The World Health Organization’s Early Adolescent Skills for Emotions: A systematic review on current evidence regarding effectiveness and implementation

Introduction. Adolescents in many low- and middle-income countries are frequently exposed to adversities such as armed conflicts and economic hardship. These stressors occur during a critical developmental period marked by profound physical, social, and psychological changes, increasing vulnerability to mental disorders. To address this mental health care need, the World Health Organization (WHO) and UNICEF developed Early Adolescent Skills for Emotions (EASE), a 10-session group intervention for adolescents and their caregivers. This systematic review summarizes current evidence regarding the effectiveness and implementation of EASE. Methods. We searched five electronic databases up to July 26, 2025, for trials evaluating the effects of EASE on adolescents’ mental distress and caregivers’ parenting behaviors. Random-effects multilevel meta-analyses were conducted using standardized mean differences (SMDs) at post-intervention and 3-month follow-up, complemented by a qualitative synthesis of implementation outcomes. Preregistration-ID: CRD42023488490. Results. No evidence was found for superiority of EASE over a 1-session psychoeducation control on overall mental distress or caregiver outcomes. However, for the primary outcome internalizing symptoms, there was strong evidence of a very small to small favorable effect at post-intervention, SMD=–0.17, 95% CI [–0.31, –0.04], which was maintained at follow-up. Implementation studies indicated that EASE is acceptable, feasible, and delivered with good fidelity; yet low caregiver engagement and contextual challenges hindered implementation. Conclusion. Observed effects were smaller than those reported for a comparable WHO intervention for adults, highlighting substantial scope for optimization. Additional high-quality trials are warranted to improve the effectiveness of EASE and maximize its potential public health impact.