Transparency in Cognitive Training Meta-analyses: A Meta-review.

Meta-analyses often present flexibility regarding their inclusion criteria, outcomes of interest, statistical analyses, and assessments of the primary studies. For this reason, it is necessary to transparently report all the information that could impact the results. In this meta-review, we aimed to assess the transparency of meta-analyses that examined the benefits of cognitive training, given the ongoing controversy that exists in this field. Ninety-seven meta-analytic reviews were included, which examined a wide range of populations with different clinical conditions and ages. Regarding the reporting, information about the search of the studies, screening procedure, or data collection was detailed by most reviews. However, authors usually failed to report other aspects such as the specific meta-analytic parameters, the formula used to compute the effect sizes, or the data from primary studies that were used to compute the effect sizes. Although some of these practices have improved over the years, others remained the same. Moreover, examining the eligibility criteria of the reviews revealed a great heterogeneity in aspects such as the training duration, age cut-offs, or study designs that were considered. Preregistered meta-analyses often specified poorly how they would deal with the multiplicity of data or assess publication bias in their protocols, and some contained non-disclosed deviations in their eligibility criteria or outcomes of interests. The findings shown here, although they do not question the benefits of cognitive training, illustrate important aspects that future reviews must consider.

Heterogeneity estimation in meta-analysis of standardized mean differences when the distribution of random effects departs from normal: A Monte Carlo simulation study.

BACKGROUND: Advantages of meta-analysis depend on the assumptions underlying the statistical procedures used being met. One of the main assumptions that is usually taken for granted is the normality underlying the population of true effects in a random-effects model, even though the available evidence suggests that this assumption is often not met. This paper examines how 21 frequentist and 24 Bayesian methods, including several novel procedures, for computing a point estimate of the heterogeneity parameter ([Formula: see text]) perform when the distribution of random effects departs from normality compared to normal scenarios in meta-analysis of standardized mean differences. METHODS: A Monte Carlo simulation was carried out using the R software, generating data for meta-analyses using the standardized mean difference. The simulation factors were the number and average sample size of primary studies, the amount of heterogeneity, as well as the shape of the random-effects distribution. The point estimators were compared in terms of absolute bias and variance, although results regarding mean squared error were also discussed. RESULTS: Although not all the estimators were affected to the same extent, there was a general tendency to obtain lower and more variable [Formula: see text] estimates as the random-effects distribution departed from normality. However, the estimators ranking in terms of their absolute bias and variance did not change: Those estimators that obtained lower bias also showed greater variance. Finally, a large number and sample size of primary studies acted as a bias-protective factor against a lack of normality for several procedures, whereas only a high number of studies was a variance-protective factor for most of the estimators analyzed. CONCLUSIONS: Although the estimation and inference of the combined effect have proven to be sufficiently robust, our work highlights the role that the deviation from normality may be playing in the meta-analytic conclusions from the simulation results and the numerical examples included in this work. With the aim to exercise caution in the interpretation of the results obtained from random-effects models, the tau2() R function is made available for obtaining the range of [Formula: see text] values computed from the 45 estimators analyzed in this work, as well as to assess how the pooled effect, its confidence and prediction intervals vary according to the estimator chosen.

Florida Obsessive-Compulsive Inventory and Children's Florida Obsessive Compulsive Inventory: A reliability generalization meta-analysis.

BACKGROUND: The Florida Obsessive Compulsive Inventory (FOCI) and its pediatric version, the Children's Florida Obsessive Compulsive Inventory (C-FOCI), are instruments for evaluating obsessive-compulsive symptomatology. METHOD: A reliability generalization meta-analysis was conducted to estimate an average reliability of the scores and to identify study characteristics that explained the heterogeneity among scores. Using Kuder-Richardson 20 (KR-20) and Cronbach's α, a total of 23 and 20 independent samples were included in the meta-analysis for the FOCI and C-FOCI. RESULTS: We found an average KR-20 of 0.826 for the FOCI's Symptom Checklist and an α of 0.882 FOCI's Symptom Severity. An average KR-20 of 0.740 was found for the C-FOCI's Symptom Checklist, while an average α of 0.794 was found for the C-FOCI's Symptom Severity. Moderator analyses showed that the source of the coefficients (i.e., whether they were reported by the authors of the primary study or estimated by the meta-analysts) was an important variable for the FOCI Symptom Severity, and that the focus of the study (i.e., whether it was psychometric or applied) and the sample size were relevant for the C-FOCI Symptom Checklist. CONCLUSIONS: Considering that the FOCI and C-FOCI are scales characterized by their brevity and ease of use, and the reliabilities obtained here, both scales are well suited for screening purposes.

