Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies

Morina, Nexhmedin; Koerssen, Rachel; Pollet, Thomas V.

doi:10.1016/j.cpr.2016.05.006

Cited by 198 publications

(134 citation statements)

References 71 publications

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“…In our view this shows how understudied this field of research is, as there are too few studies with obviously too different interventions available. Effect sizes in our sample were somewhat lower than effect sizes from the general population (Gillies et al, 2013: SMD = 1.34 compared to any control condition; Gutermann et al, 2016: SMC = 0.89 and SMD = 0.89 compared to untreated controls; Morina et al, 2016: SMD = 0.83 compared to waitlist controls), although they probably overestimated true treatment effects. They were also lower than those reported in children affected by war (Morina et al, 2017: SMC = 1.15).…”

Section: Discussioncontrasting

confidence: 73%

“…This, again, is in line with the meta-analysis of Gillies et al (2013), who showed that exposure-based interventions in children and adolescents from the general population had larger effects on depression symptoms than other psychological approaches. CBT treatments resulted in an overall small to medium pre-post effect size for depressive symptoms (SMC = 0.30) in this group, which is lower than psychotherapy effects in general population minors with mixed traumata (Gillies et al, 2013: SMD = 0.80 compared to any control condition; Gutermann et al, 2016: SMC = 0.62; Morina et al, 2016: SMD = 0.30 compared to waitlist controls).…”

Section: Discussionmentioning

confidence: 65%

“…Recent meta-analyses on PTSD treatment in children and adolescents after various kinds of trauma show converging evidence with overall effect sizes of g = 0.83 and 0.89 when compared to waitlist and of g = 0.41 and 0.45 when compared to active controls (Gutermann et al, 2016; Morina, Koerssen, & Pollet, 2016; respectively). Effect sizes for depression were 0.60 and for anxiety 0.67 when compared to waitlist, and 0.37 and 0.42 in comparison to active controls (Gutermann et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Nocon

Eberle-Sejari

Unterhitzenberger

et al. 2017

European Journal of Psychotraumatology

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Background: The United Nations reported that in 2016 over 65 million people worldwide have forcibly left home. Over 50% are children and adolescents; a substantial number has been traumatized and displaced by war. Objective: To provide an overview of the effectiveness of psychosocial interventions in this group we conducted a narrative review and a meta-analysis of intervention studies providing data on posttraumatic stress symptoms (PTSS), depression, anxiety, grief, and general distress. Method: We searched PILOTS, MEDLINE, WoS, Embase, CENTRAL, LILACS, PsycINFO, ASSIA, CSA, and SA for studies on treatment outcomes for war-traumatized displaced children and adolescents. Between-group effect sizes (ES) and pre-post ES were reconstructed for each trial. Overall pre-post ES were calculated using a random effects model. Results: The narrative review covers 23 studies with a variety of treatments. Out of the 35 calculated between-group ES, only six were significant, all compared to untreated controls. Two of them indicated significant adverse effects on symptoms of general distress or depression. When calculating pre-post effect sizes, the positive between-group results of cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) were reproduced and singular other treatments showed significant positive effects. However, the mean pre-post effects for PTSS and depression could not be interpreted due to the high heterogeneity of the included studies (PTSS: ES = 0.78; I2 = 88.6%; depression: ES = 0.35; I2 = 93.1%). Only the mean pre-post effect for seven active CBT treatment groups for depression (ES = 0.30, 95% CI [0.18, 0.43]) was interpretable (Q = 3.3, df = 6, p = .77). Conclusion: Given the large number of children and adolescents displaced by war there were regrettably few treatment studies available, and many of them were of low methodological quality. The effect sizes lagged behind the effects observed in traumatized minors in general, and often were small or non-significant. However, CBT and IPT showed promising results that need further replication.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Nocon

Eberle-Sejari

Unterhitzenberger

et al. 2017

European Journal of Psychotraumatology

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“…Randomized controlled trials comparing TF-CBT efficacy against other psychotherapies have been performed by multiple investigators who have replicated findings of the original treatment developers. 9,10) Furthermore, TF-CBT offers the opportunity to address commonly experienced psychological sequallae of traumatic experiences such as childhood sexual abuse such as traumatic sexualization, betrayal, feeling powerless and stigmatization. 49) TF-CBT is generally provided over 12-24 weeks for symptoms that result from a single episode of trauma, but might last longer for children and adolescents who suffer from polyvictimization.…”

Section: Trauma Focused Cognitive Behavioral Therapymentioning

confidence: 99%

“…9) This is in contrast to the large body of literature that supports the effectiveness of evidence-based psychotherapies for children and adolescent with PTSD. 10) Several components common to evidence based psychotherapies include: providing psychoeducation regarding the common effects of traumatic experiences; developing effective and healthy relaxation skills and coping responses when confronted by intrusive trauma memories or reminders; and accessing family and social supports to enhance safety and routine. 11) Over the following sections, we will review effective methods of assessing and treating pediatric PTSD, with a special focus on the limited potential role of pharmacotherapy.…”

Section: Introductionmentioning

confidence: 99%

Pharmacologic Considerations for Youth with Posttraumatic Stress Disorder

Keeshin

2017

J Korean Acad Child Adolesc Psychiatry

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Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse

et al. 2019

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IMPORTANCE Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. OBJECTIVE To examine whether developmentally adapted cognitive processing therapy (D-CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. DESIGN, SETTING, AND PARTICIPANTS This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. INTERVENTIONS Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. MAIN OUTCOMES AND MEASURES All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. RESULTS The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The D-CPT participants also showed greater and stable improvement in all secondary outcomes, with between-groups effect sizes ranging from 0.65 to 1.08 at the posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). CONCLUSIONS AND RELEVANCE Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. TRIAL REGISTRATION German Clinical Trials Register identifier: DRKS00004787

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Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies

Cited by 198 publications

References 71 publications

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

Pharmacologic Considerations for Youth with Posttraumatic Stress Disorder

Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse

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