# A Systematic Review on the Effects of Psychosocial Interventions on Quality of Life and Functioning Outcomes Among Populations Experiencing Ongoing Threat

## TL;DR

This review finds that psychosocial interventions can improve quality of life and functioning for people in ongoing threat situations, even without reducing symptoms.

## Contribution

The study systematically evaluates nonsymptom-focused outcomes of psychosocial interventions in populations facing ongoing threat.

## Key findings

- Both trauma- and present-focused interventions improve quality of life and functioning under ongoing threat.
- Comparison between intervention types remains inconclusive due to limited direct comparisons.
- Task sharing is a feasible delivery model in low-resource areas with proper supervision.

## Abstract

Humanitarian emergencies increasingly involve ongoing traumatic stress, characterised by a lack of environmental safety that is often required for recovery. Evaluating quality of life (QoL) and functioning is essential in these contexts, as symptom reduction alone may not capture the multidimensional nature of resilience and social adaptation under continuous threat. This systematic review aims to evaluate the effectiveness of psychosocial interventions on nonsymptom‐focused outcomes—specifically QoL and functioning—for populations facing ongoing violence or interpersonal violence. Following PRISMA guidelines, a systematic search of PubMed, Medline and PsycINFO was conducted. Interventions were categorised using layers two to four of the International Red Cross and Red Crescent Movement's MHPSS framework. Data from 18 studies (17 unique studies) comprising 3165 participants were synthesised using a narrative approach. Evidence indicates that both trauma‐ and present‐focused interventions were likely to improve QoL and functioning despite ongoing threat. Comparison between interventions remained inconclusive. There were also discrepancies between informants regarding intervention outcomes. Future research should include operationalisation of ‘ongoing threat’ where possible and include and standardise nonsymptom‐focused outcomes when evaluating interventions.

Through this systematic review, practitioners can recognise that both trauma‐ and present‐focused psychosocial interventions are effective in improving quality of life (QoL) and daily functioning, even when populations remain under ongoing threat. However, evidence remains inconclusive as to which therapeutic framework is superior, as few studies conducted direct comparisons between the two frameworks. Practitioners are encouraged to adopt a ‘both/and’ therapeutic stance—validating the realistic nature of ongoing risks while simultaneously helping clients differentiate between past traumas and present dangers.The review shows that task sharing is a feasible and successful delivery model in low‐resource or conflict‐affected areas, although regular supervision needs to be in place particularly in lower resource settings.Future research should prioritise standardising nonsymptom‐focused outcomes, such as QoL and functioning, and provide explicit documentation of implementation fidelity and supervision structures.

Through this systematic review, practitioners can recognise that both trauma‐ and present‐focused psychosocial interventions are effective in improving quality of life (QoL) and daily functioning, even when populations remain under ongoing threat. However, evidence remains inconclusive as to which therapeutic framework is superior, as few studies conducted direct comparisons between the two frameworks. Practitioners are encouraged to adopt a ‘both/and’ therapeutic stance—validating the realistic nature of ongoing risks while simultaneously helping clients differentiate between past traumas and present dangers.

The review shows that task sharing is a feasible and successful delivery model in low‐resource or conflict‐affected areas, although regular supervision needs to be in place particularly in lower resource settings.

Future research should prioritise standardising nonsymptom‐focused outcomes, such as QoL and functioning, and provide explicit documentation of implementation fidelity and supervision structures.