbeing and full mental health [112]: Social integration, social contribution, social actualisation, social acceptance and social adherence, which has been argued as critical to global mental health practice previously [113]. However, attempts to create frameworks of active ingredients need to be co-produced within culturally and structurally sensitive paradigms that hold complexity [33]as the true value of social interventions, lies in its ability to respond to the specific challenges of a social environment – which demands a hyper-local perspective on scale and impact, which counters current priorities.

We also note that assessing impact of social interventions was largely reliant on quantitative methods. This itself may also shape the limited clarity on the of ‘active ingredients’ within social interventions. Despite the use of wide inclusion criteria which included the use of qualitative studies, our review only identified two studies using qualitative methods to describe the impact of interventions. Developing understandings of social processes is more aligned with qualitative evaluations, which we suggest should be expanded in this field, aligning with earlier calls for Global Mental Health research evaluate the methodological relevance of the tools we use to address these dimensions [114,115].

While quantitative research design yield important insights, there are necessary considerations around context, and lived experience that these may not be able to capture. Qualitative studies will be important to inform the future of social interventions, as these can help us better articulate the why and how these interventions work. Some qualitative methods relevant to the study of social interventions include ethnographic studies, which have been highlighted for their ability to centre localised conceptualisation of (good) mental health drawing on context-specific historical, social, and political realities [1]. Overall, target communities were usually not involved in the conceptualisation and design phases of social interventions. This perhaps points to an oversight of local voices, as focus is on scalability over specificity (as is indicative in the dominance of randomised-control trial design). Participatory methods may be of significant value, particularly in their ability to include and centre community voices in the conceptualisation and design of relevant interventions.

The dominance of child- and youth-focused social interventions for mental health in our settings, reflects a strong recognition of the importance of early interventions for mental health, and a clear response to the growing burden of mental health conditions among young populations [116–118]. Schools, as structured and accessible settings, provide a natural entry point for the design and delivery of such interventions, making them both feasible and scalable [119–121]. Yet, this convenience also raises concerns about the risk of these programs becoming institutionalized “tick-box exercises” that prioritize coverage over depth, potentially undermining their effectiveness and long-term impact. Furthermore, the reliance on school-based platforms highlights a gap in reaching individuals outside the formal education systems, such as out-of-school youth, marginalized children, or those in unstable living conditions. These groups may have equal, if not greater, need for psychosocial support, yet remain harder to access and often excluded from intervention efforts. Future research and practice must therefore balance the advantages of structured delivery within schools with innovative strategies to engage populations that fall outside these systems.

Overall, our findings indicate that the levels of engagement with social interventions were flexible, and rarely neatly fit rigidly pre-determined categories. As such, social interventions observed in this review were boundary spanning, allowing movement between individual, community and society levels of action. There is an immense, and under appreciate value to the ability of these types of interventions to hold complexity and produce true ‘ecosystem’ type approaches to addressing mental health challenges. For example, the Atmiyata intervention in India offered psychosocial interventions delivered by community volunteers but equally considered the importance of opening up community-level discussions around social issues impacting mental health, such as unemployment, domestic violence, family conflict and alcoholism [69]. This recognises care not only as an individual-level offering, but as an effort to build environments that have the capacity to be caring. In Bangladesh, the intervention for maternal depression not only offered clinical care, as might often be the case for such interventions, but also provided food supplementation for children [74], recognising that much of the mental health of mothers is bound up in material demands that exist outside of the clinic. Such approaches align with recent calls within the WHO for mental health in all government sectors [122].

Our findings potentially direct us towards the value of different logics of care in mental health landscapes, which more actively acknowledges the numerous social aspects of care needed for improved mental health. Elsewhere, we have described this as the need for logics of care that centre remedy and repair; where the objective of action is to also ensure that we are working to build mental health sustaining environments [123,124]. Such logics of care demand that we expand our typical remit of engagement with social dynamics, to include action at political and structural dynamics of everyday life. The object of care would be to support others in the process of building ‘better worlds’ and ‘repairing’ the social fabrics and broken social environments that lead to the expression and development of poor mental health, rather than force complicated demands for justice to fit into psychological language which flattens need The social interventions described in this review acknowledge that mental health related repair can be achieved through action in small scale action in the social landscapes of peoples lives at the levels of individuals, communities, as well as populations..

