Improving child mental health and learning outcomes and reducing stigma and discrimination in conflict setting: findings from a cluster randomized controlled trial of a classroom-based psychosocial intervention in rural primary schools in Afghanistan

Background: Conflict and crises have long-lasting and dramatic consequences on the mental health of children. We aimed to investigate the effectiveness of a psychosocial intervention on child mental health in Afghanistan. Methods: A two-arm cluster-randomized controlled trial was conducted in 83 rural primary schools within three provinces of Afghanistan. Children in Grades 3–6, their teachers, and one adult family member were enrolled. Schools were randomly assigned (1:1) to one of two groups: a treatment group composed of entire classes receiving a week-long classroom-based teacher-and-child psychosocial training, a one-day family engagement component, and a community-based system dynamics workshop; and a control group. Primary outcomes were anxiety, depression, life skills, self-efficacy, and resilience of the child. Secondary outcomes included reading and mathematical literacy, mathematical problem-solving, and school-based discrimination and stigma. This trial is registered with the International Standard Randomized Controlled Trials Number registry (ISRCTN83632872). Results: In June 2021, 40 schools and n = 2,262 children were randomly assigned to the intervention group and 43 schools and n = 2,277 children to the control group. Preintervention survey started October 2, 2021 (first batch) and April 10^th, 2023 (second batch). After a minimum of 4-month intervention, a postintervention survey took place. No treatment effects were found on anxiety, depression, resilience, self-efficacy, life skills, or stigma. Effects were found for academic outcomes and school-based discrimination. Shorter interventions displayed reductions in depression, anxiety, stigma, and discrimination, and an increase in life skills. Additional analyses showed significant effects on several outcomes for boys, on a few outcomes for girls, and in areas where the governmental did not disrupt the process. Conclusions: Classroom-based interventions delivered by trained field-based educational staff can effectively promote child mental health, social–emotional skills, and academic outcomes, and reduce stigma and discrimination among subgroups of children in conflict and crisis settings and have viable potential for scalability.