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Abstract：
BACKGROUND: Depression among young people is a global health problem due to its rising prevalence and negative physical and social outcomes. The prevalence of depression and the treatment gap among young people in Sub-Saharan Africa (SSA) is higher than global estimates. Most psychosocial interventions for adolescent and youth depression were developed in high-income countries and less is known about their effectiveness in SSA. Due to contextual differences, findings from High-Income Countries (HICs) are less applicable to SSA. Yet, no systematic review of psychosocial interventions for depression among young people in SSA has been conducted.
METHODS: A systematic literature search of four databases (Medline, Web of Science, PsycInfo, and Cochrane library) was conducted. Experimental studies published before May 2024 that evaluated the effect of psychosocial interventions on depressive symptoms among young people (aged 10-24 years) in SSA were included in the systematic review. Effect sizes (Hedge\'s g (g)) indicating differences between intervention and control groups were calculated using a random effects model.
RESULTS: Twenty-two eligible studies were identified for the systematic review, of which eighteen randomized control trials (RCTs) involving 2338 participants were included in the meta-analysis. The findings revealed that psychosocial interventions significantly reduced depressive symptoms (g = -1.55, 95% CI -2.48, -0.63), although heterogeneity was high (I2 = 98.8%). Subgroup analysis revealed that efficacy differed significantly by intervention type, with Cognitive Behavioural Therapy (9 studies) showing the strongest effect (g = -2.84, 95% CI -4.29; -1.38). While Wise Interventions (a form of positive psychology interventions; 2 studies) had a moderate effect (g = -0.46, 95% C.I -0.53, -0.39), Interpersonal Psychotherapy (2 studies; g = -0.08, 95% CI -1.05, 0.88) and Creative Psychological Interventions (3 studies; g = -0.29, 95% CI -1.38, 0.79) showed smaller, non-significant effects. Sensitivity analysis excluding studies at high risk of bias strengthened the effect size. Few studies assessed factors affecting intervention efficacy and showed mixed effects of age, gender, and adherence levels.
CONCLUSIONS: Psychosocial interventions, particularly CBT, significantly reduced depressive symptoms among young people in SSA. However, it is crucial to acknowledge the high heterogeneity which likely stems from variations in study populations and intervention delivery modalities. This highlights the need for further research to identify the specific intervention components and delivery methods that work best for distinct subpopulations. Future research should also explore how long intervention effects are maintained and factors affecting efficacy.
METHODS: A systematic literature search of four databases (Medline, Web of Science, PsycInfo, and Cochrane library) was conducted. Experimental studies published before May 2024 that evaluated the effect of psychosocial interventions on depressive symptoms among young people (aged 10-24 years) in SSA were included in the systematic review. Effect sizes (Hedge\'s g (g)) indicating differences between intervention and control groups were calculated using a random effects model.
RESULTS: Twenty-two eligible studies were identified for the systematic review, of which eighteen randomized control trials (RCTs) involving 2338 participants were included in the meta-analysis. The findings revealed that psychosocial interventions significantly reduced depressive symptoms (g = -1.55, 95% CI -2.48, -0.63), although heterogeneity was high (I2 = 98.8%). Subgroup analysis revealed that efficacy differed significantly by intervention type, with Cognitive Behavioural Therapy (9 studies) showing the strongest effect (g = -2.84, 95% CI -4.29; -1.38). While Wise Interventions (a form of positive psychology interventions; 2 studies) had a moderate effect (g = -0.46, 95% C.I -0.53, -0.39), Interpersonal Psychotherapy (2 studies; g = -0.08, 95% CI -1.05, 0.88) and Creative Psychological Interventions (3 studies; g = -0.29, 95% CI -1.38, 0.79) showed smaller, non-significant effects. Sensitivity analysis excluding studies at high risk of bias strengthened the effect size. Few studies assessed factors affecting intervention efficacy and showed mixed effects of age, gender, and adherence levels.