Notwithstanding, this review has several limitations that should be considered when interpreting the findings. First, the included studies examined a wide range of outcomes and employed diverse measures. Because of this variability, we were only able to conduct a meta-analysis on depression outcomes. This restricted scope reduces the ability to capture more nuanced patterns of causation or correlation that might exist across different outcomes in individual studies. Second, the availability of data across studies was limited. Many studies did not report sufficient short-term or long-term follow-up data, making it difficult to draw firm conclusions about the sustainability of intervention effects over time. Third, although our inclusion criteria focus on studies with experimental or controlled conditions to strengthen the rigor of the synthesized evidence, this decision also reduced the number of studies that could be included in the review. As a result, potentially relevant evidence from other study designs was not captured. We also focused on a sub-set of conditions from the mhGAP (2nd version), meaning that other conditions may link to sets of other social interventions within the literature may not have been captured here. We suggest that future studies build on our findings, organising searches around the recent update of the mhGAP, launched after the start of our review, or explore alternative sub-categories of interest (for example, mental health conditions in old age, such as Dementia). Finally, our search strategy relied primarily on English-language databases and search terms. This approach may have excluded relevant studies published in languages other than English or indexed on non-English databases, which could have provided additional insights and strengthened the comprehensiveness of the review.

Conclusion

The importance of addressing social determinants in the Global Mental Health field is widely acknowledged [125]. Yet the uptake of social interventions does not align with anticipated demands. For example, the scale of social development needs in LMIC settings is immense. Across countries, many communities face challenges in access to basic social welfare needs – such as safe housing, WASH infrastructure. Access to employment opportunities remain unequally distributed. For example, many of the countries most represented in our review have high GINI-coefficients, indicating particularly high levels of income inequality [126,127]. Social interventions in these landscapes matter more than ever – as people living with mental illness are known to face multiple intersecting forms of oppression that decrease their access to social welfare supports and needs [33,37].

Our work suggests that a range of effective interventions that take seriously calls for action and attention to the unequal social worlds where mental health is lived, do exist. As such, we take Wahlbek’s [38] crucial point – that lack of evidence does not equal lack of effectiveness – as a rallying cry – to expand our focus on social interventions, with calls for further discovery research into this area.

Future work should focus on the value of social interventions such as social enterprise and employment training as embedded into mental health supports in LMIC settings, or interventions creating opportunity for social justice as this is the area we found the least evidence to date. Finally, while the list of social interventions outlined in Whalbeck’s work served as a helpful orientation for our review, and a good example of the range of social interventions available, this cannot serve as a fixed category for exploration. The power of social interventions is that they will vary depending on context. As such, rather than argue or benchmark ‘gold standard’ social intervention types in LMICs, or compare them against those developed in HICs, we urge future studies to explore and interrogate the field with diversity and curiosity as their starting point.

Social interventions are as expansive as the social worlds we live in. Opening ourselves up to these diversities and opportunities, often embedded in community -led responses to mental health challenges [128,129], remains an un-tapped opportunity for our field.

Further work in this area will illuminate the undeniable truth that efforts to improve mental health, must be inseparable from investments to strengthen the social fabrics of our lives, and are an equally valued investment for worlds where mental health for all is finally a reality.

References

  1. 1. Jain S, Orr DMR. Ethnographic perspectives on global mental health. Transcult Psychiatry. 2016;53(6):685–95. pmid:28317467
  2. 2. Summerfield D. How scientifically valid is the knowledge base of global mental health? BMJ. 2008;336(7651):992–4. pmid:18456630
  3. 3. Ingleby D. How ‘evidence-based’ is the movement for global mental health? Disabil Glob South. 2014;1(2):203–26.
  4. 4. Kleinman A. Global mental health: a failure of humanity. Lancet. 2009;374(9690):603–4. pmid:19708102
  5. 5. Patel V. Mental health in low- and middle-income countries. Br Med Bull. 2007;81–82:81–96. pmid:17470476
  6. 6. Thornicroft G. Most people with mental illness are not treated. Lancet. 2007;370(9590):807–8. pmid:17826153
  7. 7. Purgato M, Uphoff E, Singh R, Thapa Pachya A, Abdulmalik J, van Ginneken N. Promotion, prevention and treatment interventions for mental health in low- and middle-income countries through a task-shifting approach. Epidemiol Psychiatr Sci. 2020;29:e150. pmid:32744223
  8. 8. Patel V, Simon G, Chowdhary N, Kaaya S, Araya R. Packages of care for depression in low- and middle-income countries. PLoS Med. 2009;6(10):e1000159. pmid:19806179
  9. 9. Benegal V, Chand PK, Obot IS. Packages of care for alcohol use disorders in low- and middle-income countries. PLoS Med. 2009;6(10):e1000170. pmid:19859536
  10. 10. Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, et al. Community-based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence. World Psychiatry. 2022;21(1):96–123. pmid:35015358
  11. 11. de Jesus MJ, Razzouk D, Thara R, Eaton J, Thornicroft G. Packages of care for schizophrenia in low- and middle-income countries. PLoS Med. 2009;6(10):e1000165. pmid:19841735
  12. 12. Galvin M, Byansi W. A systematic review of task shifting for mental health in sub-Saharan Africa. Int J Ment Health. 2020;49(4):336–60.
