A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
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
Tekijät: de Haan Anke, Meiser-Stedman Richard, Landolt Markus A, Kuhn Isla, Black Melissa J, Klaus Kristel, Patel Shivam D, Fisher David J, Haag Christina, Ukoumunne Obioha C, Jones Benjamin G, Flaiyah Ashraf Muwafaq, Catani Claudia, Dawson Katie, Bryant Richard A, de Roos Carlijn, Ertl Verena, Foa Edna B, Ford Julian D, Gilboa-Schechtman Eva, Tutus Dunja, Hermenau Katharin, Hecker Tobias, Hultmann Ole, Axberg Ulf, Jaberghaderi Nasrin, Jensen Tine K, Ormhaug Silje M, Kenardy Justin, Lindauer Ramon J L, Diehle Julia, Murray Laura K, Kane Jeremy C, Peltonen Kirsi, Kangaslampi Samuli, Robjant Katy, Koebach Anke, Rosner Rita, Rossouw Jaco, Smith Patrick, Tonge Bruce J, Hitchcock Caitlin, Dalgleish Tim
Kustantaja: Elsevier
Julkaisuvuosi: 2024
Journal: The Lancet Child & Adolescent Health
Tietokannassa oleva lehden nimi: The Lancet Child & Adolescent Health
Vuosikerta: 8
Numero: 1
ISSN: 2352-4642
eISSN: 2352-4650
DOI: https://doi.org/10.1016/S2352-4642(23)00253-5
Verkko-osoite: https://doi.org/10.1016/S2352-4642(23)00253-5
Rinnakkaistallenteen osoite: https://research.utu.fi/converis/portal/detail/Publication/380524192
Background
Existing 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.
Methods
This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6−18 years exposed to trauma.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and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets.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.
Findings
We 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.
Interpretation
This 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. Funding Swiss National Science Foundation.
Ladattava julkaisu This is an electronic reprint of the original article. |  |
