Evaluating mental health and psychosocial support outcomes of the Self-Efficacy and Knowledge (SEEK) community-based randomized controlled trial in lebanon during active conflict

Abstract Background Adolescent girls and young women (AGYW) affected by forced displacement are at high risk of poorer mental health and psychosocial wellbeing due to intersecting stressors. In humanitarian contexts like Lebanon, mental health challenges are exacerbated by protracted crises, including the 2024 war. In response to such challenges, the World Health Organization developed the Self-Efficacy and Knowledge (SEEK) package which is a low-resource, low-intensity community-based intervention designed to improve wellbeing and sexual reproductive health in an integrated manner. This study evaluates the effectiveness of SEEK in improving mental health and psychosocial outcomes among Syrian AGYW refugees in Lebanon. Methods A single-blinded randomized controlled trial was conducted with 267 Syrian AGYW (15–24 years old), randomly assigned to intervention or waitlisted control groups. The intervention comprised eight weekly sessions covering various topics including SRH, emotional regulation, problem-solving among others, delivered at two primary healthcare centers. Outcomes were assessed at baseline (T0), immediately post-intervention (T1), and three months post-intervention (T2), using validated tools to measure wellbeing (WHO-5), self-efficacy (GSES), coping (RWCCL), social support (MSPSS-AW), Interpersonal Communication Competency Skills (ICCS), anxiety and depression (HSCL-25), and emotional regulation (DERS-SF). Results Participants in the intervention group experienced significant improvements in wellbeing (T1: β = 3.33, p < 0.001; T2: β = 6.66, p = 0.035), self-efficacy at only T1 (β = 3.44, p < 0.001), coping (T1: β = 3.28, p < 0.01; T2: β = 2.82, p < 0.01), communication skills only at T2 (β = 4.48, p < 0.01) and perceived social support (T1: β = 3.82, p = 0.020; T2: β = 4.39, p = 0.021). No statistically significant improvements were found for anxiety, depression, or emotional regulation. Conclusion: SEEK demonstrated effectiveness in enhancing wellbeing, self-efficacy, coping, and communication skills, and social support among Syrian AGYW during a period of active conflict, but did not significantly impact anxiety, depression, or emotional regulation. These findings support the potential of integrated community-based approaches in humanitarian settings, while highlighting the need for further research under more stable conditions to evaluate effects on clinical mental health outcomes. Conclusions SEEK demonstrated effectiveness in enhancing wellbeing, self-efficacy, coping, and communication skills, and social support among Syrian AGYW during a period of active conflict, but did not significantly impact anxiety, depression, or emotional regulation. These findings support the potential of integrated community-based approaches in humanitarian settings, while highlighting the need for further research under more stable conditions to evaluate effects on clinical mental health outcomes. Trial registration Clinical Trial Number NCT07008950 initial release on February 28th 2025 and last release on June 5th 2025 with the clinical trial registry at National Institute of Health (NIH) protocol registration system.