  13. 13. Chibanda D, Verhey R, Munetsi E, Rusakaniko S, Cowan F, Lund C. Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe. Glob Ment Health (Camb). 2016;3:e13. pmid:28596882
  14. 14. Maddock A, Blair C, Ean N, Best P. Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review. Int J Ment Health Syst. 2021;15(1):56. pmid:34090491
  15. 15. Buttorff C, Hock RS, Weiss HA, Naik S, Araya R, Kirkwood BR, et al. Economic evaluation of a task-shifting intervention for common mental disorders in India. Bull World Health Organ. 2012;90(11):813–21. pmid:23226893
  16. 16. Michelson D, Malik K, Parikh R, Weiss HA, Doyle AM, Bhat B, et al. Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial. Lancet Child Adolesc Health. 2020;4(8):571–82. pmid:32585185
  17. 17. Agrest M, Le PD, Yang LH, Mascayano F, Alves-Nishioka S, Dev S, et al. Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users. Int J Soc Psychiatry. 2019;65(1):38–45. pmid:30791796
  18. 18. Minoletti A, Galea S, Susser E. Community mental health services in Latin America for people with severe mental disorders. Public Health Rev. 2012;34(2):1. pmid:25339792
  19. 19. Roberts T, Miguel Esponda G, Torre C, Pillai P, Cohen A, Burgess RA. Reconceptualising the treatment gap for common mental disorders: a fork in the road for global mental health? Br J Psychiatry. 2022;221(3):553–7. pmid:35137680
  20. 20. Burgess RA, Jain S, Petersen I, Lund C. Social interventions: a new era for global mental health? Lancet Psychiatry. 2020;7(2):118–9. pmid:31653556
  21. 21. Johnson S. Social interventions in mental health: a call to action; 2017.
    • 22. McGuire J, Kaiser C, Bach-Mortensen AM. A systematic review and meta-analysis of the impact of cash transfers on subjective well-being and mental health in low- and middle-income countries. Nat Hum Behav. 2022;6(3):359–70. pmid:35058643
    • 23. Plagerson S, Patel V, Harpham T, Kielmann K, Mathee A. Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa. Glob Public Health. 2011;6(7):760–76. pmid:20938853
    • 24. Ssewamala FM, Nabunya P, Ilic V, Mukasa MN, Ddamulira C. Relationship between family economic resources, psychosocial well-being, and educational preferences of AIDS-orphaned children in southern Uganda: baseline findings. Glob Soc Welf. 2015;2(2):75–86.
    • 25. Ssewamala FM, Karimli L, Torsten N, Wang JSH, Han CK, Ilic V. Applying a family-level economic strengthening intervention to improve education and health-related outcomes of school-going AIDS-orphaned children: Lessons from a randomized experiment in southern Uganda. Prev Sci. 2016;17(1):134–43.
    • 26. Mann F, Bone JK, Lloyd-Evans B, Frerichs J, Pinfold V, Ma R, et al. A life less lonely: the state of the art in interventions to reduce loneliness in people with mental health problems; 2017.
      • 27. Cacioppo S, Grippo AJ, London S, Goossens L, Cacioppo JT. Loneliness: clinical import and interventions. Perspect Psychol Sci. 2015;10(2):238–49. pmid:25866548
      • 28. Siette J, Cassidy M, Priebe S. Effectiveness of befriending interventions: a systematic review and meta-analysis. BMJ Open. 2017;7(4):e014304. pmid:28446525
      • 29. McGowan B, Jowett C. Promoting positive mental health through befriending. Int J Ment Health Promot. 2003;5(2):12–24.
      • 30. Chinman M, George P, Dougherty RH, Daniels AS, Ghose SS, Swift A, et al. Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv. 2014;65(4):429–41. pmid:24549400
      • 31. Patterson J, Barlow J, Mockford C, Klimes I, Pyper C, Stewart-Brown S. Improving mental health through parenting programmes: block randomised controlled trial. Arch Dis Child. 2002;87(6):472–7. pmid:12456542
      • 32. Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health. 2011;20(4):392–411. pmid:21770786
      • 33. Burgess RA, Chobhthaigh SN, Biswal B, Ceccolini D, Fadipe B, Khan D. Intersectional discrimination, exclusion and the socio-political economy of global mental health: a systematic scoping review of the literature. SSM - Ment Health. 2025;7:100382.
