Assessment of School Anti-Bullying Interventions A Meta-analysis of Randomized Clinical Trials
Assessment of School Anti-Bullying Interventions A Meta-analysis of Randomized Clinical Trials
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DOI：
10.1001/jamapediatrics.2020.3541
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发表时间：
2020-11-02
期刊：
影响因子：
26.1
通讯作者：
Arango, Celso
中科院分区：
文献类型：
--
作者：
Fraguas, David;Diaz-Caneja, Covadonga M.;Arango, Celso
重要性 欺凌是精神健康障碍的一个普遍且可改变的风险因素。尽管之前的研究支持反欺凌计划的有效性；其人群影响以及特定调节因素与结果的关联仍不清楚。 目的 评估学校反欺凌干预措施的有效性、其人群影响以及调节变量与结果之间的关联。 数据来源 使用 3 组搜索词对 Ovid MEDLINE、ERIC 和 PsycInfo 数据库进行搜索，以确定评估反欺凌的随机临床试验 (RCT) 从数据库建立到 2020 年 2 月期间发布的干预措施。还对之前的系统评价和荟萃分析中包含的文章参考文献列表进行了手动检索。 研究选择 最初的文献检索产生了 34 798 项研究。研究中包括以下文章：(1) 评估学校欺凌行为； (2) 评估反欺凌计划的有效性； （3）有RCT设计； （四）报告结果； (5)以英文出版。在确定的 16 707 项研究中，有 371 项符合全文文章审查标准；确定了 77 项随机对照试验，报告的数据允许计算效应量 (ES)。其中，69 项独立试验被纳入最终的荟萃分析数据库中。 数据提取和合成 使用随机效应和荟萃回归模型来导出 Cohen d 值，并汇集 95% CI 作为 ES 估计值，并测试调节变量和 ES 估计值之间的关联。人口影响数 (PIN) 定义为总人口中可通过干预措施预防 1 次事件的儿童人数，用于估计针对所有学生的普遍干预措施对人口影响的估计，无论个人风险如何。 主要结果和措施 主要结果是反欺凌干预措施对以下 8 个变量类别的有效性（通过 ES 衡量）和人口影响（通过 PIN 衡量）：总体欺凌、欺凌 行为、欺凌暴露、网络欺凌、阻止欺凌的态度、鼓励欺凌的态度、心理健康问题（例如焦虑和抑郁）和学校氛围，以及对试验或干预特征与结果之间潜在关联的评估。 结果 这项研究包括来自 69 项随机对照试验的 77 个样本（111 659 名参与者[干预组 56 511 名参与者，干预组 55 148 名参与者）。 对照组]）。干预组参与者的加权平均（范围）年龄为 11.1（4-17）岁，对照组参与者为 10.8（4-17）岁。干预组中女性参与者的加权平均（范围）比例为 49.9%（0%-100%），对照组为 50.5%（0%-100%）。在研究结束时，反欺凌干预措施可有效减少欺凌行为（ES，-0.150；95% CI，-0.191 至-0.109）并改善心理健康问题（ES，-0.205；95% CI，-0.277 至-0.133），针对 147 名学生总人口的通用干预措施 PIN（95% CI， 113-213） 分别为 107 和 107（95% CI，73-173）。干预持续时间与干预效果没有统计学显着相关性（干预平均[范围]持续时间，29.4[1至144]周）。在随访期间，反欺凌计划的有效性并没有随着时间的推移而减弱（平均[范围]随访，30.9 [2-104]周）。结论和相关性尽管有效性方面的 ES 较小且存在一些地区差异，但学校反欺凌干预措施对人口的影响似乎很大。有必要设计更好的试验来评估最佳干预时机和持续时间。
IMPORTANCE Bullying is a prevalent and modifiable risk factor for mental health disorders. Although previous studies have supported the effectiveness of anti-bullying programs; their population impact and the association of specific moderators with outcomes are still unclear.OBJECTIVE To assess the effectiveness of school anti-bullying interventions, their population impact, and the association between moderator variables and outcomes.DATA SOURCES A search of Ovid MEDLINE, ERIC, and PsycInfo databases was conducted using 3 sets of search terms to identify randomized clinical trials (RCTs) assessing anti-bullying interventions published from database inception through February 2020. A manual search of reference lists of articles included in previous systematic reviews and meta-analyses was also performed.STUDY SELECTION The initial literature search yielded 34 798 studies. Included in the study were articles that (1) assessed bullying at school; (2) assessed the effectiveness of an anti-bullying program; (3) had an RCT design; (4) reported results; and (5) were published in English. Of 16 707 studies identified, 371 met the criteria for review of full-text articles; 77 RCTs were identified that reported data allowing calculation of effect sizes (ESs). Of these, 69 independent trials were included in the final meta-analysis database.DATA EXTRACTION AND SYNTHESIS Random-effects and meta-regression models were used to derive Cohen d values with pooled 95% CIs as estimates of ES and to test associations between moderator variables and ES estimates. Population impact number (PIN), defined as the number of children in the total population for whom 1 event may be prevented by an intervention, was used as an estimate of the population impact of universal interventions targeting all students, regardless of individual risk.MAIN OUTCOMES AND MEASURES The main outcomes are the effectiveness (measured by ES) and the population impact (measured by the PIN) of anti-bullying interventions on the following 8 variable categories: overall bullying, bullying perpetration, bullying exposure, cyberbullying, attitudes that discourage bullying, attitudes that encourage bullying, mental health problems (eg, anxiety and depression), and school climate as well as the assessment of potential assocations between trial or intervention characteristics and outcomes.RESULTS This study included 77 samples from 69 RCTs (111 659 participants [56 511 in the intervention group and 55 148 in the control group]). The weighted mean (range) age of participants in the intervention group was 11.1 (4-17) years and 10.8 (4-17) years in the control group. The weighted mean (range) proportion of female participants in the intervention group was 49.9% (0%-100%) and 50.5% (0%-100%) in the control group. Anti-bullying interventions were efficacious in reducing bullying (ES,-0.150; 95% CI,-0.191 to-0.109) and improving mental health problems (ES,-0.205; 95% CI,-0.277 to-0.133) at study end point, with PINs for universal interventions that target the total student population of 147 (95% CI, 113-213) and 107 (95% CI, 73-173), respectively. Duration of intervention was not statistically significantly associated with intervention effectiveness (mean [range] duration of interventions, 29.4 [1 to 144] weeks). The effectiveness of anti-bullying programs did not diminish over time during follow-up (mean [range] follow-up, 30.9 [2-104] weeks).CONCLUSIONS AND RELEVANCE Despite the small ESs and some regional differences in effectiveness, the population impact of school anti-bullying interventions appeared to be substantial. Better designed trials that assess optimal intervention timing and duration are warranted.