Meta-analytic review: Group-based interventions for treating post-traumatic stress symptoms in children and adolescents

Rebecca S. Davis; Richard Meiser-Stedman; Nimrah Afzal; John Devaney; Sarah L. Halligan; Katie Lofthouse; Patrick Smith; Paul Stallard; Siyan  Ye; Rachel M. Hiller

doi:10.1016/j.jaac.2023.02.013

Meta-analytic review: Group-based interventions for treating post-traumatic stress symptoms in children and adolescents

Rebecca S. Davis, Richard Meiser-Stedman, Nimrah Afzal, John Devaney, Sarah L. Halligan, Katie Lofthouse, Patrick Smith, Paul Stallard, Siyan Ye, Rachel M. Hiller^*

^*Corresponding author for this work

School of Social and Political Science

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Objective: Trauma exposure in childhood is common and can lead to a range of negative mental health outcomes, including posttraumatic stress disorder (PTSD). In many settings, resources to address this distress are scarce. Group-based interventions require minimal resources and training, can be delivered by non–mental health specialists, and target larger numbers of children and adolescents. This meta-analysis sought to establish whether such an approach is an effective method for targeting PTSD symptoms and to identify potential moderators of effectiveness.

Method: PubMed, PsycNET, and PTSDPubs were searched for randomized controlled trials that used a group-based PTSD intervention with children and adolescents aged 6 to 18 years. Data were extracted for PTSD symptoms and depression symptoms. A random-effects meta-analysis was conducted to obtain between-group pooled effect size estimates. This study was registered on PROSPERO (CRD42020187214).

Results: The initial search identified 9,650 studies, of which 42 were eligible for inclusion (N = 5,998). Children randomized to a group-based intervention had significantly lower PTSD symptoms after treatment compared with a control group, with a medium pooled effect (g = −0.55, 95% CI [−0.76, −0.35]). Group interventions were superior when compared with either active or passive controls, at follow-up, and for depression symptoms. There was a large amount of heterogeneity, but no evidence that this was explained by whether the intervention was delivered in a low- and middle-income or high-income country, included caregivers, or was universal or targeted.

Conclusion: Group PTSD interventions, particularly cognitive-behavioral therapy–based interventions, are effective at targeting posttrauma distress in children and adolescents. There was evidence of effectiveness when delivered in highly complex and resource-scarce settings and to a range of trauma-exposed groups, including groups exposed to war/conflict, natural disasters, and abuse.

Original language	English
Pages (from-to)	1217-1232
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	62
Issue number	11
Early online date	19 Mar 2023
DOIs	https://doi.org/10.1016/j.jaac.2023.02.013
Publication status	Published - Nov 2023

Keywords / Materials (for Non-textual outputs)

PTSD
trauma
children
treatment
group

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Davis, R. S., Meiser-Stedman, R., Afzal, N., Devaney, J., Halligan, S. L., Lofthouse, K., Smith, P., Stallard, P., Ye, S., & Hiller, R. M. (2023). Meta-analytic review: Group-based interventions for treating post-traumatic stress symptoms in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 62(11), 1217-1232. https://doi.org/10.1016/j.jaac.2023.02.013

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title = "Meta-analytic review: Group-based interventions for treating post-traumatic stress symptoms in children and adolescents",

abstract = "Objective: Trauma exposure in childhood is common and can lead to a range of negative mental health outcomes, including posttraumatic stress disorder (PTSD). In many settings, resources to address this distress are scarce. Group-based interventions require minimal resources and training, can be delivered by non–mental health specialists, and target larger numbers of children and adolescents. This meta-analysis sought to establish whether such an approach is an effective method for targeting PTSD symptoms and to identify potential moderators of effectiveness.Method: PubMed, PsycNET, and PTSDPubs were searched for randomized controlled trials that used a group-based PTSD intervention with children and adolescents aged 6 to 18 years. Data were extracted for PTSD symptoms and depression symptoms. A random-effects meta-analysis was conducted to obtain between-group pooled effect size estimates. This study was registered on PROSPERO (CRD42020187214).Results: The initial search identified 9,650 studies, of which 42 were eligible for inclusion (N = 5,998). Children randomized to a group-based intervention had significantly lower PTSD symptoms after treatment compared with a control group, with a medium pooled effect (g = −0.55, 95% CI [−0.76, −0.35]). Group interventions were superior when compared with either active or passive controls, at follow-up, and for depression symptoms. There was a large amount of heterogeneity, but no evidence that this was explained by whether the intervention was delivered in a low- and middle-income or high-income country, included caregivers, or was universal or targeted.Conclusion: Group PTSD interventions, particularly cognitive-behavioral therapy–based interventions, are effective at targeting posttrauma distress in children and adolescents. There was evidence of effectiveness when delivered in highly complex and resource-scarce settings and to a range of trauma-exposed groups, including groups exposed to war/conflict, natural disasters, and abuse.",