      • 34. Bemme D, Béhague D. Theorising the social in mental health research and action: a call for more inclusivity and accountability. Soc Psychiatry Psychiatr Epidemiol. 2024;59(3):403–8. pmid:38407626
      • 35. Jenkins R, Baingana F, Ahmad R, McDaid D, Atun R. Social, economic, human rights and political challenges to global mental health. Ment Health Fam Med. 2011;8(2):87–96. pmid:22654971
      • 36. Fendt-Newlin M, Jagannathan A, Webber M. Cultural adaptation framework of social interventions in mental health: evidence-based case studies from low- and middle-income countries. Int J Soc Psychiatry. 2019;66(1):41–8.
      • 37. Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry. 2018;5(4):357–69. pmid:29580610
      • 38. Wahlbeck K, Cresswell-Smith J, Haaramo P, Parkkonen J. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol. 2017;52(5):505–14. pmid:28280872
      • 39. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. pmid:19622551
      • 40. Polanin JR, Pigott TD, Espelage DL, Grotpeter JK. Best practice guidelines for abstract screening large‐evidence systematic reviews and meta‐analyses. Res Synth Methods. 2019;10(3):330–42.
      • 41. Hinde S, Spackman E. Bidirectional citation searching to completion: an exploration of literature searching methods. Pharmacoeconomics. 2015;33(1):5–11. pmid:25145803
      • 42. World Health Organisation (WHO). World mental health report: transforming mental health for all [Internet]. World Health Organisation (WHO); 2022 [cited 2025 Jul 14]. Available from: https://www.who.int/publications/i/item/9789240049338
        • 43. Burgess R, Jain S, Petersen I, Lund C. Social interventions: a new era for global mental health? Lancet Psychiatry. 2020;7(2).
        • 44. Porritt K, Gomersall J, Lockwood C. JBI’s systematic reviews: study selection and critical appraisal. Am J Nurs. 2014;114(6):47–52. pmid:24869584
        • 45. Hedges LV, Tipton E. Meta-analysis. In: Steptoe A, editor. Handbook of behavioral medicine: methods and applications [Internet]. New York (NY): Springer; 2010 [cited 2025 Oct 5]. p. 909–21. Available from:
        • 46. Melendez-Torres GJ. Next-generation meta-analysis for next-generation questions: Introducing the prevention science special issue on modern meta-analytic methods. Prev Sci. 2022;23(3):467–71.
        • 47. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 2013. 567 p.
        • 48. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206. pmid:16784338
        • 49. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. pmid:12958120
        • 50. Bella-Awusah T, Ani C, Ajuwon A, Omigbodun O. Effectiveness of brief school-based, group cognitive behavioural therapy for depressed adolescents in south west Nigeria. Child Adolesc Ment Health. 2016;21(1):44–50. pmid:32680363
        • 51. Unterhitzenberger J, Rosner R. Lessons from writing sessions: a school-based randomized trial with adolescent orphans in Rwanda. Eur J Psychotraumatol. 2014;5:24917. pmid:25537814
        • 52. Baumgartner JN, Mohammed A, Gallis JA, Lillie M, Owusu R, Abubakr-Bibilazu S, et al. Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial | Cambridge Prisms: Global Mental Health | Cambridge Core. Glob Ment Health [Internet]. 2021 [cited 2025 Sep 11];8. Available from: https://www.cambridge.org/core/journals/global-mental-health/article/effect-of-a-lay-counselordelivered-integrated-maternal-mental-health-and-early-childhood-development-groupbased-intervention-in-northern-ghana-a-clusterrandomized-controlled-trial/224AD03417FFC432716A0358372EB12C
        • 53. Gureje O, Oladeji BD, Kola L, Bello T, Ayinde O, Faregh N, et al. Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): a cluster randomized controlled trial. J Affect Disord. 2022;312:169–76. pmid:35752215
        • 54. Jiang Q, Dill S-E, Sylvia S, Singh MK, She X, Wang E, et al. Parenting centers and caregiver mental health: evidence from a large-scale randomized controlled trial in China. Child Dev. 2022;93(5):1559–73. pmid:35481708
        • 55. Bass J, Murray SM, Mohammed TA, Bunn M, Gorman W, Ahmed AMA, et al. A Randomized controlled trial of a trauma-informed support, skills, and psychoeducation intervention for survivors of torture and related trauma in Kurdistan, Northern Iraq. Glob Health Sci Pract. 2016;4(3):452–66. pmid:27609624
        • 56. Cikuru J, Bitenga A, Balegamire JBM, Salama PM, Hood MM, Mukherjee B, et al. Impact of the Healing in Harmony program on women’s mental health in a rural area in South Kivu province, Democratic Republic of Congo. Glob Ment Health (Camb). 2021;8:e13. pmid:34026242
        • 57. Dias A, Azariah F, Anderson SJ, Sequeira M, Cohen A, Morse JQ, et al. Effect of a lay counselor intervention on prevention of major depression in older adults living in low- and middle-income countries. JAMA Psychiatry. 2019;76(1):13.
