Uppendahl Jana R, Alozkan-Sever Cansu, Cuijpers Pim, de Vries Ralph, Sijbrandij Marit
Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.
Medical Library, Vrije Universiteit, Amsterdam, Netherlands.
Front Psychiatry. 2020 Feb 18;10:933. doi: 10.3389/fpsyt.2019.00933. eCollection 2019.
In low- and middle-income countries, rates of common mental health disorders are found to be very high among children and adolescents while individuals, particularly in these countries, face barriers to mental health care. In the recent years, randomized controlled trials (RCTs) have been conducted that implemented and tested different psychological and psychosocial treatment approaches to treat common mental disorders. This review aims to analyze psychological interventions among children and adolescents in low- and middle-income countries.
RCTs carried out in low- and middle-income countries on psychological and psychosocial interventions for children and adolescents with symptoms of trauma- and stressor related disorders, depression or anxiety were identified in bibliographic databases. Databases were systematically searched until December 14, 2018. Effect sizes indicating differences between treatment and control groups at post-test were computed using a random-effects model. Outcomes were symptoms of depression, anxiety and posttraumatic stress disorder (PTSD).
Thirteen studies with a total of 2,626 participants aged between 5 and 18 years were included. Treatments varied between studies and number of treatment sessions ranged from 1 to 16. The pooled effect size, combining outcomes of depression, anxiety and PTSD of psychological or psychosocial intervention versus care-as-usual or a control conditions yielded a medium effect ( = 0.62; 95% CI: 0.27-0.98). Heterogeneity was very high ( = 94.41; 95% = 80-91). The beneficial effect of interventions increased after excluding outliers ( = 0.72; 95% : 0.37-1.07), while heterogeneity remained high ( = 86.12; 95% = 87-94).
High quality RCTs investigating the effect of psychological and psychosocial interventions on PTSD, depression and anxiety among children and adolescents in low- and middle-income countries are scarce. Results of the available studies may suggest that psychological and psychosocial interventions might be more effective in reducing symptoms of anxiety, depression and PTSD compared to control conditions. Due to very high heterogeneity, this evidence must be considered with caution.
在低收入和中等收入国家，儿童和青少年中常见精神障碍的发病率很高，而这些国家的个人，尤其是儿童和青少年，在获得精神卫生保健方面面临障碍。近年来，已经开展了随机对照试验（RCT），实施并测试了不同的心理和社会心理治疗方法来治疗常见精神障碍。本综述旨在分析低收入和中等收入国家儿童和青少年的心理干预措施。
在文献数据库中识别在低收入和中等收入国家开展的、针对有创伤和应激源相关障碍、抑郁或焦虑症状的儿童和青少年进行心理和社会心理干预的随机对照试验。对数据库进行系统检索，直至2018年12月14日。使用随机效应模型计算表明治疗组和对照组在测试后差异的效应量。结果指标为抑郁、焦虑和创伤后应激障碍（PTSD）的症状。
纳入了13项研究，共有2626名年龄在5至18岁之间的参与者。各研究的治疗方法不同，治疗疗程数从1至16不等。将心理或社会心理干预与常规护理或对照条件相比，综合抑郁、焦虑和PTSD结果的合并效应量为中等效应（=0.62；95%可信区间：0.27 - 0.98）。异质性非常高（=94.41；95% = 80 - 91）。排除异常值后，干预的有益效果有所增加（=0.72；95% ：0.37 - 1.07），而异质性仍然很高（=86.12；95% = 87 - 94）。
在低收入和中等收入国家，针对儿童和青少年创伤后应激障碍、抑郁和焦虑进行心理和社会心理干预效果的高质量随机对照试验很少。现有研究结果可能表明，与对照条件相比，心理和社会心理干预在减轻焦虑、抑郁和创伤后应激障碍症状方面可能更有效。由于异质性非常高，对这一证据必须谨慎考虑。