A meta-review of transparency and reproducibility-related reporting practices in published meta-analyses on clinical psychological interventions (2000-2020).

Meta-analysis is a powerful and important tool to synthesize the literature about a research topic. Like other kinds of research, meta-analyses must be reproducible to be compliant with the principles of the scientific method. Furthermore, reproducible meta-analyses can be easily updated with new data and reanalysed applying new and more refined analysis techniques. We attempted to empirically assess the prevalence of transparency and reproducibility-related reporting practices in published meta-analyses from clinical psychology by examining a random sample of 100 meta-analyses. Our purpose was to identify the key points that could be improved, with the aim of providing some recommendations for carrying out reproducible meta-analyses. We conducted a meta-review of meta-analyses of psychological interventions published between 2000 and 2020. We searched PubMed, PsycInfo and Web of Science databases. A structured coding form to assess transparency indicators was created based on previous studies and existing meta-analysis guidelines. We found major issues concerning: completely reproducible search procedures report, specification of the exact method to compute effect sizes, choice of weighting factors and estimators, lack of availability of the raw statistics used to compute the effect size and of interoperability of available data, and practically total absence of analysis script code sharing. Based on our findings, we conclude with recommendations intended to improve the transparency, openness, and reproducibility-related reporting practices of meta-analyses in clinical psychology and related areas.

Homicide as a Source of Posttraumatic Stress?: A Meta-Analysis of the Prevalence of Posttraumatic Stress Disorder After Committing Homicide.

There is a growing body of literature on the diagnosis of posttraumatic stress disorder (PTSD) after committing homicide that has examined the prevalence of this phenomenon among individuals who have been convicted, but these studies considerably vary. The present study was the first meta-analysis to synthesize scientific evidence regarding the prevalence of offense-related PTSD among convicted killers. A total of 691 articles were identified through an initial screening process, and the final analysis included 11 studies that met the analysis criteria. We examined the prevalence of PTSD after committing homicide and explored how these rates varied by sample type, offender type, diagnosis timeframe, and diagnosis type. Among adult offenders, the pooled prevalence was 42.6%, 95% CI [38.0%, 47.4%], for current full-criteria homicide-related PTSD and 13.1%, 95% CI [9.9%, 17.2%], for current partial-criteria homicide-related PTSD. For mixed offenders (i.e., killers and violent offenders), the pooled prevalence of current full-criteria offense-related PTSD was 33.1% (95% CI [14.1, 59.8]). Thus, we found that PTSD prevalence was higher in killers than mixed offenders, although this difference was not statistically significant. Finally, among youth mixed offenders, the pooled prevalence for current full-criteria offense-related PTSD was 5.3%, 95% CI [2.9%, 9.5%]. These findings provide evidence of the high rate of this phenomenon, especially among convicted adults.

Are the Current Cardiac Rehabilitation Programs Optimized to Improve Cardiorespiratory Fitness in Patients? A Meta-Analysis.

