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.-猫眼课题宝

DOI：

10.1016/s2352-4642(23)00253-5

发表时间：

2023-11

期刊：

The Lancet. Child & adolescent health

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

Anke de Haan;R. Meiser-Stedman;Markus A. Landolt;Isla Kuhn;Melissa J Black;Kristel Klaus;Shivam D. Patel;David J Fisher;C. Haag;O. Ukoumunne;Benjamin G Jones;Ashraf Muwafaq Flaiyah;Claudia Catani;K. Dawson;Richard A. Bryant;C. de Roos;Verena Ertl;Edna B. Foa;Julian D Ford;E. Gilboa-Schechtman;D. Tutus;Katharin Hermenau;Tobias Hecker;Ole Hultmann;Ulf Axberg;Nasrin Jaberghaderi;T. Jensen;S. Ormhaug;J. Kenardy;Ramon Lindauer;Julia Diehle;Laura K. Murray;J. Kane;Kirsi Peltonen;Samuli Kangaslampi;K. Robjant;Anke Koebach;R. Rosner;J. Rossouw;Patrick Smith;Bruce J Tonge;C. Hitchcock;T. Dalgleish

背景现有的以创伤为焦点的认知行为疗法（CBTs-TF）的临床试验不足以检查可能调节治疗效果的关键变量。我们的目的是确定CBTs-TF对年轻人的疗效，相对于被动和主动控制条件，并阐明假定的个人水平和治疗水平moderators.MethodsThis是一个个人参与者的数据荟萃分析发表和未发表的随机研究，在年轻人年龄在6 - 18岁暴露于创伤。我们纳入了最新的英国国家健康与护理卓越研究所指南（于2018年1月29日完成）确定的研究，并更新了他们的检索。检索策略包括数据库检索，仅限于2018年1月1日至2019年11月12日期间的出版物;试验注册中心ClinicalTrials.gov和ISRCTN的灰色文献检索;预印本档案PsyArXiv和bioRxiv;以及使用社交媒体和电子邮件发送给关键作者，以识别任何未发表的数据集。主要结果是治疗后的创伤后应激症状（最后一次治疗后<1个月）。主要是一阶段随机效应模型拟合。该研究在PROSPERO注册，CRD 42019151954。结果我们确定了38项研究; 25项研究提供了个体参与者数据，包括1686名年轻人（平均年龄13·65岁[SD 3·01]），其中802名接受CBTs-TF，884名为对照组。偏倚风险评估表明，5项研究为低风险，20项研究存在一些问题。在调整治疗前的创伤后应激症状后，接受CBTs-TF的参与者在治疗后的平均创伤后应激症状低于接受对照条件的参与者（B=−13·17，95% CI −17·84至−8·50，p<0·001，τ2=103·72）。适度分析表明，CBTs-TF对治疗后创伤后应激症状的影响增加了0.15个单位（B=− 0.15，95%CI − 0.29至− 0.01，p= 0.041，τ2= 0.03），治疗前创伤后应激症状每增加一个单位。我们的研究结果支持CBTs-TF作为一线治疗，无论年龄，性别，创伤特征，或照顾者参与治疗，特别是对那些有较高的初始痛苦的好处。

BackgroundExisting 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and treatment-level moderators.MethodsThis was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6−18 years exposed to trauma.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.FindingsWe 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.InterpretationThis 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.FundingSwiss National Science Foundation.

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.

文献摘要

相似文献