WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.
Cochrane Global Mental Health, University of Verona, Verona, Italy.
J Child Psychol Psychiatry. 2020 May;61(5):584-593. doi: 10.1111/jcpp.13151. Epub 2019 Nov 7.
Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways.
We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review.
We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%.
Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency.
心理学干预研究一直集中在心理干预对心理健康结果的有效性上，而没有探索干预措施如何产生有益的效果。确定干预措施发挥作用的潜在途径可能通过强调与这些途径相关的特定组成部分，从而进一步加强干预措施。
我们使用来自 11 项随机对照试验（RCT）数据集的个体参与者数据进行了预先计划的中介分析，这些试验比较了聚焦于心理社会支持的干预措施与中低收入国家（LMIC）中受人道主义危机影响的儿童的对照条件。基于生态弹性框架，我们假设（a）应对，（b）希望，（c）社会支持和（d）功能障碍在干预与 PTSD 症状之间的关系中起中介作用。我们对 Cochrane 中央对照试验注册中心（CENTRAL）、MEDLINE、PubMed、PsycARTICLES、Web of Science 以及主要的本地中低收入国家数据库进行了系统检索，检索截至 2018 年 8 月。我们使用从系统评价中包含的所有研究的研究作者获得的个体参与者数据来检验假设。
我们纳入了来自 11 项研究的 3143 名儿童（包括纳入研究的所有数据的 100%），其中来自 6 项研究的 1877 名儿童为中介分析做出了贡献。功能障碍是聚焦于心理社会支持的干预对 PTSD 的最强中介（中介系数 -0.087，标准误差 0.040）。功能障碍介导的效应的估计比例，以及调整混杂因素后，为 31%。
研究结果不支持应对、希望和社会支持的中介假设。通过功能障碍进行的中介可能代表未测量的代理测量，或者指向影响自我效能感和能动性的更广泛机制。