CONCLUSIONS: Psychosocial interventions, particularly CBT, significantly reduced depressive symptoms among young people in SSA. However, it is crucial to acknowledge the high heterogeneity which likely stems from variations in study populations and intervention delivery modalities. This highlights the need for further research to identify the specific intervention components and delivery methods that work best for distinct subpopulations. Future research should also explore how long intervention effects are maintained and factors affecting efficacy.
摘要：
背景：年轻人中的抑郁症是一个全球性的健康问题，由于其患病率上升以及负面的身体和社会后果。撒哈拉以南非洲（SSA）年轻人的抑郁症患病率和治疗差距高于全球估计。大多数针对青少年和青年抑郁症的心理社会干预措施都是在高收入国家开发的，而对其在SSA中的有效性知之甚少。由于上下文的差异，来自高收入国家(HIC)的调查结果不太适用于SSA。然而，尚未对SSA年轻人抑郁症的社会心理干预进行系统评价.
方法：对四个数据库进行系统的文献检索(Medline，WebofScience,PsycInfo,和Cochrane图书馆)进行。2024年5月之前发表的实验研究评估了心理社会干预对SSA年轻人（10-24岁）抑郁症状的影响。使用随机效应模型计算表明干预组和对照组之间差异的效应大小(Hedge/sg(g))。
结果：为系统评价确定了22项符合条件的研究，其中包含2338名参与者的18项随机对照试验(RCT)被纳入荟萃分析.研究结果表明，心理社会干预显着降低了抑郁症状（g=-1.55，95％CI-2.48，-0.63），尽管异质性很高（I2=98.8％）。亚组分析显示，疗效因干预类型而异，认知行为疗法（9项研究）显示出最强的效果（g=-2.84，95%CI-4.29；-1.38）。而明智的干预（一种积极心理学干预；2项研究）具有中等效果（g=-0.46，95％C.I-0.53，-0.39），人际心理治疗(2项研究;g=-0.08,95%CI-1.05,0.88)和创造性心理干预(3项研究;g=-0.29,95%CI-1.38,0.79)显示较小,不显著的影响。排除高偏倚风险研究的敏感性分析增强了效应大小。很少有研究评估影响干预效果的因素，并显示年龄的混合效应，性别,和坚持水平。
结论：心理社会干预，尤其是CBT,显着减少SSA年轻人的抑郁症状。然而,必须承认高度异质性,这可能源于研究人群和干预实施方式的差异.这突出了需要进一步研究，以确定对不同亚群最有效的具体干预成分和递送方法。未来的研究还应探讨干预效果维持多长时间以及影响疗效的因素。
方法：对四个数据库进行系统的文献检索(Medline，WebofScience,PsycInfo,和Cochrane图书馆)进行。2024年5月之前发表的实验研究评估了心理社会干预对SSA年轻人（10-24岁）抑郁症状的影响。使用随机效应模型计算表明干预组和对照组之间差异的效应大小(Hedge/sg(g))。
结果：为系统评价确定了22项符合条件的研究，其中包含2338名参与者的18项随机对照试验(RCT)被纳入荟萃分析.研究结果表明，心理社会干预显着降低了抑郁症状（g=-1.55，95％CI-2.48，-0.63），尽管异质性很高（I2=98.8％）。亚组分析显示，疗效因干预类型而异，认知行为疗法（9项研究）显示出最强的效果（g=-2.84，95%CI-4.29；-1.38）。而明智的干预（一种积极心理学干预；2项研究）具有中等效果（g=-0.46，95％C.I-0.53，-0.39），人际心理治疗(2项研究;g=-0.08,95%CI-1.05,0.88)和创造性心理干预(3项研究;g=-0.29,95%CI-1.38,0.79)显示较小,不显著的影响。排除高偏倚风险研究的敏感性分析增强了效应大小。很少有研究评估影响干预效果的因素，并显示年龄的混合效应，性别,和坚持水平。
结论：心理社会干预，尤其是CBT,显着减少SSA年轻人的抑郁症状。然而,必须承认高度异质性,这可能源于研究人群和干预实施方式的差异.这突出了需要进一步研究，以确定对不同亚群最有效的具体干预成分和递送方法。未来的研究还应探讨干预效果维持多长时间以及影响疗效的因素。
