Effects of a brief digital problem-solving intervention on depression and anxiety symptoms in Ukrainian children and adolescents displaced by war: a crossover, randomised controlled trial (Ougrin, 2025)
Weisz, Steinberg Sun, Mair, Fitzpatrick, Karapata, Yusyn, Sood, Danese, Adams, Ougrin
In The Lancet Primary Care July 2025 1(1)
Summary Background Children and adolescents (hereafter referred to as youths) displaced from their home and country by war face many problems and increased risk of depression and anxiety (ie, internalising) symptoms, but have little access to in-person mental health care. We tested the hypothesis that a digital mental health intervention (DMHI) might reduce internalising symptoms.Methods In this crossover, randomised controlled trial, we tested Project SOLVE, a 30-min intervention that teaches problem solving. Refugee Ukrainian youths in school grades 5–12 (ie, aged 10–18 years) who were able to read Ukrainian and had access to a digital device (ie, mobile phone or tablet) in five schools in Poland were randomly assigned (1:1) to immediate SOLVE or control (academic practice, then crossover to SOLVE at 4 months) implemented during class. The preregistered coprimary outcomes were changes in scores on the Behavior and Feelings Survey (BFS) Internalizing Subscale (for youths and caregivers; each item rated on a scale of 0–4, with higher ratings indicating more symptoms) and post-Project SOLVE ratings on the Program Feedback Scale (for youths only; each item rated on a scale of 1–5, with higher ratings indicating more favourable views of the intervention). Using β-distributed linear mixed-effects models, we analysed longitudinal outcomes both for the full intention-to-treat sample (ie, the full sample after excluding violations of randomisation) and the subsample with elevated baseline symptoms (ie, >1 SD above the mean), testing whether SOLVE was effective as a universal intervention and/or for highly symptomatic youths. The trial is registered with ClinicalTrials.gov (NCT06064578) and Open Science Framework (https://osf.io/u495j) and is complete.Findings We recruited youths from Oct 23 to Dec 18, 2023, 898 youths were assessed for eligibility and 818 were eligible, 709 (87%) of whom were randomly assigned (345 to SOLVE, 364 to Control) and provided usable data; 333 (47%) were boys, 338 (48%) were girls, 25 (4%) preferred not to say their gender, and 13 (2%) identified as a gender not listed (mean age 13·38 years, SD 2·04). Analyses of BFS responses included youths but not caregivers (whose response rates were too low for meaningful analysis). In full-sample intention-to-treat analyses, participants in the immediate SOLVE group (n=345) showed a greater reduction in internalising symptoms than participants in the control group (n=364) at both post-intervention assessments: 1-month item-level mean symptom scores were 1·08 (SD 0·89) for participants in the immediate SOLVE group and 1·26 (0·93) for participants in the control group (odds ratio [OR] 1·31, 95% CI 1·08–1·59, p=0·0066) and 4-month mean symptom scores were 0·99 (SD 0·89) for participants in the immediate SOLVE group and 1·20 (0·93) for participants in the control group (OR 1·36, 95% CI 1·08–1·71, p=0·0081). Among youths with elevated symptoms (n=123), the effect sizes increased. Participants in the immediate SOLVE group (n=57) showed a greater reduction in internalising symptoms than participants in the control group (n=66) at both post-intervention assessments: 1-month item-level mean symptom scores were 2·05 (SD 0·94) for participants in the immediate SOLVE group and 2·38 (SD 0·76) for participants in the control group (OR 2·37, 95% CI 1·51–3·72, p=0·0002); 4-month item-level mean symptom scores were 1·95 (SD 1·10) for participants in the immediate SOLVE group and 2·26 (SD 0·89) for participants in the control group (OR=1·71, 95% CI 1·03–2·84, p=0·039). Youths rated Project SOLVE as acceptable and useful (mean rating 3·61, SD 0·88).Interpretation Our data suggest that a brief problem-solving DMHI, efficiently implemented in schools, could reduce internalising symptoms in refugee Ukrainian youths. After context-specific adaptations, DMHIs could be useful for other youths displaced by war who do not have access to in-person professional care.Funding Dean’s Competitive Fund, Harvard University.