Previous meta-analyses have shown that high-intensity interval training (HIIT) is more suitable than moderate continuous training (MCT) for improving peak oxygen uptake (VO2peak) in patients with coronary artery disease. However, none of these meta-analyses have tried to explain the heterogeneity of the empirical studies in optimizing cardiac rehabilitation programs. Therefore, our aims were (a) to estimate the effect of MCT and HIIT on VO2peak, and (b) to find the potential moderator variables. A search was conducted in PubMed, Scopus, and ScienceDirect. Out of the 3,110 references retrieved, 29 studies fulfilled the selection criteria to be included in our meta-analysis. The mean difference was used as the effect size index. Our results showed significant enhancements in VO2peak after cardiac rehabilitation based on MCT and HIIT (mean difference = 3.23; 95% confidence interval [2.81, 3.65] ml·kg-1·min-1 and mean difference = 4.61; 95% confidence interval [4.02, 5.19] ml·kg-1·min-1, respectively), with greater increases after HIIT (p < .001). Heterogeneity analyses reached statistical significance with moderate heterogeneity for MCT (p < .001; I2 = 67.0%), whereas no heterogeneity was found for the effect of HIIT (p = .220; I2 = 22.0%). Subgroup analyses showed significant between-group heterogeneity of the MCT-induced effect based on the training mode (p < .001; I2 = 90.4%), the risk of a new event (p = .010; I2 = 77.4%), the type of cardiovascular event (p = .009; I2 = 84.8%), the wait time to start cardiac rehabilitation (p = .010; I2 = 76.6%), and participant allocation (p = .002; I2 = 89.9%). Meta-regressions revealed that the percentages of patients undergoing a revascularization procedure (B = -0.022; p = .041) and cardiorespiratory fitness at baseline (B = -0.103; p = .025) were inversely related to the MCT-induced effect on the VO2peak.

The Padua Inventory-Washington State University Revision of Obsessions and Compulsions: A Reliability Generalization Meta-Analysis.

The Padua Inventory-Washington State University Revision (PI-WSUR) is a frequently used test to assess obsessive-compulsive symptoms in screening and clinical contexts. A reliability generalization meta-analysis was carried out to estimate the average reliability of the PI-WSUR scores and its subscales and to search for characteristics of the studies that can explain the heterogeneity among reliability coefficients. A total of 124 independent samples reported some coefficient alpha or test-retest correlation with the data at hand for the PI-WSUR scores. The average internal consistency reliability of the PI-WSUR total scores was .929 (95% CI [.922, .936]), and for the subscales, the means ranged from .792 to .900. The test-retest reliability for PI-WSUR total scores was .767 (95% CI [.700, .820]), with the subscales ranging from .540 to .790. Moderator analyses revealed a positive relationship between the standard deviation of PI-WSUR total scores and alpha coefficients, as well as higher reliability estimates for the original version of the test and for studies from North America. The reliability induction rate for the PI-WSUR was 53.7%. Regarding reliability, the PI-WSUR ranks among the best scales for assessing obsessive-compulsive symptoms. Internal consistency reliability was excellent for the PI-WSUR total score and good for the subscales.

Psychological treatment for family members of children with cancer: A systematic review and meta-analysis.

OBJECTIVE: This meta-analytical study examined the effects of psychological treatments applied to family members of children and adolescents with cancer, as well as the characteristics of the studies that can be associated with their effects. METHODS: Four databases were searched between January 1980 and January 2017; the references of the located studies were reviewed, and emails were sent to experts in this topic. Forty articles fulfilled the selection criteria. The standardized mean pretest-posttest (or pretest-follow-up) change was used as the effect-size index for the treatment and control groups. RESULTS: The 40 articles included 40 treatment groups and 21 control groups. When treatment and control pretest-posttest mean effects were compared, psychological interventions revealed positive, statistically significant results for anxiety (dadj  = 0.339) and problem-solving skills (dadj  = 0.385) and, to a lesser extent, for posttraumatic stress (dadj  = 0.224). No statistically significant differences were found for mood (dadj  = 0.147), acute stress (dadj  = -0.010), coping skills (dadj  = 0.123), social support (dadj  = 0.245), or quality of life (dadj  = 0.538). CONCLUSIONS: Positive effects of mild to moderate magnitude were found in the posttests for some outcome measures. Behavioral interventions seem to be the most promising. Interventions achieved the best results when they were long in duration and low in intensity and when they were applied to family members with young children who were undergoing medical treatment. At follow-up, the intervention benefits were diminished. The application of psychological interventions is recommended to mitigate the negative psychological repercussions in this population.

A methodological review of meta-analyses of the effectiveness of clinical psychology treatments.

