A realist synthesis of evidence on the effectiveness of interventions to prevent mental health problems in children and parents living in poverty

Abstract Background Children, adolescents and parents living in poverty are at high risk of experiencing mental health problems and their impacts. This synthesis aims to examine what works to prevent mental health problems in children and parents living in poverty, in what circumstance, and why. Method We conducted a realist synthesis to explore the key contextual factors and mechanisms through which mental health problems in children and parents may be prevented. We systematically searched for evidence within electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL, Applied Social Science Index and Abstract and Scopus) and supplemented this by searching for grey literature. Findings We included 67 unique studies reported in 73 papers examining interventions for children and/or their parents. We found that a nurturing early years educational intervention provided universally to children living in poverty may address the differential risk exposure experienced by young children and effectively prevent behavioural problems. However, where these children experience greater vulnerability in the early, mid or adolescent years, or are demonstrating higher consequences from their risk exposure, targeted interventions which recognise and respond to poverty and its impacts whilst supporting parents in their parenting role may be required. Conclusion To prevent mental health problems in children and their parents living in circumstances of material deprivation, a poverty-informed response which is proportionate to need may be required. Evidence suggests this response is most likely to be effective if it addresses the interacting mechanisms and associated pathways of differential risk, vulnerability and consequence experienced by both the parent and the child. Limitations with this evidence include short follow-up periods, an absence of evidence considering paternal mental health and limited diversity in samples.