A mental health intervention for schoolchildren exposed to violence - A randomized controlled trial
A mental health intervention for schoolchildren exposed to violence - A randomized controlled trial
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DOI：
10.1001/jama.290.5.603
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发表时间：
2003-08-06
影响因子：
120.7
通讯作者：
Fink, A
中科院分区：
文献类型：
--
作者：
Stein, BD;Jaycox, LH;Fink, A
背景没有随机对照研究已经进行了心理干预的有效性与创伤后应激障碍（PTSD）的症状，已导致亲自目睹或亲自暴露于暴力的儿童到目前为止。设计一项2001年至2009年进行的随机对照试验，背景和参与者：来自洛杉矶两所大型中学的六年级学生，他们报告暴露于暴力，并有临床水平的PTSD症状。干预学生被随机分配到一个10节的标准化认知行为治疗（学校创伤认知行为干预）早期干预组（n = 61）或等待名单延迟干预对照组（n = 65）进行了培训的学校心理健康临床医生。主要结果措施学生进行了评估干预前和3个月后的措施，评估儿童报告的PTSD症状（儿童PTSD症状量表;范围，0-51分）和抑郁症（儿童抑郁量表;范围，0-52分），父母报告的心理社会功能障碍（儿科症状检查表;范围，0-70分），以及教师使用教师-儿童评定量表报告的课堂问题（表现出，害羞/焦虑和学习问题;结果延迟干预组与等待干预组比较，差异有统计学意义（P < 0. 05（无干预），干预3个月后，被随机分配到早期干预组的学生在创伤后应激障碍症状上的得分显著降低（8.9 vs 15.5，校正的平均差异，-7.0; 95%置信区间[CI]，-10.8至-3.2），抑郁症（9.4 vs 12.7，校正平均差异，-3.4; 95% CI，-6.5至-0.4）和心理社会功能障碍（12.5 vs 16.5，校正平均差异，-6.4; 95% CI，-10.4至-2.3）。在3个月时，两组之间的校正平均差异未显示教师报告的课堂问题在表现（-1.0; 95% CI，-2.5至0.5），害羞/焦虑（0.1; 95% CI，-1.5至1.7）和学习（-1.1，95% CI，-2.9至0.8）方面存在显著差异。干预6个月后，两组患者的PTSD和抑郁症状无显著差异，心理社会功能评分相似;教师在课堂行为上没有显著差异。行为团体干预可以显着减少创伤后应激障碍和抑郁症的症状，在学生谁是暴露于暴力，并可以有效地提供校园训练有素的学校，心理健康临床医生。
Context No randomized controlled studies have been conducted to date on the effectiveness of psychological interventions for children with symptoms of posttraumatic stress disorder (PTSD) that has resulted from personally witnessing or being personally exposed to violence.Objective To evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children's symptoms of PTSD and depression that has resulted from exposure to violence.Design A randomized controlled trial conducted during the 2001-2002 academic year.Setting and Participants Sixth-grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had clinical levels of symptoms of PTSD.Intervention Students were randomly assigned to a 10-session standardized cognitive-behavioral therapy (the Cognitive-Behavioral Intervention for Trauma in Schools) early intervention group (n = 61) or to a wait-list delayed intervention comparison group (n = 65) conducted by trained school mental health clinicians.Main Outcome Measures Students were assessed before the intervention and 3 months after the intervention on measures assessing child-reported symptoms of PTSD (Child PTSD Symptom Scale; range, 0-51 points) and depression (Child Depression Inventory; range, 0-52 points), parent-reported psychosocial dysfunction (Pediatric Symptom Checklist; range, 0-70 points), and teacher-reported classroom problems using the Teacher-Child Rating Scale (acting out, shyness/anxiousness, and learning problems; range of subscales, 6-30 points).Results Compared with the wait-list delayed intervention group (no intervention), after 3 months of intervention students who were randomly assigned to the early intervention group had significantly lower scores on symptoms of PTSD (8.9 vs 15.5, adjusted mean difference, -7.0; 95% confidence interval [CI], -10.8 to -3.2), depression (9.4 vs 12.7, adjusted mean difference, -3.4; 95% CI, -6.5 to -0.4), and psychosocial dysfunction (12.5 vs 16.5, adjusted mean difference, -6.4; 95% CI, -10.4 to -2.3). Adjusted mean differences between the 2 groups at 3 months did not show significant differences for teacher-reported classroom problems in acting out (-1.0; 95% CI, -2.5 to 0.5), shyness/anxiousness (0.1; 95% CI, -1.5 to 1.7), and learning (-1.1, 95% CI, -2.9 to 0.8). At 6 months, after both groups had received the intervention, the differences between the 2 groups were not significantly different for symptoms of PTSD and depression; showed similar ratings for psychosocial function; and teachers did not report significant differences in classroom behaviors.Conclusion A standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence and can be effectively delivered on school campuses by trained school-based mental health clinicians.