Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany.
Psychol Med. 2017 Aug;47(11):1893-1905. doi: 10.1017/S0033291717000496. Epub 2017 Apr 11.
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
儿童和青少年是自然灾害或人为灾害后发生创伤后应激症状的脆弱群体。鉴于全世界 18 岁以下难民人数不断增加，因此非常需要有效的治疗方法。本荟萃分析研究了人为灾害和自然灾害后针对儿童和青少年的特定心理社会治疗方法。通过对 MEDLINE、EMBASE 和 PsycINFO 进行系统文献检索，以及对手头现有综述进行手工检索和联系专业协会，确定了 36 项研究。应用随机效应和混合效应模型来检验平均效应大小和调节变量。总体而言，治疗方法在前后比较中显示出较高的效果大小（Hedges'g=1.34），与对照条件相比，效果大小为中等（Hedges'g=0.43）。至少有两项研究调查的治疗方法包括认知行为疗法（CBT）、眼动脱敏再加工（EMDR）、儿童叙事暴露疗法（KIDNET）和基于课堂的干预措施，这些方法显示出相似的效果大小。然而，这些研究在其结果方面存在很大的异质性。效果受到专业类型的调节（培训水平越高，效果越大）。存在一些针对灾害儿童和青少年幸存者的有效心理社会治疗方法。CBT、EMDR、KIDNET 和基于课堂的干预措施可以同样推荐。尽管灾难需要立即做出反应和即兴发挥，但仍需要进行具有更大样本量和更严格方法的未来研究。
