Internet-delivered psychological treatment as an add-on to treatment as usual for common mental disorders: A systematic review with meta-analysis of randomized trials.

BACKGROUND: Psychological treatments for common mental disorders are increasingly being delivered remotely via the internet. Evidence suggests that internet-delivered cognitive behavioural therapy (iCBT) is superior to waitlist. However, the benefits are unclear of using this treatment modality as an add-on to treatment as usual (TAU) in regular healthcare. METHODS: The literature was systematically searched up to August 2021 for randomized trials of internet-delivered psychological treatments using TAU as the comparator. Eligible participants were diagnosed with depressive, anxiety, obsessive-compulsive, or trauma- and stress-related disorders. Outcomes of interest were symptoms, functioning, quality of life, healthcare utilization, and negative effects. Results were synthesized using random-effects meta-analyses. Quality of evidence was assessed using GRADE. RESULTS: The included studies evaluated iCBT for adults with depression (k = 9), depressive or anxiety disorders (k = 4), and post-traumatic stress disorder (k = 2) and were conducted in primary care or similar settings. For depression, low-certainty evidence suggested beneficial short-term effects on symptoms (g = -0.23; 95 % CI: = -0.37, -0.09), response rate (OR = 2.46; 1.31, 4.64), and remission (OR = 1.70; 1.19, 2.42;). The certainty of evidence was very low for long-term effects, other outcomes, and other disorders. LIMITATIONS: TAU varied across studies and was often insufficiently described. CONCLUSIONS: iCBT as a complement to usual care for adult with depression may result in a small incremental effect, which potentially could be clinically important. Studies are lacking for several common disorders and for children, adolescents, and the elderly. More robust studies of long-term effects are also needed, to better inform clinical decision-making.

The devil is in the details: Unpackaging the systematic in systematic reviews: Short reply to reconsidering the effectiveness of mentoring for prevention of juvenile criminal recidivism.

Replies to a comment made by DuBois (see record 2022-98051-005). The systematic review is an important tool for decision makers, intervention researchers, and practitioners to gain a clear and comprehensive overview of the available evidence on a given topic. We would, in this short reply, like to raise the two additional issues of critical appraisal and research synthesis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Systematic review and meta-analysis of noninstitutional psychosocial interventions to prevent juvenile criminal recidivism.

OBJECTIVE: To assess the effectiveness of noninstitutional psychosocial interventions in preventing recidivism among criminal adolescents. METHOD: We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials assessing the impact on recidivism among juveniles aged 12-17. The included studies had a low to medium risk of bias and were published between 2000 and 2019. Standardized mean differences or risk differences were calculated. RESULTS: We included 35 (20 randomized, 15 nonrandomized) studies evaluating 17 unique, noninstitutional psychosocial interventions. A meta-analysis found no significant reductions in recidivism for studied interventions compared to control conditions. Although single studies suggested some positive effects, the evidence provided by these studies was found to have very low certainty. Post hoc analyses indicated that studies including a low-intensity control condition might have stronger relative intervention effects compared to studies with medium or high-intensity control conditions. CONCLUSION: This systematic review did not find any one noninstitutional psychosocial intervention to be more effective than control treatments in reducing future criminality among juvenile offenders aged 12-17. We discuss the implications of the present findings for social work and child and adolescent psychiatry practices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Treatment of radius or ulna fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and current practice.

BACKGROUND: The objective of the present study was to evaluate effectiveness, complications and cost-effectiveness of any surgical or non-surgical treatment for radius or ulna fractures in elderly patients. Secondary objectives were to analyze present treatment traditions of distal radius fractures (DRF) in Sweden and to calculate resource usage for its treatment. METHODS AND FINDINGS: The assessment contains a systematic review of clinical and health economic studies comparing treatment options for radius or ulna fractures. The results regarding the effectiveness of the treatments are summarized in meta-analyses. In addition, the assessment contains a cost analysis for different treatment options commonly used for DRF care, and an analysis of registry data on the incidence and treatment of DRF. In total 31 randomized controlled trials were included in meta-analyses. When comparing functional outcome for plate fixation versus non-surgical treatment for DRF, there were no clinically important differences at one-year follow-up (mean difference [MD], -3.29, 95% CI, -7.03; 0.44). Similar results were found when comparing plating and percutaneous methods with respect to functional outcome (standardized mean difference [SMD], -0.07, 95% CI, -0.21; 0.07) and grip strength (MD, -3.47, 95% CI, -11.21; 4.28). There were no differences for minor complications, (risk difference [RD], -0.01, 95% CI, -0.07; 0.05) whereas major complications were less common for the percutaneous group, (RD, 0.02, 95% CI, 0.02; 0.03). Given the low number of studies, the evidence above was rated as moderate certainty. The cost for plate fixation versus plaster cast was estimated to 1698 compared to 137 US dollars. For DRF, plate fixation increased in Sweden between 2005 and 2013, and was the most common surgical method in 2013. CONCLUSIONS: Surgical treatment of moderately displaced distal radius fractures in elderly patients offers no clear benefit compared to non-surgical treatment. Plating procedures have become more common during the second millennium and involve higher costs and higher risk of major complications than percutaneous options.

