低收入和中等收入国家儿童及青少年心理健康问题的校本干预措施效果：一项系统评价与荟萃分析
Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: A systematic review and meta-analysis.
作者信息
Grande Antonio Jose, Hoffmann Mauricio Scopel, Evans-Lacko Sara, Ziebold Carolina, de Miranda Claudio Torres, Mcdaid David, Tomasi Cristiane, Ribeiro Wagner Silva
机构信息
Department of Medicine, Universidade Estadual de Mato Grosso do Sul, Campo Grande, Brazil.
Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.
出版信息
Front Psychiatry. 2023 Jan 6;13:1012257. doi: 10.3389/fpsyt.2022.1012257. eCollection 2022.
BACKGROUND
Implementation of interventions to treat child and adolescent mental health problems in schools could help fill the mental health care gap in low- and middle-income countries (LMICs). Most of the evidence available come from systematic reviews on mental health prevention and promotion, and there is less evidence on treatment strategies that can be effectively delivered in schools. The aim of this review was to identify what school-based interventions have been tested to treat children and adolescents in LMICs, and how effective they are.
METHODS
We conducted a systematic review including seven electronic databases. The search was carried out in October 2022. We included randomised or non-randomised studies that evaluated school-based interventions for children or adolescents aged 6-18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems.
RESULTS
We found 39 studies with 43 different pairwise comparisons, treatment for attention-deficit and hyperactivity (ADHD), anxiety, depression, and posttraumatic stress disorder (PTSD), Conduct disorder (CD). Pooled SMD were statistically significant and showed that, overall, interventions were superior to comparators for PTSD (SMD = 0.61; 95% CI = 0.37-0.86), not statistically significant for anxiety (SMD = 0.11; 95% CI = -0.13 to 0.36), ADHD (SMD = 0.36; 95% CI = -0.15 to 0.87), and for depression (SMD = 0.80; 95% CI = -0.47 to 2.07). For CD the sample size was very small, so the results are imprecise.
CONCLUSION
A significant effect was found if we add up all interventions compared to control, suggesting that, overall, interventions delivered in the school environment are effective in reducing mental health problems among children and adolescents.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376], identifier [CRD42019129376].
背景
在学校实施干预措施以治疗儿童和青少年心理健康问题有助于填补低收入和中等收入国家（LMICs）的心理健康护理缺口。现有的大多数证据来自关于心理健康预防和促进的系统评价，而关于可在学校有效实施的治疗策略的证据较少。本评价的目的是确定在LMICs中已测试的哪些基于学校的干预措施可用于治疗儿童和青少年，以及它们的效果如何。
方法
我们进行了一项系统评价，纳入了七个电子数据库。检索于2022年10月进行。我们纳入了随机或非随机研究，这些研究评估了针对居住在LMICs且患有或有患一种或多种心理健康问题风险的6至18岁儿童或青少年的基于学校的干预措施。
结果
我们发现了39项研究，包含43种不同的两两比较，涉及注意力缺陷多动障碍（ADHD）、焦虑症、抑郁症、创伤后应激障碍（PTSD）和品行障碍（CD）的治疗。合并标准化均数差具有统计学意义，表明总体而言，干预措施在治疗PTSD方面优于对照（标准化均数差 = 0.61；95%置信区间 = 0.37 - 0.86），在治疗焦虑症（标准化均数差 = 0.11；95%置信区间 = -0.13至0.36）、ADHD（标准化均数差 = 0.36；95%置信区间 = -0.15至0.87）和抑郁症（标准化均数差 = 0.80；95%置信区间 = -0.47至2.07）方面无统计学意义。对于CD，样本量非常小，因此结果不准确。
结论
如果将所有干预措施与对照相加，发现有显著效果，这表明总体而言，在学校环境中实施的干预措施在减少儿童和青少年心理健康问题方面是有效的。
系统评价注册
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376]，标识符[CRD42019129376]。
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