        • 58. Ssewamala FM, Neilands TB, Waldfogel J, Ismayilova L. The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda. J Adolesc Health. 2012;50(4):346–52. pmid:22443837
        • 59. Han C-K, Ssewamala FM, Wang JS-H. Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: evidence from a randomised evaluation in southwestern Uganda. J Epidemiol Community Health. 2013;67(3):225–30. pmid:23410851
        • 60. Karimli L, Ssewamala FM, Neilands TB, Wells CR, Bermudez LG. Poverty, economic strengthening, and mental health among AIDS orphaned children in Uganda: mediation model in a randomized clinical trial. Soc Sci Med. 2019;228:17–24. pmid:30870668
        • 61. Cavazos-Rehg P, Byansi W, Xu C, Nabunya P, Sensoy Bahar O, Borodovsky J. The impact of a family-based economic intervention on the mental health of HIV-infected adolescents in Uganda: results from Suubi + Adherence. J Adolesc Health. 2021;68(4):742–9.
        • 62. Byansi W, Ssewamala FM, Neilands TB, Sensoy Bahar O, Nabunya P, Namuwonge F, et al. The short-term impact of a combination intervention on depressive symptoms among school-going adolescent girls in southwestern Uganda: the Suubi4Her cluster randomized trial. J Adolesc Health. 2022;71(3):301–7. pmid:35660128
        • 63. Peele M, Wolf S. Predictors of anxiety and depressive symptoms among teachers in Ghana: evidence from a randomized controlled trial. Soc Sci Med. 2020;253:112957. pmid:32251932
        • 64. Burmaster KB, Landefeld JC, Rehkopf DH, Lahiff M, Sokal-Gutierrez K, Adler-Milstein S. Impact of a private sector living wage intervention on depressive symptoms among apparel workers in the Dominican Republic: a quasi-experimental study [Internet]. 2015.
        • 65. Axinn WG, Choi KW, Ghimire DJ, Cole F, Hermosilla S, Benjet C, et al. Community-level social support infrastructure and adult onset of major depressive disorder in a South Asian postconflict setting. JAMA Psychiatry. 2022;79(3):243–9. pmid:35080609
        • 66. Maselko J, Sikander S, Turner EL, Bates LM, Ahmad I, Atif N, et al. Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan. Lancet Psychiatry. 2020;7(9):775–87. pmid:32828167
        • 67. Esmaeilzadeh S, Oz F. Effect of psychosocial care model applied in an “elderly day care center” on loneliness, depression, quality of life, and elderly attitude. Niger J Clin Pract. 2020;23(2):189.
        • 68. Miller K, Koppenol-Gonzalez G, Jawad A, Steen F, Sassine M, Jordans MJD. A randomised controlled trial of the I-deal life skills intervention with syrian refugee adolescents in Northern Lebanon. Intervention. 2020;18(2):119.
        • 69. Pathare S, Joag K, Kalha J, Pandit D, Krishnamoorthy S, Chauhan A, et al. Atmiyata, A community led psychosocial intervention in reducing symptoms associated with common mental disorders: a stepped wedge cluster randomized controlled trial in Rural Gujarat, India [SSRN Scholarly Paper] [Internet]. Rochester (NY): Social Science Research Network; 2020 [cited 2025 Oct 23]. Available from: https://papers.ssrn.com/abstract=3546059
          • 70. Broström S, Johansson BA, Verhey R, Landgren K. “Seeing a brighter future” - experiences of adolescents with common mental disorders receiving the problem-solving therapy “youth Friendship Bench” In Zimbabwe. Issues Ment Health Nurs. 2021;42(11):1019–29. pmid:34048312
          • 71. Kachingwe M, Chikowe I, van der Haar L, Dzabala N. Assessing the impact of an intervention project by the young women’s christian association of Malawi on psychosocial well-being of adolescent mothers and their children in Malawi. Front Public Health. 2021;9:585517. pmid:33842417
          • 72. Goodman ML, Elliott AJ, Gitari S, Keiser P, Onwuegbuchu E, Michael N, et al. Come Together to Decrease Depression: women’s mental health, social capital, and participation in a Kenyan combined microfinance program. Int J Soc Psychiatry. 2020;67(6):613–21.