This article presents a methodological review of 54 meta-analyses of the effectiveness of clinical psychological treatments, using standardized mean differences as the effect size index. We statistically analyzed the distribution of the number of studies of the meta-analyses, the distribution of the sample sizes in the studies of each meta-analysis, the distribution of the effect sizes in each of the meta-analyses, the distribution of the between-studies variance values, and the Pearson correlations between effect size and sample size in each meta-analysis. The results are presented as a function of the type of standardized mean difference: posttest standardized mean difference, standardized mean change from pretest to posttest, and standardized mean change difference between groups. These findings will help researchers design future Monte Carlo and theoretical studies on the performance of meta-analytic procedures, based on the manipulation of realistic model assumptions and parameters of the meta-analyses. Furthermore, the analysis of the distribution of the mean effect sizes through the meta-analyses provides a specific guide for the interpretation of the clinical significance of the different types of standardized mean differences within the field of the evaluation of clinical psychological interventions.

Reliability generalization study of the Yale-Brown Obsessive-Compulsive Scale for children and adolescents.

The Yale-Brown Obsessive-Compulsive Scale for children and adolescents (CY-BOCS) is a frequently applied test to assess obsessive-compulsive symptoms. We conducted a reliability generalization meta-analysis on the CY-BOCS to estimate the average reliability, search for reliability moderators, and propose a predictive model that researchers and clinicians can use to estimate the expected reliability of the CY-BOCS scores. A total of 47 studies reporting a reliability coefficient with the data at hand were included in the meta-analysis. The results showed good reliability and a large variability associated to the standard deviation of total scores and sample size.

Meta-analysis of multiple outcomes: a multilevel approach.

In meta-analysis, dependent effect sizes are very common. An example is where in one or more studies the effect of an intervention is evaluated on multiple outcome variables for the same sample of participants. In this paper, we evaluate a three-level meta-analytic model to account for this kind of dependence, extending the simulation results of Van den Noortgate, López-López, Marín-Martínez, and Sánchez-Meca Behavior Research Methods, 45, 576-594 (2013) by allowing for a variation in the number of effect sizes per study, in the between-study variance, in the correlations between pairs of outcomes, and in the sample size of the studies. At the same time, we explore the performance of the approach if the outcomes used in a study can be regarded as a random sample from a population of outcomes. We conclude that although this approach is relatively simple and does not require prior estimates of the sampling covariances between effect sizes, it gives appropriate mean effect size estimates, standard error estimates, and confidence interval coverage proportions in a variety of realistic situations.

Prevalence of low back pain in children and adolescents: a meta-analysis.

BACKGROUND: Low back pain (LBP) is common in children and adolescents, and it is becoming a public health concern. In recent years there has been a considerable increase in research studies that examine the prevalence of LBP in this population, but studies exhibit great variability in the prevalence rates reported. The purpose of this research was to examine, by means of a meta-analytic investigation, the prevalence rates of LBP in children and adolescents. METHODS: Studies were located from computerized databases (ISI Web of Knowledge, MedLine, PEDro, IME, LILACS, and CINAHL) and other sources. The search period extended to April 2011. To be included in the meta-analysis, studies had to report a prevalence rate (whether point, period or lifetime prevalence) of LBP in children and/or adolescents (≤ 18 years old). Two independent researchers coded the moderator variables of the studies, and extracted the prevalence rates. Separate meta-analyses were carried out for the different types of prevalence in order to avoid dependence problems. In each meta-analysis, a random-effects model was assumed to carry out the statistical analyses. RESULTS: A total of 59 articles fulfilled the selection criteria. The mean point prevalence obtained from 10 studies was 0.120 (95% CI: 0.09 and 0.159). The mean period prevalence at 12 months obtained from 13 studies was 0.336 (95% CI: 0.269 and 0.410), whereas the mean period prevalence at one week obtained from six studies was 0.177 (95% CI: 0.124 and 0.247). The mean lifetime prevalence obtained from 30 studies was 0.399 (95% CI: 0.342 and 0.459). Lifetime prevalence exhibited a positive, statistically significant relationship with the mean age of the participants in the samples and with the publication year of the studies. CONCLUSIONS: The most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.

Physical therapy treatments for low back pain in children and adolescents: a meta-analysis.

BACKGROUND: Low back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents. METHODS: Studies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments). RESULTS: Eight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant. CONCLUSIONS: Of all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.

Three-level meta-analysis of dependent effect sizes.

