中低收入国家儿童破坏性行为问题的心理社会干预措施：系统评价和荟萃分析。
Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis.
机构信息
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
University of British Columbia, Vancouver, BC, Canada.
出版信息
J Child Psychol Psychiatry. 2018 Sep;59(9):982-993. doi: 10.1111/jcpp.12894. Epub 2018 Apr 6.
BACKGROUND
Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown.
METHODS
We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC).
RESULTS
Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95% confidence interval (CI): -0.41 to -0.09; I : 78%) and of treatment studies was -0.56 (95% CI: -0.51 to -0.24; I : 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95% CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95% CI: -0.66 to -0.20), and that interventions were effective across age ranges.
CONCLUSIONS
Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.
背景
大多数针对破坏性行为问题的心理社会干预措施的证据来自西方高收入国家。这些证据在文化多元化、资源匮乏且心理健康专家较少的低收入和中等收入国家（LMIC）的适用性尚不清楚。
方法
我们对评估心理社会干预措施对降低 LMIC 中儿童（18 岁以下）行为问题的影响的随机对照试验进行了系统评价和随机效应荟萃分析。
结果
符合选择标准的 26 项随机对照试验（代表 28 项心理社会干预措施），评估了 4441 名受试者。15 项（54%）预防干预措施针对一般或高危人群，而 13 项（46%）治疗干预措施针对因行为问题升高而选择的儿童。大多数干预措施在小组环境中实施（96%），一半（50%）由非专业人员提供。预防研究的总体效果（标准化均数差，SMD）为-0.25（95%置信区间（CI）：-0.41 至 -0.09；I²：78%），治疗研究的总体效果为-0.56（95% CI：-0.51 至 -0.24；I²：74%）。亚组分析表明，针对儿童的干预措施（SMD：-0.35；95% CI：-0.57 至 -0.14）和行为养育干预措施（SMD：-0.43；95% CI：-0.66 至 -0.20）有效，并且干预措施在各个年龄段都有效。
结论
我们的荟萃分析支持将心理社会干预措施作为在 LMIC 中降低儿童破坏性行为问题的一种可行且有效的方法。我们的研究为针对儿童的干预措施和行为养育干预措施、跨年龄段的干预措施以及小组环境中的干预措施提供了强有力的证据。需要进一步研究在 LMIC 环境中培训和监督非专业人员以及实施有效干预措施的问题。
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