Improving children's mental health and educational outcomes post-disaster: a systematic comparison of environmental, human and COVID-19 interventions

Children's mental health and education are profoundly affected by natural, human‑made and pandemic‑related disasters, but policymakers lack synthesized evidence across health and education on effective post-disaster interventions, hindering post-disaster recovery. We searched 13 databases for peer-reviewed randomized controlled trials (RCTs) published after 2000. Eligible studies included children aged less than 18 years exposed to environmental, human or COVID-19-related disasters, with mental health or educational outcomes measured using standardized tools and assessed with RoB2 to be low risk of bias. A total of 25 RCTs met the inclusion criteria: nine non-COVID mental health studies, 11 COVID-19 mental health studies and five COVID-19 education studies. No eligible non-COVID education RCTs were identified. Trauma-focused cognitive behavioural therapy was consistently reported to reduce post-traumatic stress disorder, depression and anxiety following natural and human-made disasters. Psychotherapeutic approaches were reported to improve mental health post-COVID-19, despite some anomalous findings. Physical activity emerged as a cross-cutting mechanism supporting well-being and academic outcomes. Group-based interventions within schools and delivered by educational staff were effective. Structured tutoring and carer-supported home learning improved literacy and numeracy. These findings provide evidence towards the importance of education and health systems working more collaboratively to effectively facilitate post-disaster recovery, where further high-quality RCTs are needed.