Treatment of humerus fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and evolution of practice.

OBJECTIVES: The objective of this Health Technology Assessment was to evaluate effectiveness, complications and cost-effectiveness of surgical or non-surgical treatment for proximal, diaphyseal or distal fractures of the humerus in elderly patients. Secondary objectives were to evaluate the intervention costs per treatment of proximal humerus fractures (PHF) and to investigate treatment traditions of PHF in Sweden. METHODS AND FINDINGS: The assessment contains a systematic review of clinical and health economic studies comparing treatment options for humerus fractures in elderly patients. The results regarding the effectiveness of treatments are summarized in meta-analyses. The assessment also includes a cost analysis for treatment options and an analysis of registry data of PHF. For hemiarthroplasty (HA) and non-operative treatment, there was no clinically important difference for moderately displaced PHF at one-year follow-up regarding patient rated outcomes, (standardized mean difference [SMD]) -0.17 (95% CI: -0.56; 0.23). The intervention cost for HA was at least USD 5500 higher than non-surgical treatment. The trend in Sweden is that surgical treatment of PHF is increasing. When functional outcome of percutaneous fixation/plate fixation/prosthesis surgery and non-surgical treatment was compared for PHF there were no clinically relevant differences, SMD -0.05 (95% CI: -0.26; 0.15). There was not enough data for interpretation of quality of life or complications. Evidence was scarce regarding comparisons of different surgical options for humerus fracture treatment. The cost of plate fixation of a PHF was at least USD 3900 higher than non-surgical treatment, costs for complications excluded. In Sweden the incidence of plate fixation of PHF increased between 2005 and 2011. CONCLUSIONS: There is moderate/low certainty of evidence that surgical treatment of moderately displaced PHF in elderly patients has not been proven to be superior to less costly non-surgical treatment options. Further research of humerus fractures is likely to have an important impact.

Police interviews with child sexual abuse victims: patterns of reporting, avoidance and denial.

OBJECTIVE: The present study investigated 27 sexually abused children's reports about abuse given in the context of police interviews. All abuse cases had been verified (with, e.g., photographs or video films), proving that abuse had occurred. METHOD: The interviews with the children were analyzed regarding amount and type of information reported, and the frequency of denial and avoidance. Furthermore, children's reporting on different interview occasions was investigated. RESULTS: Children reported significantly more neutral information from the abusive acts per se than sexual information. The children were also highly avoidant and, on several occasions, denied that (documented) sexual acts had occurred. Furthermore, the second and third interviews generated twice as many (new) sexual details as the first interview. The children also produced more denials and avoidances at the first interview compared to subsequent interviews. CONCLUSIONS: The present study indicates that sexually abused children may be highly resistant to reporting about the abuse in police interviews, and that two or three interviews may be needed to enable children to give complete and informative reports. It is of vital importance that professionals within the legal system be aware of this problem when conducting child interviews and when evaluating the reliability of child sexual abuse reports.

Judges', lay judges', and police officers' beliefs about factors affecting children's testimony about sexual abuse.

The authors examined Swedish judges', lay judges', and police officers' beliefs about factors that may complicate or facilitate children's reports of sexual abuse. Participants (N = 562) rated potential complicating and facilitating factors and freely reported which criteria they considered important when assessing the reliability of child witnesses. The groups had similar opinions regarding which factors are complicating and facilitating. Furthermore, the groups tended to regard emotional factors as more complicating than cognitive factors. When freely reporting criteria that are important when assessing reliability, judges and police officers reported criteria pertaining mainly to the child, whereas lay judges reported mainly criteria pertaining mainly to the police interview. Results indicate that participants believe that children have the capacity to remember and report about abuse but are hindered in doing so by emotional factors. Results also suggest that police officers may underestimate their own influence on the reliability of children's reports.

Children exposed to obscene phone calls: what they remember and tell.

OBJECTIVE: This case study examined children's reports from an obscene phone call (i.e., a verbal sexual abuse). We investigated which type of information the children reported, the completeness and accuracy of the children's statements, and whether there were systematic patterns in terms of memory distortions and omissions. METHOD: The completeness and the accuracy of the children's statements were examined by matching 64 children's statements given during police interviews with a detailed documentation of each phone call, made by the perpetrator during the actual phone calls. RESULTS: All children remembered the phone call per se, but they were found to omit almost all of the sexual and sensitive information (perpetrator's questions and statements) and about 70% of the neutral information given by the perpetrator. However, the children were accurate in the information they did report. CONCLUSIONS: The fact that the children did remember more of the neutral information suggests that they actually remembered the sexual information as well, but that they chose not to report it. Results indicate that children who have been sexually abused may remember more than they report in an initial interview. One possible underlying reason is that children experience shame or embarrassment.