Boldrini Tommaso, Ghiandoni Viola, Mancinelli Elisa, Salcuni Silvia, Solmi Marco
University of Padua, Via Venezia, Italy.
University of Perugia, Perugia, Italy.
J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):169-189. doi: 10.1016/j.jaac.2022.05.002. Epub 2022 May 9.
Disruptive behavior disorders (DBDs) represent a common motive for referral among youths. This meta-analysis aimed at estimating the efficacy of psychosocial interventions for adolescents with DBDs.
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of MEDLINE/PubMED/PsycINFO/Cochrane Central Register of Controlled Trials was conducted. Eligible studies were randomized controlled trials (RCTs) administering psychosocial interventions to adolescents with DBD, published before April 5, 2020. From the initial set of 6,006 records, 17 RCTs involving 18 cohorts (16 publications) were subjected to a random-effect meta-analysis (involving sensitivity, subgroup, and meta-regression analyses). Primary and secondary outcomes were externalizing symptoms at RCT endpoint (ie, standardized mean difference [SMD]) and acceptability (drop-out odds ratio [OR]), respectively. Risk of bias was assessed using the Risk of Bias 2 tool.
A total of 17 RCTs, involving 1,954 adolescents, were included. The mean age was 14.09 (SD 1.33) years; 61% were male. The mean RCT duration was 12 weeks, with a mean follow-up of 8 (SD 3.98) months. Concern over risk of bias emerged in 12 studies, with high concern in 6. Psychosocial interventions had a large effect size at RCT endpoint (SMD = 0.98, 95% CI = -0.55 to -1.38, k = 18) and were acceptable (drop-out OR = 1.29, 95% CI = 0.62-2.70, k = 13). However, this beneficial effect did not persist at follow-up (SMD = -0.36, 95% CI = 0.06 to -0.78, k = 10). Family format was the most effective variable. No other clinically significant moderator was found.
Psychosocial interventions involving the families of DBD adolescents are effective and acceptable in the short term. Future studies should focus on strategies to achieve their long-term efficacy.
破坏性行为障碍（DBDs）是青少年转诊的常见原因。本荟萃分析旨在评估针对患有DBDs的青少年的心理社会干预措施的疗效。
对MEDLINE/PubMED/PsycINFO/考克兰对照试验中心注册库进行了一项符合系统评价和荟萃分析的首选报告项目（PRISMA）的系统评价。符合条件的研究为2020年4月5日前发表的对患有DBD的青少年实施心理社会干预的随机对照试验（RCTs）。从最初的6006条记录中，选取了17项涉及18个队列（16篇出版物）的随机对照试验进行随机效应荟萃分析（包括敏感性分析、亚组分析和荟萃回归分析）。主要和次要结局分别为随机对照试验终点时的外化症状（即标准化均数差[SMD]）和可接受性（失访比值比[OR]）。使用偏倚风险2工具评估偏倚风险。
共纳入17项随机对照试验，涉及1954名青少年。平均年龄为14.09（标准差1.33）岁；61%为男性。随机对照试验的平均持续时间为12周，平均随访时间为8（标准差3.98）个月。12项研究中出现了对偏倚风险的担忧，其中6项高度担忧。心理社会干预在随机对照试验终点时具有较大的效应量（SMD = 0.98，95%CI = -0.55至-1.38，k = 18）且可接受（失访OR = 1.29，95%CI = 0.62 - 2.70，k = 13）。然而，这种有益效果在随访时并未持续（SMD = -0.36，95%CI = 0.06至-0.78，k = 10）。家庭模式是最有效的变量。未发现其他具有临床意义的调节因素。
涉及DBD青少年家庭的心理社会干预在短期内是有效且可接受的。未来的研究应关注实现其长期疗效的策略。