          • 73. James LE, Welton-Mitchell C, Noel JR, James AS. Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti. Psychol Med. 2020;50(2):342–52. pmid:30782236
          • 74. Nahar B, Hossain I, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson L-A. Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh. Child Care Health Dev. 2015;41(3):483–93. pmid:25040164
          • 75. Vanobberghen F, Weiss HA, Fuhr DC, Sikander S, Afonso E, Ahmad I, et al. Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: pooled analysis of two randomized controlled trials in India and Pakistan. J Affect Disord. 2020;265:660–8. pmid:32090783
          • 76. Scazufca M, Nakamura CA, Seward N, Moreno-Agostino D, van de Ven P, Hollingworth W, et al. A task-shared, collaborative care psychosocial intervention for improving depressive symptomatology among older adults in a socioeconomically deprived area of Brazil (PROACTIVE): a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial. Lancet Healthy Longev. 2022;3(10):e690–702. pmid:36202129
          • 77. Puspitosari WA, Wardaningsih S, Nanwani S. Improving the quality of life of people with schizophrenia through community based rehabilitation in Yogyakarta Province, Indonesia: a quasi experimental study. Asian J Psychiatr. 2019;42:67–73. pmid:30974306
          • 78. Nakku JEM, Nalwadda O, Garman E, Honikman S, Hanlon C, Kigozi F, et al. Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study. BMC Pregnancy Childbirth. 2021;21(1):584. pmid:34429087
          • 79. Nakimuli-Mpungu E, Kwesiga JM, Bwanika JM, Musinguzi D, Nakanyike C, Iya J, et al. Developing and testing tele-support psychotherapy through mobile phones for youth (15–30 years) with depression in Uganda. In: Psychotherapy in the third millennium - cross-cutting themes and proposals for reflection. IntechOpen; 2025 [cited 2025 Jul 3] Available from:
          • 80. do Carmo DA, Palma SMM, Ribeiro A, Trevizol AP, Brietzke E, Abdalla RR, et al. Preliminary results from Brazil’s first recovery housing program. Trends Psychiatry Psychother. 2018;40(4):285–91. pmid:30570100
          • 81. Padmakar A, de Wit EE, Mary S, Regeer E, Bunders-Aelen J, Regeer B. Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: learning from an innovative de-hospitalization process. PLoS One. 2020;15(4):e0230074. pmid:32271784
          • 82. Jamshidi F, Shayan A, Forouhari S, Taherkhani H, Seyedi M. The effect of community re-entry program (CRP) on social function of patients with chronic mental disorders. Acta Med Mediterr. 2016;32.
          • 83. Peltonen K, Qouta S, El Sarraj E, Punamäki R-L. Effectiveness of school-based intervention in enhancing mental health and social functioning among war-affected children. Traumatology. 2012;18(4):37–46.
          • 84. Tol WA, Komproe IH, Jordans MJD, Vallipuram A, Sipsma H, Sivayokan S, et al. Outcomes and moderators of a preventive school-based mental health intervention for children affected by war in Sri Lanka: a cluster randomized trial. World Psychiatry. 2012;11(2):114–22. pmid:22654944
          • 85. Dhital R, Shibanuma A, Miyaguchi M, Kiriya J, Jimba M. Effect of psycho-social support by teachers on improving mental health and hope of adolescents in an earthquake-affected district in Nepal: a cluster randomized controlled trial. PLoS One. 2019;14(10):e0223046. pmid:31574127
          • 86. Qouta SR, Palosaari E, Diab M, Punamäki R-L. Intervention effectiveness among war-affected children: a cluster randomized controlled trial on improving mental health. J Trauma Stress. 2012;25(3):288–98. pmid:22648703
          • 87. Tol WA, Komproe IH, Jordans MJD, Ndayisaba A, Ntamutumba P, Sipsma H, et al. School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial. BMC Med. 2014;12:56. pmid:24690470
          • 88. Sanchez ZM, Valente JY, Galvão PP, Gubert FA, Melo MHS, Caetano SC, et al. A cluster randomized controlled trial evaluating the effectiveness of the school-based drug prevention program #Tamojunto2.0. Addiction. 2021;116(6):1580–92. pmid:33245788
          • 89. Sanchez ZM, Valente JY, Sanudo A, Pereira APD, Cruz JI, Schneider D. The #Tamojunto drug prevention program in Brazilian schools: a randomized controlled trial. Prev Sci. 2017;18(7):772–82.
          • 90. Berger R, Benatov J, Cuadros R, VanNattan J, Gelkopf M. Enhancing resiliency and promoting prosocial behavior among Tanzanian primary-school students: a school-based intervention. Transcult Psychiatry. 2018;55(6):821–45. pmid:30091688
          • 91. Singla DR, Shinde S, Patton G, Patel V. The mediating effect of school climate on adolescent mental health: findings from a randomized controlled trial of a school-wide intervention. J Adolesc Health. 2021;69(1):90–9. pmid:33127241
          • 92. Dang HM, Weiss B, Nguyen CM, Tran N, Pollack A. Vietnam as a case example of school-based mental health services in low and middle income countries: efficacy and effects of risk status. Sch Psychol Int. 2017;38(1):22–41.