Although dependence in effect sizes is ubiquitous, commonly used meta-analytic methods assume independent effect sizes. We describe and illustrate three-level extensions of a mixed effects meta-analytic model that accounts for various sources of dependence within and across studies, because multilevel extensions of meta-analytic models still are not well known. We also present a three-level model for the common case where, within studies, multiple effect sizes are calculated using the same sample. Whereas this approach is relatively simple and does not require imputing values for the unknown sampling covariances, it has hardly been used, and its performance has not been empirically investigated. Therefore, we set up a simulation study, showing that also in this situation, a three-level approach yields valid results: Estimates of the treatment effects and the corresponding standard errors are unbiased.

Perfectionism and binge eating association: a systematic review and meta-analysis.

BACKGROUND: Perfectionism is considered a vulnerability factor for eating disorders. However, the role of perfectionism in binge eating needs clarification due to notably inconsistencies between studies. The purpose to this study was to conduct a systematic review and meta-analysis to estimate the perfectionism-binge eating association. METHOD: Systematic review was performed according to the PRISMA 2020 statement. Four databases (Web of Science, Scopus, PsycINFO and Psicodoc) were searched to identify studies published until September 2022. The literature search yielded 30 published articles (N = 9392) that provided 33 independent estimations of the correlation between the two variables. RESULTS: Random-effects meta-analysis revealed a small-to-moderate positive average effect size between general perfectionism and binge eating (r+ = .17) with a large heterogeneity. Perfectionistic Concerns showed a significant small-to-moderate relationship with binge eating (r+ = .27), whereas Perfectionistic Strivings presented a negligible relationship with binge eating (r+ = .07). Moderator analyses showed that the age, the type of the sample, the study design, and the tools for assessing both variables were statistically associated with the perfectionism-binge eating effect sizes. CONCLUSIONS: Our findings suggest that Perfectionism Concerns are closely associated with binge eating symptomatology. This relationship might be moderated by certain variables, especially by the clinical or non-clinical nature of the sample and the instrument employed to assess binge eating.

Perfectionism is a trait of personality comprising two facets, Perfectionistic Strivings (entails the desire to reach perfection and to pursue unrealistically high standards) and Perfectionistic Concerns (involves self-criticism, concerns over making mistakes, fears about social negative evaluation and lack of satisfaction with achievements). Perfectionist individuals have an increased risk for developing eating disorders. However, whether perfectionism or any of its facets is associated with binge eating (an episode of overeating together with a feeling of loss of control) is an unanswered question. The purpose of this systematic review and meta-analysis was to clarify this question. Our results evidenced that overall perfectionism is associated with binge eating. It means that perfectionist people are more vulnerable to developing binge eating symptomatology, although Perfectionistic Concerns entails a higher risk in comparison with Perfectionistic Strivings. Our study also provides valuable information on the aspects that might explain the variations in the results of previous studies that have analyzed the perfectionism-binge eating association.

Peripheral venous catheter-related phlebitis: A meta-analysis of topical treatment.

AIM: To systematically evaluate the efficacy of different topical treatments for PVC-related phlebitis in hospital in-patients. DESIGN: A systematic review and meta-analysis. METHODS: A selection was made of experimental and quasi-experimental studies published in English or Spanish. These should provide data on the degree of phlebitis, pain and infiltration (means and standard deviations, mainly) of hospitalized patients with phlebitis secondary to peripheral venous catheter. All those studies that reflected systemic or exclusive prevention treatments were excluded. Searches were from inception to April 2020. The date of data collection was from December 2020 to May 2021. The selection criteria were based on the PICOS model. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS: Twelve studies (726 patients) met the inclusion criteria. With respect to the decrease in the degree of phlebitis, was found ichthammol glycerine, followed by heparinoids. As for degree of pain, sesame oil obtained the most marked reduction. In terms of degree of infiltration, heparinoids and ichthammol glycerine were the only products to achieve a statistically significant reduction. The most important limitations are the low quantity and quality of the trials included. Insufficient data are available to draw valid conclusions about the efficacy of any treatment.

Preventive physiotherapy interventions for back care in children and adolescents: a meta-analysis.

