Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children.
Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children.
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DOI：
10.1016/j.jaac.2021.05.026
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发表时间：
2022-03
影响因子：
13.3
通讯作者：
Meiser-Stedman R
中科院分区：
文献类型：
--
作者：
Woolgar F;Garfield H;Dalgleish T;Meiser-Stedman R
创伤暴露在学龄前儿童中很常见。了解这种暴露的心理影响和创伤后应激障碍(PTSD)在该人群中的流行情况，对于提供适当和及时的干预非常重要。这项预先登记(PROSPERO：CRD41019133984)的系统回顾和荟萃分析研究了创伤暴露的学龄前儿童中创伤后应激障碍的患病率。对PubMed(Medline)、SqucINFO和Pilots进行文献搜索，并列出相关综述的参考列表。如果研究包括平均年龄小于6.5岁的创伤暴露样本，则选择研究，并使用标准化访谈评估创伤后至少1个月的创伤后应激障碍。提取了有关样本特征、创伤暴露、创伤后应激障碍测量和诊断标准的信息。对于应用不止一种创伤后应激障碍诊断算法的研究，使用最适合年龄的标准来估计跨研究的合并患病率估计。Meta分析采用随机效应模型。共纳入18项研究(N=1941)。当使用可用的最适合发育的诊断算法时，合并的创伤后应激障碍患病率为21.5%(95%可信区间=13.8%-30.4%)。当聚焦于同时报道标准成人标准和适龄标准(k=12)的研究子集时，标准成人标准(DSM-IV)的合并估计为4.9%(95%可信区间=2.5%-8.0%)，适龄标准(PTSD-AA)的汇总估计为19.9%(95%可信区间=12.1%-29.0%)。人际关系和重复创伤暴露后的患病率分别是非人际或单一事件创伤的3倍。当使用适合年龄的诊断工具时，发现患病率更高。各研究之间存在显著的异质性，缺乏在低收入国家进行的研究和应用适合年龄的诊断算法的研究。学龄前儿童在创伤暴露后容易患上创伤后应激障碍。在经历了不同类型的创伤后，年龄较小的儿童表现出与年龄较大的年轻人和成年人类似的流行趋势。适合年龄的诊断标准对于确保提供适当的识别和早期支持至关重要。
Trauma exposure is common in preschool-aged children. Understanding the psychological impact of such exposure and the prevalence of posttraumatic stress disorder (PTSD) in this population is important for provision of appropriate and timely intervention. This pre-registered (PROSPERO: CRD41019133984) systematic review and meta-analysis examined the prevalence of PTSD in trauma-exposed preschool-aged children. Literature searches were conducted of PubMed (Medline), PsycINFO and PILOTS, alongside reference lists of relevant reviews. Studies were selected if they comprised trauma-exposed samples with a mean age of less than 6.5 years, and PTSD was assessed using standardized interviews at least 1-month post trauma. Information on sample characteristics, trauma exposure, PTSD measurement, and diagnostic criteria were extracted. For studies that applied more than one PTSD diagnostic algorithm, the most age-appropriate criteria were used to estimate pooled prevalence estimate across studies. A random-effects model was used for meta-analysis. Eighteen studies were included (N = 1941). The pooled PTSD prevalence was 21.5% (95% CI = 13.8%-30.4%) when using the most developmentally appropriate diagnostic algorithm that was available. When focusing on the subset of studies that reported both standard adult criteria and age-appropriate criteria (k = 12), a pooled estimate of 4.9% (95% CI = 2.5%-8.0%) was obtained for standard adult criteria (DSM-IV), and 19.9% (95% CI = 12.1%-29.0%) was obtained for age-appropriate criteria (PTSD-AA). Prevalence was 3-fold higher following interpersonal and repeated trauma exposure, compared to non-interpersonal or single-event trauma, respectively. Higher prevalence was found when age-appropriate diagnostic tools were used. There was significant heterogeneity across studies and a lack of studies conducted in low-income countries and applying age-appropriate diagnostic algorithms. Preschool-aged children are vulnerable to developing PTSD following trauma exposure. Younger children show prevalence trends similar to those of older youths and adults following different types of trauma. Age-appropriate diagnostic criteria are essential to ensure that appropriate identification and early support are provided.
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3.3
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