Mental health and psychosocial support interventions for individuals affected by gender-based violence in fragile contexts: A systematic review.

Abstract

Gender-based violence (GBV) is a global public health crisis exacerbated in fragile settings by gender inequalities, displacement, and resource scarcity. While mental health and psychosocial support (MHPSS) interventions aim to support people with experience of GBV, research on their effectiveness across diverse fragile contexts remains limited. In this review, we answer the following questions: (1) What type(s) of MHPSS interventions are commonly implemented with survivors of GBV in humanitarian/fragile settings? (2) What outcome(s) are targeted by MHPSS interventions implemented for those exposed to GBV in fragile settings? (3) What is the reported effectiveness of these interventions in addressing these specified outcomes? Seven electronic databases (PubMed, PsycINFO, Cochrane, CINAHL, ERIC, ProQuest, and Web of Science) and grey literature were searched for studies published up to July 2024. Following screening of 2,268 titles and abstracts, 157 full texts were screened (20% independently), with included studies analysed using narrative synthesis. Quality of studies was assessed using the Quality Assessment with Diverse Studies (QuADS). Forty-seven studies are included in this review. MHPSS interventions addressed four broad categories of outcomes: mental health, incidences of GBV, social and community outcomes, and women's economic empowerment. MHPSS interventions for GBV survivors in fragile settings show promising mental health benefits, with the highest quality evidence found for cognitive behavioural therapy-based approaches in reducing post-traumatic stress, depression, and anxiety. Economic and psychosocial empowerment interventions also led to reduced incidences of intimate partner violence, enhanced financial autonomy, and shifts in social norms, though some interventions yielded mixed or non-significant effects. While many MHPSS interventions for people who had experienced GBV led to meaningful improvements in mental health, GBV reduction and economic empowerment, variability in effectiveness highlights the need for culturally adapted, context-specific approaches and further research on long-term effects in fragile settings.