Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany.
Eur J Psychotraumatol. 2024;15(1):2406136. doi: 10.1080/20008066.2024.2406136. Epub 2024 Oct 2.
Diagnostic criteria of posttraumatic stress disorder in children and adolescents and corresponding instruments have undergone significant changes over time. However, the impact of different outcome measures on treatment effects in the context of posttraumatic stress symptoms (PTSS) has not yet been explored. TF-CBT is a well-researched first-line treatment for PTSS among children and adolescents and thus, an ideal candidate to examine the potential influence of different outcome measures by meta-analysis. A comprehensive literature search was conducted in December 2023 using seven databases. Studies included RCTs as well as non-controlled studies examining the effects of TF-CBT on pediatric PTSS. We extracted treatment effects and investigated whether there were systematic differences in the effects based on the outcome measures and their underlying DSM version. In total, 76 studies (35 RCTS) met the eligibility criteria. Hedges g effect sizes with 95% confidence intervals (CI) were computed and high-risk of bias studies were excluded. No significant difference was observed between DSM-IV and DSM-5 based instruments. Individual outcome measures were found to be comparable overall, with some appearing somewhat more sensitive to change. Although a small but significant difference in true effect sizes for individual outcome measures was found, this only concerned the UCLA PTSD ( = 1.06) and the CPSS ( = 1.61) with the effect most likely being due to chance or confounding variables. TF-CBT showed large effect sizes on PTSS in within-study comparison ( = 1.32) and medium between-studies effect sizes ( = .57). While we could not establish equivalence, there seems to be no difference regarding the measurement of treatment effects based on outcome measure and underlying DSM version. The updated TF-CBT effect size confirmed it as an effective treatment for PTSS and secondary outcomes in children and adolescents.
儿童和青少年创伤后应激障碍的诊断标准和相应的工具随着时间的推移发生了重大变化。然而，不同的结局测量指标对创伤后应激症状（PTSS）治疗效果的影响尚未得到探索。TF-CBT 是儿童和青少年 PTSD 的一种经过充分研究的一线治疗方法，因此，通过荟萃分析来检查不同结局测量指标的潜在影响是一个理想的选择。我们于 2023 年 12 月使用七个数据库进行了全面的文献检索。研究包括 RCT 和非对照研究，旨在检查 TF-CBT 对儿科 PTSD 的影响。我们提取了治疗效果，并研究了根据结局测量指标及其潜在的 DSM 版本，这些效果是否存在系统差异。共有 76 项研究（35 项 RCT）符合入选标准。计算了具有 95%置信区间（CI）的 Hedges g 效应大小，并排除了高偏倚风险的研究。基于 DSM-IV 和 DSM-5 的工具之间没有观察到显著差异。总体而言，发现个体结局测量指标具有可比性，其中一些指标对变化的敏感性更高。尽管发现个体结局测量指标的真实效应大小存在微小但显著的差异，但这仅与 UCLA PTSD（ = 1.06）和 CPSS（ = 1.61）有关，这种差异很可能是由于偶然因素或混杂变量所致。TF-CBT 在研究内比较中对 PTSD 具有较大的效应大小（ = 1.32），在研究间比较中具有中等的效应大小（ = .57）。虽然我们不能确定等效性，但基于结局测量指标和潜在的 DSM 版本，治疗效果的测量似乎没有差异。更新后的 TF-CBT 效应大小证实了它作为一种有效治疗儿童和青少年 PTSD 和次要结局的方法。