          • 93. Olowokere AE, Okanlawon FA. The effects of a school-based psychosocial intervention on resilience and health outcomes among vulnerable children. J Sch Nurs. 2014;30(3):206–15. pmid:23962976
          • 94. Kulis SS, Marsiglia FF, Porta M, Arévalo Avalos MR, Ayers SL. Testing the keepin’ it REAL substance use prevention curriculum among early adolescents in Guatemala City. Prev Sci. 2019;20(4):532–43.
          • 95. Green EP, Blattman C, Jamison J, Annan J. Does poverty alleviation decrease depression symptoms in post-conflict settings? A cluster-randomized trial of microenterprise assistance in Northern Uganda. Glob Ment Health (Camb). 2016;3:e7. pmid:28596876
          • 96. Falb KL, Blackwell AH, Stennes J, Annan J. Cash assistance programming and changes over time in ability to meet basic needs, food insecurity and depressive symptoms in Raqqa Governorate, Syria: evidence from a mixed methods, pre-posttest. PLoS One. 2020;15(5):e0232588. pmid:32379836
          • 97. Prencipe L, Houweling TAJ, van Lenthe FJ, Palermo T. Do conditional cash transfers improve mental health? Evidence from Tanzania’s governmental social protection program. J Adolesc Health. 2021;69(5):797–805.
          • 98. Bliznashka L, Yousafzai AK, Asheri G, Masanja H, Sudfeld CR. Effects of a community health worker delivered intervention on maternal depressive symptoms in rural Tanzania. Health Policy Plan. 2021;36(4):473–83. pmid:33313814
          • 99. Prencipe L, Houweling TAJ, van Lenthe FJ, Kajula L, Palermo T. Effects of adolescent-focused integrated social protection on depression: a pragmatic cluster-randomized controlled trial of Tanzania’s Cash Plus intervention. Am J Epidemiol. 2022;191(9):1601–13.
          • 100. Haushofer J, Chemin M, Jang C, Abraham J. Economic and psychological effects of health insurance and cash transfers: evidence from a randomized experiment in Kenya. J Dev Econ. 2020;144:102416.
          • 101. Machado DB, Williamson E, Pescarini JM, Alves FJ, Castro-de-Araujo LFSC, Ichihara MY, et al. Relationship between the Bolsa Família national cash transfer programme and suicide incidence in Brazil: a quasi-experimental study. PLoS Med [Internet]. 2022 [cited 2025 Oct 23];19(5). Available from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004000
          • 102. Powell-Jackson T, Pereira SK, Dutt V, Tougher S, Haldar K, Kumar P. Cash transfers, maternal depression and emotional well-being: Quasi-experimental evidence from India’s Janani Suraksha Yojana programme. Soc Sci Med. 2016;162:210–8. pmid:27387651
          • 103. Sahoo P, Singh MK, Pathak DC. Poverty changes among regions of Uttar Pradesh: a decomposition exercise during the 2000s. Indian Econ J [Internet]. 2023 [cited 2025 Oct 23];72(1). Available from: https://journals.sagepub.com/doi/full/10.1177/00194662231203455
          • 104. Angeles G, de Hoop J, Handa S, Kilburn K, Milazzo A, Peterman A, et al. Government of Malawi’s unconditional cash transfer improves youth mental health. Soc Sci Med. 2019;225:108–19. pmid:30826585
          • 105. Shangani S, Operario D, Genberg B, Kirwa K, Midoun M, Atwoli L, et al. Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing? PLoS One. 2017;12(5):e0178076. pmid:28562627
          • 106. Amador Buenabad NG, Sánchez Ramos R, Schwartz S, Gutiérrez López ML, Díaz Juárez AD, Ortiz Gallegos AB, et al. Cluster randomized trial of a multicomponent school-based program in Mexico to prevent behavioral problems and develop social skills in children. Child Youth Care Forum. 2019;49(3):343–64.