BACKGROUND: Preventive interventions improve healthy behaviours and they also increase knowledge regarding back care in children and adolescents, but studies exhibit great variability in their contents, duration and number of sessions, and in the assessment methods. The purpose of this study was to review the empirical evidence regarding preventive physiotherapy interventions for back care in children and adolescents, and to ascertain the most efficacious treatments, in what way and under which circumstances. METHODS: Studies were located from computerized databases (Cochrane Library, Medline, PEDro, Web of Science and IME) and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents, and to compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviours and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses and sensitivity analyses were carried out in order to check the robustness of the meta-analytic results. RESULTS: A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviours acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest; d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists. CONCLUSIONS: The interventions were successful in significantly increasing the behaviours and knowledge acquired both in the posttest and in the follow-up. The combined treatment of postural hygiene with physiotherapy exercise exhibited the best results. The small number of studies limits the generalizability of the results.

Overviews of Reviews: Concept and Development.

BACKGROUND: In the last years, overviews of systematic reviews, or umbrella reviews, have seen a dramatic increase in their use. An overview aims to provide a summary of the included reviews and will often examine research questions beyond those addressed in the systematic reviews being synthesised. The purpose of this article is to provide some recommendations on how overviews should be conducted and reported. METHOD: A literature review was performed to identify relevant papers on both methodological and applied overviews. RESULTS: The current literature recommends carrying out overviews by following similar steps to those of systematic reviews: (a) Defining the overview research question; (b) inclusion and exclusion criteria; (c) literature search; (d) data extraction; (e) assessment of risk of bias and reporting quality; (f) overview results; and (g) reporting the overview. Of special interest is how to address dependencies between the systematic reviews. CONCLUSIONS: Overviews allow evidence to be efficiently combined from multiple systematic reviews. This offers the possibility of translating and summarizing large amounts of information. As in primary studies and systematic reviews, conducting and reporting of overviews must meet appropriate quality standards.

A Meta-analysis of Gut Microbiota in Children with Autism.

Previous studies have reported dysbiosis in the gut microbiota (GM) of children with autism spectrum disorders (ASD), which may be a determining factor on child development through the microbiota-gut-brain axis. However, it is not clear if there is a specific group of dysbiotic bacteria in ASD. The aim of this study was to carry out a meta-analysis on the studies that analyze GM in children with ASD. 18 studies fulfilled our selection criteria. Our results showed a lower relative abundance of Streptococcus (SMD+ = - 0.999; 95% CI - 1.549, - 0.449) and Bifidobacterium genera (SMD+ = - 0.513; 95% CI - 0.953, - 0.073) in children with ASD. Overall, the Bifidobacterium genera is involved. However, differences found between studies are attributed to factors such as reporting bias.

Cognitive-Behavioral Therapy and Anxiety and Depression Level in Pediatric Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis.

BACKGROUND: Although some meta-analyses have identified potential moderators associated with treatment outcomes for pediatric obsessive-compulsive disorder (OCD), there is as yet no consensus regarding the influence of anxiety and depression symptoms on the recovery from pediatric OCD. A meta-analysis was conducted to investigate the effects of depression and anxiety symptoms and their comorbidities on the efficacy of CBT in pediatric OCD, as well as other potential moderators that may be associated with outcomes. METHOD: An exhaustive literature search from 1983 to March 2021 located 22 published articles that applied cognitive-behavioral therapy (CBT) to pediatric OCD, producing a total of 26 treatment groups. Some of the moderator variables analyzed included age, gender, comorbidity baseline in anxiety, depression and obsession, and methodological quality. RESULTS: Results showed that the psychological treatment of OCD achieves clinically significant effectiveness, both for measures of obsessions and compulsions ( d + = 2.030), and for anxiety ( d + = 0.613) and depression ( d + = 0.451). An explanatory model for the CY-BOCS effect sizes showed that three moderator variables were statistically related: the mean of the CY-BOCS (Children´s Yale Brown Obsessive Compulsive Scale) in pretest, the effect size for anxiety, and the mean age of the sample. CONCLUSIONS: CBT reduced obsessive-compulsive symptoms and, to a lesser extent, anxiety and depression symptoms. Since anxiety symptoms are reduced with the same therapy, resources would be saved compared to other treatments.