Department of Psychiatry and Behavioral Sciences, College of Medicine, and Terrorism and Disaster Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Compr Psychiatry. 2014 Jan;55(1):11-24. doi: 10.1016/j.comppsych.2013.08.014. Epub 2013 Oct 8.
In the last decade, the development of community-based and clinical interventions to assist children and adolescents after a disaster has become an international priority. Clinicians and researchers have begun to scientifically evaluate these interventions despite challenging conditions. The objective of this study was to conduct a systematic review of the research methodology used in studies of child disaster mental health interventions for posttraumatic stress.
This scientifically rigorous analysis used standards for methodological rigor of psychosocial treatments for posttraumatic stress disorder (PTSD) to examine 29 intervention studies.
This analysis revealed that further refinement of methodology is needed to determine if certain intervention approaches are superior to other approaches and if they provide benefit beyond natural recovery. Most studies (93.1%) clearly described the interventions being tested or used manuals to guide application and most (89.7%) used standardized instruments to measure outcomes, and many used random assignment (69.0%) and provided assessor training (65.5%). Fewer studies used blinded assessment (44.8%) or measured treatment adherence (48.3%), and sample size in most studies (82.8%) was not adequate to detect small effects generally expected when comparing two active interventions. Moreover, it is unclear what constitutes meaningful change in relation to treatment especially for the numerous interventions administered to children in the general population.
Overall, the results are inconclusive about which children, what settings, and what approaches are most likely to be beneficial.
在过去十年中，针对灾难后儿童和青少年的基于社区和临床的干预措施的发展已成为国际重点。临床医生和研究人员已开始对这些干预措施进行科学评估，尽管条件具有挑战性。本研究的目的是对创伤后应激障碍儿童灾难心理健康干预研究中使用的研究方法进行系统评价。
本研究采用创伤后应激障碍心理社会治疗方法严谨性标准，对 29 项干预研究进行了科学严谨的分析。
该分析表明，需要进一步改进方法学，以确定某些干预方法是否优于其他方法，以及它们是否提供了超越自然恢复的益处。大多数研究（93.1%）清楚地描述了正在测试的干预措施或使用手册来指导应用，大多数研究（89.7%）使用标准化工具来衡量结果，许多研究使用随机分配（69.0%）和提供评估者培训（65.5%）。较少的研究使用盲法评估（44.8%）或测量治疗依从性（48.3%），并且大多数研究的样本量（82.8%）不足以检测到在比较两种积极干预措施时通常预期的小效应。此外，尚不清楚在治疗方面什么构成有意义的变化，尤其是对于在普通人群中向儿童提供的众多干预措施。
总体而言，结果不确定哪些儿童、哪些环境和哪些方法最有可能受益。