          • 107. El-Khani A, Cartwright K, Maalouf W, Haar K, Zehra N, Çokamay-Yılmaz G, et al. Enhancing teaching recovery techniques (TRT) with parenting skills: RCT of TRT + parenting with trauma-affected syrian refugees in lebanon utilising remote training with implications for insecure contexts and COVID-19. Int J Environ Res Public Health. 2021;18(16):8652. pmid:34444403
          • 108. Arenas-Monreal L, Hidalgo-Solórzano E, Chong-Escudero X, Durán-De la Cruz JA, González-Cruz NL, Pérez-Matus S, et al. Suicidal behaviour in adolescents: educational interventions in Mexico. Health Soc Care Community. 2022;30(3):998–1005. pmid:33675567
          • 109. Ismayilova L, Karimli L, Sanson J, Gaveras E, Nanema R, Tô-Camier A, et al. Improving mental health among ultra-poor children: two-year outcomes of a cluster-randomized trial in Burkina Faso. Soc Sci Med. 2018;208:180–9. pmid:29743136
          • 110. Cooper M, Avery L, Scott J, Ashley K, Jordan C, Errington L, et al. Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review [Internet]; 2022.
          • 111. Keyes CLM. Social well-being. Soc Psychol Q. 1998;61(2):121–40.
          • 112. Ryff CD. Psychological well-being revisited: advances in the science and practice of eudaimonia. Psychother Psychosom. 2014;83(1):10–28. pmid:24281296
          • 113. Burgess R. Supporting ‘community’ in an era of global mental health: a case study of an HIV-affected South African community; LSE thesis online: https://researchonline.lse.ac.uk/id/eprint/131834/. 2013.
            • 114. Kirmayer LJ. Cultural competence and evidence-based practice in mental health: epistemic communities and the politics of pluralism. Soc Sci Med. 2012;75(2):249–56. pmid:22575699
            • 115. Bemme D, Kirmayer LJ. Global mental health: interdisciplinary challenges for a field in motion. Transcult Psychiatry. 2020;57(1):3–18. pmid:32106797
            • 116. Erskine HE, Moffitt TE, Copeland WE, Costello EJ, Ferrari AJ, Patton G, et al. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med. 2015;45(7):1551–63. pmid:25534496
            • 117. Benton TD, Boyd RC, Njoroge WFM. Addressing the global crisis of child and adolescent mental health. JAMA Pediatr. 2021;175(11):1108–10.
            • 118. McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore S-J, Browne V, et al. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry. 2024;11(9):731–74. pmid:39147461
            • 119. Ma KKY, Anderson JK, Burn A-M. Review: School-based interventions to improve mental health literacy and reduce mental health stigma - a systematic review. Child Adolesc Ment Health. 2023;28(2):230–40. pmid:35005830
            • 120. Pulimeno M, Piscitelli P, Colazzo S, Colao A, Miani A. School as ideal setting to promote health and wellbeing among young people. Health Promot Perspect. 2020;10(4):316–24. pmid:33312927
            • 121. Cunningham E, Raman S, Taylor A, Svirydzenka N, Siddiqi AM, Abdinasir K, et al. Supporting the mental health of young people from ethnically diverse groups during the transition from primary to secondary school. Health Educ J [Internet]. 2024 [cited 2025 Oct 5];83(5). Available from: https://journals.sagepub.com/doi/full/10.1177/00178969241249833
            • 122. WHO. Guidance on policy and strategic actions to protect and promote mental health and well-being across government sectors [Internet]; 2025 [cited 2026 Apr 21]. Available from: https://www.who.int/publications/i/item/9789240114388
            • 123. Ionescu A. Resistance in the everyday: an ethnographic study of mental health activism in Uganda [Doctoral] [Internet]. UCL (University College London); 2025 [cited 2026 Apr 21]. Available from: https://discovery.ucl.ac.uk/id/eprint/10216461/
              • 124. Burgess RA. The struggle for the social: rejecting the false separation of “social” worlds in mental health spaces. Soc Psychiatry Psychiatr Epidemiol. 2024;59(3):409–16. pmid:37400665
              • 125. Rose-Clarke K, Gurung D, Brooke-Sumner C, Burgess R, Burns J, Kakuma R, et al. Rethinking research on the social determinants of global mental health. 2020. Lancet Psychiatry. 7(8) 659–662.
              • 126. Dagum C. A new approach to the decomposition of the Gini income inequality ratio. Empir Econ. 1997;22(4):515–31.
              • 127. Charles V, Gherman T, Paliza JC. The Gini index: a modern measure of inequality. In: Charles V, Emrouznejad A, editors. Modern indices for international economic diplomacy. Cham: Palgrave Macmilan; 2022. p. 55–84.
              • 128. Burgess RA, Nwaka C, Larrieta J, Biriotti M, Kydd A. Community-led visions of care for better mental health. Lancet Psychiatry. 2026;13(7):542–3. pmid:41839197
              • 129. Yoder-Maina A. Healing is what makes peace work: a healing-centered peacebuilding approach, Vol. 39 [Internet]. Cham: Springer International Publishing; 2022 [cited 2026 Apr 21]. (SpringerBriefs in Environment, Security, Development and Peace). Available from: https://link.springer.com/10.1007/978-3-031-05251-4