A systematic review of psychosocial interventions for children affected by armed conflict: mapping what works, for whom, and under what conditions

Abstract Background Armed conflict exposes children to prolonged and multifaceted adversity, including violence, displacement, bereavement, family disruption, poverty, insecurity, and disrupted schooling. Although research on psychosocial interventions for conflict-affected children has grown, the evidence remains heterogeneous, and causal conclusions are often difficult to distinguish from feasibility, contextual, or implementation findings. Objective This systematic interpretive mapping review aimed to synthesize evidence on psychosocial interventions for children affected by armed conflict by mapping intervention types, delivery platforms, mechanism-related intervention content, family and caregiving context, and implementation conditions, while explicitly separating levels of evidentiary inference. Methods A systematic search of five major databases identified 7,729 unique records, of which 50 evidence sources met the final inclusion criteria. Evidence sources included randomized controlled trials, cluster randomized trials, crossover randomized trials, quasi-experimental studies, pilot and usability studies, observational studies, reviews, conceptual papers, guidelines, operational guidance, and implementation sources. Data were extracted and synthesized using a convergent segregated mixed-methods approach. Evidence sources were classified into 17 effectiveness studies, 2 non-comparative intervention studies, and 31 contextual or implementation evidence sources to separate cautious causal inference from feasibility, contextual, policy, and implementation interpretation. Methodological quality was assessed using Joanna Briggs Institute tools where applicable, and certainty of evidence was assessed separately from study-level methodological quality. Results Effectiveness evidence was concentrated in school-based, community-based, trauma-focused, group-based, family-focused, and emerging digital interventions, often delivered by non-specialist providers in resource-constrained or humanitarian settings. Controlled studies suggested modest and heterogeneous improvements in post-traumatic stress, depression, anxiety, behavioral difficulties, and psychosocial functioning. Family-focused and caregiver-relevant interventions appeared promising, but the number of rigorous trials was limited. Trauma-focused and skills-based interventions showed potential benefit when delivered with adequate structure, supervision, cultural adaptation, and continuity. Digital interventions remained at an early stage of evaluation. Contextual and implementation evidence highlighted the importance of caregiver functioning, ongoing daily stressors, displacement, safety, school continuity, supervision, service access, and delivery platform stability, but these factors were rarely tested as formal mechanisms or moderators. Conclusions Psychosocial interventions for conflict-affected children show promise, but outcomes vary across intervention types, populations, delivery platforms, and conflict settings. Rather than identifying a single optimal intervention, this review suggests that intervention benefit should be understood within a broader ecological and implementation system. Future research should directly test mechanisms, moderators, developmental differences, implementation conditions, equity, digital access, and long-term outcomes to strengthen causal understanding and improve intervention design in humanitarian settings.