Non-specialist delivered psychosocial care after war and interpersonal violence: a systematic review and meta-analysis

BACKGROUND: The effectiveness of non-specialist provider-delivered care for mood and anxiety disorders has been established, but effects in violence-exposed populations remain unclear. We examine the net effectiveness of psychosocial treatments delivered by non-specialists to adults experiencing distress following interpersonal and war-related violence. METHODS: In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Embase, PsycINFO, Global Health, Cochrane Library, Latin American and Caribbean Health Sciences Literature, and SciELO from Jan 1, 2000, to June 1, 2025. Studies were included if they were psychosocial treatment randomised controlled trials for adults exposed to violence; additionally, the treatment had to be delivered by a non-specialist provider. Pairs of authors double-screened and double-extracted data by applying a codebook developed for this study. We extracted information on data, population characteristics, and four primary outcomes (depression, post-traumatic stress disorder, anxiety, and impairment symptom severity), and used standardised checklists to assess risk of bias. We pooled study-level data in pairwise meta-analyses using a random-effects model to examine subgroup differences by national setting, treatment setting, provider type, violence type, and treatment focus. Our study did not involve people with lived experience of mental health conditions. This protocol was registered a priori with PROSPERO (CRD42022306099). FINDINGS: =77-84%. INTERPRETATION: Small to moderate clinical benefits for non-specialist-delivered care were observed across a broad set of treatments for diverse populations exposed to violence worldwide. These comprehensive analyses can inform psychosocial programming related to setting, providers, types of violence, and treatment foci, to combine treatment and implementation approaches for specific settings and populations. FUNDING: None.