Review finds the strongest evidence for non-specialist depression interventions for adolescents in low- and middle-income countries

Yin, S., Tian, T., & Auslander, W. (2026). Mental health interventions for adolescents with depression and anxiety in low- and middle-income countries: A systematic review of the evidence. Frontiers in Psychology, 17, 1809434. https://doi.org/10.3389/fpsyg.2026.1809434

Summarized by Emily Buss

About the Study

About 1 in 7 adolescents ages 10 to 19 around the world has a mental disorder, and anxiety and depression make up about 40% of these disorders. Adolescents in low- and middle-income countries (LMICs), where 90% of the world’s adolescents live, may be particularly vulnerable because of financial constraints and limited access to evidence-supported mental health services. Because there are too few mental health professionals in many of these countries, there has been growing interest in task sharing, or training non-specialists such as teachers, lay counselors, and community health workers to deliver interventions. However, no previous review had systematically compared interventions by where they are delivered (school or non-school settings) and who delivers them (specialists or non-specialists).

This systematic review focused on adolescents in LMICs with subclinical symptoms of depression or anxiety (symptoms that do not meet diagnostic criteria). The authors searched 5 databases for studies published between January 2013 and July 2024 that included youth ages 10 to 19 and used experimental or quasi-experimental designs with a comparison group. The review included 22 studies with 2,336 participants from Iran, China, Hong Kong, Malaysia, Kenya, Pakistan, Nigeria, Jordan, Turkey, Lebanon, and South Africa. The most common approaches were cognitive behavioral therapy (8 studies), positive psychology (5 studies), and Early Adolescent Skills for Emotions (3 studies). Specialists (licensed mental health professionals or those with graduate-level mental health training) delivered 14 interventions, and non-specialists delivered 8. In terms of setting, 12 studies took place in schools and 10 in other settings such as hospitals, community organizations, and online platforms. The authors rated the certainty of the evidence for each comparison using the GRADE approach.

Key Findings

Non-specialists and depression. Interventions delivered by non-specialists for depressive symptoms were the only comparison with high-certainty evidence. Across 6 studies, the median effect size was 0.26 (ranging from 0.07 to 0.39), which is modest but consistent.

Specialists. Specialist-delivered interventions had larger median effect sizes for both depression (1.01) and anxiety (1.35), but the certainty of this evidence was very low, and effect sizes varied widely across studies (from 0.04 to 2.88 for depression).

Anxiety. The evidence for anxiety was less settled. Non-specialist-delivered anxiety interventions had low-certainty evidence, and specialist-delivered anxiety interventions had very low-certainty evidence.

Setting. All comparisons of school-based and non-school-based interventions were rated very low certainty, so the review could not determine whether one setting works better than the other.

Study quality. Of the 22 studies, 19 were randomized controlled trials and 3 were quasi-experimental. Among the trials, 6 were rated low risk of bias, 12 had some concerns, and 1 was high risk. All 3 quasi-experimental studies had serious risk of bias. Because the studies varied so much in design, measures, and interventions, the authors did not conduct a meta-analysis.

“With proper training and supervision, non-specialist providers can serve as an important workforce for expanding access to mental health services needed in resource-limited settings.” (Yin et al., 2026, Discussion)

Implications for Mentoring

For the mentoring field, the most relevant finding is that trained non-specialists delivered depression interventions with the most dependable evidence in the review. This adds to a growing body of work on paraprofessional and lay helper models. The authors recommend that future practice prioritize training and supervising non-specialist providers, including teachers, lay counselors, and community health workers, to deliver evidence-based depression interventions in order to expand access to mental health services for adolescents. It is worth noting that certainty refers to how confident researchers can be in an estimate rather than the size of the effect. The non-specialist effects were modest, so their value lies in their consistency and in the number of young people they can reach.

The authors also call for more rigorous research to determine whether task sharing is similarly effective for anxiety and whether the setting makes a difference. Several limitations should be considered. The number of studies was small, particularly once results were separated by outcome. Only English-language, peer-reviewed studies were included, countries and regions were unevenly represented, and outcomes were self-reported by youth with subclinical symptoms, so the findings may not apply to adolescents with diagnosed disorders. Future trials would benefit from larger samples, longer follow-up, preregistered analysis plans, and outcome measures that have been validated across cultures.