Institute of Psychology, University of Münster, Münster, Germany.
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
Br J Psychiatry. 2023 May;222(5):196-203. doi: 10.1192/bjp.2023.24.
Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas.
To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas.
We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy.
Of the 57 eligible RCTs ( = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' = 1.09; 95% CI 0.70-1.48; = 8 trials) and multiple-trauma-related PTSD ( = 1.11; 95% CI 0.74-1.47; = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity ( = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only).
The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.
先前针对创伤后应激障碍（PTSD）儿童和青少年的心理疗法的荟萃分析并未研究当患者报告多个（而非单个）创伤时，治疗效果是否会降低。
研究当患者报告多个（而非单个）创伤时，心理干预对儿科 PTSD 的疗效是否降低。
我们于 2022 年 4 月 21 日系统地在 PsycInfo、MEDLINE、Web of Science 和 PTSDpubs 上进行了检索，并纳入了符合以下标准的随机对照试验（RCT）：（a）随机分组；（b）所有参与者均表现出部分或完全 PTSD；（c）PTSD 是主要治疗重点；（d）样本平均年龄＜19 岁；（e）样本量≥20。创伤频率被分析为疗效的一个二分类（单个创伤与≥2 个创伤）和连续（暴露次数的平均值）潜在调节因素。
在 57 项符合条件的 RCT（n=4295）中，有 51 项 RCT 纳入了定量分析。与被动对照条件相比，干预措施对单一创伤相关 PTSD（Hedges' =1.09；95%置信区间 0.70-1.48；n=8 项试验）和多重创伤相关 PTSD（ =1.11；95%置信区间 0.74-1.47；n=12）均有效。与主动对照条件相比，心理疗法在减少多重创伤相关 PTSD 方面也更有效。由于可用试验数量稀少（n=1），因此无法对单一事件 PTSD 与主动对照条件进行比较。无论其操作化方式和亚组分析如何（例如，仅针对创伤的认知行为疗法），疗效均不受创伤暴露频率的影响。
目前的证据基础表明，针对儿科 PTSD 的心理干预可以有效治疗报告单个和多个创伤的人群的 PTSD。对于单一事件创伤后的 PTSD，未来的试验需要涉及主动对照条件。
