National Centre for Population Health and Wellbeing, School of Medicine, Swansea University, Swansea, United Kingdom.
School of Human Sciences, Bangor University, Wrexham, United Kingdom.
PLoS One. 2024 Sep 6;19(9):e0293248. doi: 10.1371/journal.pone.0293248. eCollection 2024.
Exposure to adverse childhood experiences (ACEs) is recognised globally as a risk factor for health problems in later life. Awareness of ACEs and associated trauma is increasing within schools and educational settings, as well as the demand for supportive services to address needs. However, there is a lack of clear evidence for effective interventions which can be delivered by non-clinicians (e.g., the school staff themselves). Thus, we undertook a systematic review to answer the question: What evidence exists for the efficacy of non-clinician delivered trauma-based interventions for improving mental health in school-age youth (4-18 years) who have experienced ACEs? The protocol for the review is registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023417286). We conducted a search across five electronic databases for studies published between January 2013 and April 2023 that reported on interventions suitable for non-clinician delivery, were published in English in the last 10 years, and involved participants aged 4-18 years (school-age) that had exposure to ACEs. Of the 4097 studies identified through the search, 326 were retrieved for full text screening, and 25 were included in the final review. Data were extracted from included articles for analysis and selected studies were quality assessed using validated assessment tools. Data were analysed through narrative synthesis. There was considerable heterogeneity in study design, outcome measures, and the interventions being studied. Interventions included CBT, mindfulness and art-based programs. A key finding was that there is a lack of high-quality research evidence to inform non-clinician delivered trauma-informed interventions. Many included studies were weak quality due to convenience sampling of participants and potential bias. Cognitive Behavioural Therapy (CBT)-based approaches are tentatively suggested as a suitable target for future rigorous evaluations of interventions addressing ACE-related trauma recovery and mental health improvement in school-age youth.
暴露于不良儿童经历 (ACEs) 被全球公认为晚年健康问题的危险因素。学校和教育环境中越来越意识到 ACEs 和相关创伤，以及对支持服务的需求以满足这些需求。然而，缺乏有效的干预措施的明确证据，这些干预措施可以由非临床医生（例如，学校工作人员自己）提供。因此，我们进行了系统评价，以回答以下问题：对于经历 ACEs 的学龄青少年（4-18 岁），非临床医生提供的基于创伤的干预措施在改善心理健康方面有哪些证据？该综述的方案已在 PROSPERO 国际前瞻性系统评价注册库（ID：CRD42023417286）中注册。我们在五个电子数据库中进行了搜索，以查找发表于 2013 年 1 月至 2023 年 4 月期间的研究报告，这些研究报告报道了适合非临床医生提供的干预措施，在过去 10 年内以英文发表，并且涉及暴露于 ACEs 的 4-18 岁（学龄）参与者。通过搜索共确定了 4097 项研究，其中 326 项进行了全文筛选，最终有 25 项研究纳入综述。从纳入的文章中提取数据进行分析，并使用经过验证的评估工具对选定的研究进行质量评估。通过叙述性综合分析进行数据分析。研究设计、结果测量和研究中的干预措施存在很大的异质性。干预措施包括 CBT、正念和艺术为基础的项目。一个主要发现是，缺乏高质量的研究证据来为非临床医生提供的创伤知情干预措施提供信息。由于参与者的便利抽样和潜在的偏倚，许多纳入的研究质量较弱。基于认知行为疗法 (CBT) 的方法被暂时建议作为未来严格评估针对 ACE 相关创伤恢复和学龄青少年心理健康改善的干预措施的合适目标。
