Evaluating the effectiveness of the Early Adolescent Skills for Emotions (EASE) intervention using an individual participant data meta-analysis (IPDMA)

Adolescents living in fragile, low-resource settings experience profound psychological distress but have limited access to evidence-based mental health support. To address this treatment gap, the World Health Organization (WHO) Early Adolescent Skills for Emotions (EASE) intervention was developed to address psychological distress and internalizing symptoms among adolescents aged 10-15 in low-resource settings. In this study, we robustly assess the effectiveness of EASE using an individual participant data meta-analytic approach. Pooling data from three randomized controlled trials (RCTs) of EASE conducted in Lebanon, Jordan, and Pakistan increases sample size and statistical power while also enabling subgroup analyses. We harmonize data across trials, use multiple imputation with chained equations to address missingness, and employe linear mixed effects models to assess changes in outcome performance between treatment groups that accounted for clustering at the trial and participant levels. The primary outcome is adolescent psychological distress. Secondary adolescent outcomes include internalizing, externalizing, attention, and depressive symptoms, as well as overall mental wellbeing. Caregiver secondary outcomes include parental involvement, positive parenting, poor monitoring and supervision, inconsistent discipline, and corporal punishment. Outcomes were assessed at baseline, endline, and 3-months follow up. Subgroup analyses include age (10-12 years, 13-15 years), gender (boy, girl), and traumatic experiences (less than or equal to the 50th percentile, greater than the 50th percentile) stratifications.