A systematic review of the mental health impacts of sport and physical activity programmes for adolescents in post conflict settings
Children and adolescents exposed to violent conflict are at high risk of developing mental health problems. Sport and physical activity is increasingly incorporated in post conflict assistance for young people. Implementing agencies make a broad array of health claims for which there is currently a fragmented evidence base. The purpose of this review was to summarise the impact evidence for sport and physical activity based programmes on the mental health of adolescents in post conflict settings, and highlight the limitations of current practice. A systematic review of 12 electronic databases, 12 journals and leading humanitarian websites was conducted in August 2014. Studies were eligible for inclusion if they described a sports or physical activity based intervention for adolescents between the ages of 12 19 in a post conflict setting. A total of 11,722 publications were initially identified, of which 3 met the inclusion criteria and were included in a narrative synthesis. Two studies described projects in northern Uganda; one reported a decline in intervention in boys' mental health when compared to controls, the other a non significant improvement. The third study reported continual improvement in symptom presentation in ex child soldiers in Sierra Leone. Common limitations were short study duration and follow up, poor or unreported adaptation of methods and a lack of treatment mechanisms research. There is a shortage of high quality and available information, which limits the strength of conclusions that can be drawn. Despite the international furore surrounding the use of sport for assisting conflict affected populations, there is not yet convincing evidence of its efficacy as a mental health intervention. Future evaluation and research should aim to identify the mechanisms and processes behind the intended impact of interventions. Background Mental illness is recognised as a major contributor to the global burden of disease. 1 The common mental health disorders (for example, depression, generalised anxiety disorder and alcohol and substance abuse) account for 14% of the global burden of disease, about 7.4% of disabilityadjusted life years worldwide and roughly a quarter of all health lost due to disability. 2 4 Mental disorders affect 1020% of children worldwide 5 and roughly 20% of children experience a mental health issue in any given year. 6 Child and adolescent mental health disorders have wide ranging social and economic impacts on individuals and states. 7 Research in this area is scant, yet results from longitudinal, clinical and population based studies indicate that emotional and conduct disorders can impair normal development for age, and can influence subsequent quality of life for those affected and their families. 7, 8 Estimating the global burden of child and adolescent mental disorders is complex and there are a number of barriers that www.jsfd.org Prospero registration number: CRD42014010833 44