Malik Nabeela, Facer-Irwin Emma, Dickson Hannah, Bird Annie, MacManus Deirdre
Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Older Adults Psychiatry, North East London Foundation NHS Trust, London, England, United Kingdom.
Trauma Violence Abuse. 2023 Apr;24(2):844-857. doi: 10.1177/15248380211043890. Epub 2021 Oct 28.
Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions.
AIM/METHODS: We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions.
From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness.
Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial's that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).
与社区人群相比，创伤后应激障碍（PTSD）在监狱中的比例过高，且在一个本质上可能加剧创伤相关症状的环境中可能难以管理。关于监狱中以创伤为重点的干预措施的有效性知之甚少，而关于调节这些干预措施有效性的因素则了解更少。
目的/方法：我们使用荟萃分析技术研究了与监狱对照相比，监狱中以创伤为重点的干预措施的有效性。我们还使用荟萃回归分析来研究治疗、方法和参与者层面的调节因素，以确定提高这些干预措施有效性的因素。
从16项符合荟萃分析条件的研究中，我们发现以创伤为重点的干预措施有一个小但显著的效应量。第二阶段创伤处理干预措施和单独实施的干预措施导致PTSD症状有更大程度的减轻。使用积极治疗对照的研究产生的效应量比使用等待名单或无接触对照的研究小。治疗时长、研究质量、结果类型和性别不是治疗效果的显著调节因素。
本综述的结果令人鼓舞，但应谨慎解释。结果表明，创伤处理疗法以及以个体方式进行的以创伤为重点的干预措施在监狱中可能有效且能成功实施。然而，比较组不充分使得无法得出确凿结论。需要高质量的随机对照试验，这些试验还应测量复杂性PTSD，采用模块化治疗方法，并包括国家卫生与保健优化研究所（NICE）指南中推荐的治疗方法，如以创伤为重点的认知行为疗法和眼动脱敏再处理疗法（EMDR）。
