Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Research article Psychosocial interventions for responding to child sexual abuse: A systematic review Jill R. McTavish a, *, Nancy Santesso b , Avni Amin c , Megin Reijnders c , Muhammad Usman Ali d , Donna Fitzpatrick-Lewis d , Harriet L. MacMillan a,e a Department of Psychiatry & Behavioural Neurosciences, McMaster University, Canada b Department of Health Research Methods, Evidence and Impact, McMaster University, Canada c Department of Reproductive Health & Research, World Health Organization, Switzerland d McMaster Evidence Review and Synthesis Team, McMaster University, Canada e Department of Pediatrics, McMaster University, Canada ARTICLE INFO Keywords: Sexual abuse Child Adolescent Psychosocial interventions World Health Organization ABSTRACT Background: In this manuscript, we summarize the findings of a systematic review that informed the development of the World Health Organization’s recommendations related to psychosocial interventions for child and adolescent sexual abuse. Method: Systematic searches across 14 databases were conducted to retrieve any published randomized controlled trials of psychosocial interventions addressing mental health outcomes among children and adolescents exposed to sexual abuse who have experienced symptoms. We assessed study risk of bias using the Cochrane Risk of Bias tool and certainty of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Results: Twenty-four articles representing fifteen studies were included in the systematic review. Only two studies were conducted in low- or middle-income countries. Few studies could be pooled together because of differences in interventions and comparators. Due to the small numbers of participants and very serious concerns with risk of bias, we are very uncertain about the benefits of interventions provided to children alone and without the involvement of their caregivers. However, cognitive behavior therapy (CBT) with a trauma focus provided to children and involving their caregivers may reduce some mental health symptoms associated with sexual abuse experiences. Discussion: The findings suggest that more and larger studies are needed to evaluate the effects of psychosocial interventions for children and adolescents exposed to sexual abuse who preside in low- and middle-income countries. PROSPERO registration number: CRD42016039656 1. Background Child and adolescent sexual abuse is defined as experiences that involve an adult or older child using a child for sexual grati- fication and can include, but is not limited to, rape, unwanted touching, threatened sexual violence, exhibitionism, and exploitive use of children in pornography or sex work (World Health Organization, 2017). In addition, adolescents experience sexual abuse in the context of peer relationships, including dating or intimate relationships. Global estimates suggest that 18% of women and 7.6% of https://doi.org/10.1016/j.chiabu.2019.104203 Received 28 August 2018; Received in revised form 19 September 2019; Accepted 22 September 2019 ⁎ Corresponding author at: McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada. E-mail address: mctavisj@mcmaster.ca (J.R. McTavish). Child Abuse & Neglect xxx (xxxx) xxxx 0145-2134/ © 2019 Elsevier Ltd. All rights reserved. Please cite this article as: Jill R. McTavish, et al., Child Abuse & Neglect, https://doi.org/10.1016/j.chiabu.2019.104203