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Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials.
de Haan, Anke; Meiser-Stedman, Richard; Landolt, Markus A; Kuhn, Isla; Black, Melissa J; Klaus, Kristel; Patel, Shivam D; Fisher, David J; Haag, Christina; Ukoumunne, Obioha C; Jones, Benjamin G; Flaiyah, Ashraf Muwafaq; Catani, Claudia; Dawson, Katie; Bryant, Richard A; de Roos, Carlijn; Ertl, Verena; Foa, Edna B; Ford, Julian D; Gilboa-Schechtman, Eva; Tutus, Dunja; Hermenau, Katharin; Hecker, Tobias; Hultmann, Ole; Axberg, Ulf; Jaberghaderi, Nasrin; Jensen, Tine K; Ormhaug, Silje M; Kenardy, Justin; Lindauer, Ramon J L; Diehle, Julia; Murray, Laura K; Kane, Jeremy C; Peltonen, Kirsi; Kangaslampi, Samuli; Robjant, Katy; Koebach, Anke; Rosner, Rita; Rossouw, Jaco; Smith, Patrick; Tonge, Bruce J; Hitchcock, Caitlin; Dalgleish, Tim.
Afiliación
  • de Haan A; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zur
  • Meiser-Stedman R; Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
  • Landolt MA; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
  • Kuhn I; Medical Library, University of Cambridge, Cambridge, UK.
  • Black MJ; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
  • Klaus K; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
  • Patel SD; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
  • Fisher DJ; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
  • Haag C; Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
  • Ukoumunne OC; National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK.
  • Jones BG; National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK; Exploristics, Belfast, UK.
  • Flaiyah AM; College of Education Ibn Rushd for Humanities, University of Baghdad, Baghdad, Iraq.
  • Catani C; Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.
  • Dawson K; School of Psychology, University of New South Wales, Sydney, NSW, Australia.
  • Bryant RA; School of Psychology, University of New South Wales, Sydney, NSW, Australia.
  • de Roos C; Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands.
  • Ertl V; Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
  • Foa EB; Department of Psychiatry, University of Pennsylvania Medical School, Philadelphia, PA, USA.
  • Ford JD; Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA.
  • Gilboa-Schechtman E; Emotional Processing Laboratory, Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel.
  • Tutus D; Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.
  • Hermenau K; University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University Medical Centre EWL, Bielefeld University, Bielefeld, Germany.
  • Hecker T; Division of Clinical Developmental Psychopathology, Department of Psychology, Bielefeld University, Bielefeld, Germany.
  • Hultmann O; Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
  • Axberg U; Faculty of Social Studies, VID Specialized University, Oslo, Norway.
  • Jaberghaderi N; Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  • Jensen TK; Department of Psychology, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
  • Ormhaug SM; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
  • Kenardy J; School of Psychology, University of Queensland, Brisbane, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
  • Lindauer RJL; Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands; Department of Child and Adolescent Psychiatry, Public Mental Health, Amsterdam Univers
  • Diehle J; WODC-Research and Documentation Centre, Ministry of Justice and Security, The Hague, Netherlands.
  • Murray LK; Department of Mental Health and International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
  • Kane JC; Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA.
  • Peltonen K; INVEST Research Flagship Centre, University of Turku, Turku, Finland.
  • Kangaslampi S; Faculty of Social Sciences, Psychology, Tampere University, Tampere, Finland.
  • Robjant K; Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany.
  • Koebach A; Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Development Research Group, Department of Politics and Administration, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany.
  • Rosner R; Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
  • Rossouw J; Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; Centre for Cognitive-Behavioural Therapy, Cape Town, South Africa.
  • Smith P; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
  • Tonge BJ; Centre for Developmental Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia.
  • Hitchcock C; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.
  • Dalgleish T; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. Electronic address: tim.dalgleish@mrc-cbu.cam.ac.uk.
Lancet Child Adolesc Health ; 8(1): 28-39, 2024 Jan.
Article en En | MEDLINE | ID: mdl-37980918
ABSTRACT

BACKGROUND:

Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators.

METHODS:

This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954.

FINDINGS:

We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms.

INTERPRETATION:

This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress.

FUNDING:

Swiss National Science Foundation.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Trastornos por Estrés Postraumático / Terapia Cognitivo-Conductual Tipo de estudio: Systematic_reviews Límite: Adolescent / Child / Humans Idioma: En Revista: Lancet Child Adolesc Health Año: 2024 Tipo del documento: Article
Texto completo
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Trastornos por Estrés Postraumático / Terapia Cognitivo-Conductual Tipo de estudio: Systematic_reviews Límite: Adolescent / Child / Humans Idioma: En Revista: Lancet Child Adolesc Health Año: 2024 Tipo del documento: Article