增强被迫流离失所儿童心理韧性的干预措施：系统评价。

Interventions to enhance psychological resilience in forcibly displaced children: a systematic review.

机构信息

Institute for Global Health Sciences, University of California, San Francisco, California, USA

Institute for Global Health Sciences, University of California, San Francisco, California, USA.

出版信息

BMJ Glob Health. 2023 Feb;8(2). doi: 10.1136/bmjgh-2021-007320.

DOI:10.1136/bmjgh-2021-007320

PMID:36731918

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9896216/

Abstract

BACKGROUND

Children represent nearly 40% of forcibly displaced populations and are subject to stressors that affect well-being. Little is known about the effects of interventions to enhance psychological resilience in these children, outside clinical settings.

METHODS

We conducted a systematic review, following Cochrane methods. Eligible studies tested resilience-enhancing interventions outside clinical settings in forcibly displaced children/adolescents. We included longitudinal quantitative studies with comparator conditions irrespective of geographical scope or language. We searched articles published between January 2010 and April 2020 in PubMed, Embase, Cochrane Library, Web of Science, PsycINFO and the WHO's Global Index Medicus. To standardise effect sizes across the different reported outcomes, we transformed reported mean differences to standardised mean differences using Hedge's g statistic with associated 95% CI. We pooled data for meta-analysis where appropriate. We used Cochrane tools to assess study risk of bias and used Grading of Recommendations Assessment, Development and Evaluation to determine evidence quality for meta-analysed outcomes.

RESULTS

Searches yielded 4829 results. Twenty-three studies met inclusion criteria. Studies reported 18 outcomes measured by 48 different scales; only 1 study explicitly measured resilience. Eight studies were randomised controlled trials; the rest were non-randomised pre-post studies. Interventions were diverse and typically implemented in group settings. Studies reported significant improvement in outcomes pertinent to behavioural problems, coping mechanisms and general well-being but not to caregiver support or psychiatric symptoms. In meta-analysis, resilience was improved (g=0.194, 95% CI 0.018 to 0.369), but anxiety symptoms and quality of life were not (g=-0.326, 95% CI -0.782 to 0.131 and g=0.325, 95% CI -0.027 to 0.678, respectively). Risk of bias varied. Quality of evidence for most graded outcomes was very low.

CONCLUSIONS

The multiplicity of study designs, intervention types, outcomes and measures incumbered quantifying intervention effectiveness. Future resilience research in this population should use rigorous methods and follow reporting guidelines.

PROSPERO REGISTRATION NUMBER

CRD42020177069.

摘要

背景

儿童约占被迫流离失所人口的 40%，他们承受着影响福祉的压力。在临床环境之外，人们对增强这些儿童心理弹性的干预措施的效果知之甚少。

方法

我们按照 Cochrane 的方法进行了系统评价。合格的研究在被迫流离失所的儿童/青少年的临床环境之外测试了增强弹性的干预措施。我们纳入了有对照条件的纵向定量研究，无论地理范围或语言如何。我们在 PubMed、Embase、Cochrane 图书馆、Web of Science、PsycINFO 和世卫组织全球医学索引中搜索了 2010 年 1 月至 2020 年 4 月期间发表的文章。为了使不同报告结果的效应大小标准化，我们使用 Hedge's g 统计量将报告的均值差异转换为标准化均值差异，并带有相关的 95%置信区间。在适当的情况下，我们对数据进行了汇总以进行荟萃分析。我们使用 Cochrane 工具评估研究的偏倚风险，并使用 Grading of Recommendations Assessment, Development and Evaluation 确定荟萃分析结果的证据质量。

结果

搜索结果产生了 4829 个结果。23 项研究符合纳入标准。研究报告了 18 个由 48 个不同量表测量的结果；只有 1 项研究明确测量了韧性。8 项研究是随机对照试验；其余的是非随机的前后研究。干预措施多种多样，通常在小组环境中实施。研究报告称，在行为问题、应对机制和一般幸福感方面的结果显著改善，但在照顾者支持或精神症状方面没有改善。荟萃分析显示，韧性得到了提高（g=0.194，95%CI 0.018 至 0.369），但焦虑症状和生活质量没有改善（g=-0.326，95%CI-0.782 至 0.131 和 g=0.325，95%CI-0.027 至 0.678）。偏倚风险各不相同。大多数分级结果的证据质量都很低。