keywords = "PTSD, trauma, children, treatment, group",

author = "Davis, {Rebecca S.} and Richard Meiser-Stedman and Nimrah Afzal and John Devaney and Halligan, {Sarah L.} and Katie Lofthouse and Patrick Smith and Paul Stallard and Siyan Ye and Hiller, {Rachel M.}",

note = "Funding Information: Disclosure: Dr. Davis has received funding from NIHR. Prof. Meiser-Stedman has received funding from NIHR and has served on the advisory board for the Children and War Foundation (no financial gain from their involvement). Prof. Devaney has received funding from NIHR, the Medical Research Council (MRC), the Economic and Social Research Council (ESRC), the Australian Research Council, and the Nuffield Foundation. Prof. Halligan has received funding from ESRC, MRC, and NIHR. Dr. Smith has received funding from MRC and NIHR, has served on the advisory board for the Children and War Foundation, and was involved in the development of the Teaching Recovery Techniques intervention (no financial gain from their involvement). Prof. Stallard has received funding from NIHR. Dr. Hiller has received funding from ESRC, MRC, and NIHR. Ms. Afzal has received funding from ESRC. Mss. Lofthouse and Ye have reported no biomedical financial interests or potential conflicts of interest. Funding Information: This study was funded by a National Institute for Health and Care Research (NIHR), Research for Patient Benefit program grant awarded to R.M.-H. (NIHR200586). The funding body was not involved in producing this manuscript or the design or running of the project. The views expressed in this article are not necessarily those of NIHR or the Department of Health and Social Care. All data collected for this review will be available from the publication date. Requests to access these data should be made to the corresponding author. Publisher Copyright: {\textcopyright} 2023 American Academy of Child and Adolescent Psychiatry",

year = "2023",

month = nov,

doi = "10.1016/j.jaac.2023.02.013",

language = "English",

volume = "62",

pages = "1217--1232",

journal = "Journal of the American Academy of Child and Adolescent Psychiatry",

issn = "0890-8567",

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number = "11",

}

Davis, RS, Meiser-Stedman, R, Afzal, N, Devaney, J, Halligan, SL, Lofthouse, K, Smith, P, Stallard, P, Ye, S & Hiller, RM 2023, 'Meta-analytic review: Group-based interventions for treating post-traumatic stress symptoms in children and adolescents', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 62, no. 11, pp. 1217-1232. https://doi.org/10.1016/j.jaac.2023.02.013

TY - JOUR

T1 - Meta-analytic review

T2 - Group-based interventions for treating post-traumatic stress symptoms in children and adolescents

AU - Davis, Rebecca S.

AU - Meiser-Stedman, Richard

AU - Afzal, Nimrah

AU - Devaney, John

AU - Halligan, Sarah L.

AU - Lofthouse, Katie

AU - Smith, Patrick

AU - Stallard, Paul

AU - Ye, Siyan

AU - Hiller, Rachel M.

N1 - Funding Information: Disclosure: Dr. Davis has received funding from NIHR. Prof. Meiser-Stedman has received funding from NIHR and has served on the advisory board for the Children and War Foundation (no financial gain from their involvement). Prof. Devaney has received funding from NIHR, the Medical Research Council (MRC), the Economic and Social Research Council (ESRC), the Australian Research Council, and the Nuffield Foundation. Prof. Halligan has received funding from ESRC, MRC, and NIHR. Dr. Smith has received funding from MRC and NIHR, has served on the advisory board for the Children and War Foundation, and was involved in the development of the Teaching Recovery Techniques intervention (no financial gain from their involvement). Prof. Stallard has received funding from NIHR. Dr. Hiller has received funding from ESRC, MRC, and NIHR. Ms. Afzal has received funding from ESRC. Mss. Lofthouse and Ye have reported no biomedical financial interests or potential conflicts of interest. Funding Information: This study was funded by a National Institute for Health and Care Research (NIHR), Research for Patient Benefit program grant awarded to R.M.-H. (NIHR200586). The funding body was not involved in producing this manuscript or the design or running of the project. The views expressed in this article are not necessarily those of NIHR or the Department of Health and Social Care. All data collected for this review will be available from the publication date. Requests to access these data should be made to the corresponding author. Publisher Copyright: © 2023 American Academy of Child and Adolescent Psychiatry

PY - 2023/11

Y1 - 2023/11

N2 - Objective: Trauma exposure in childhood is common and can lead to a range of negative mental health outcomes, including posttraumatic stress disorder (PTSD). In many settings, resources to address this distress are scarce. Group-based interventions require minimal resources and training, can be delivered by non–mental health specialists, and target larger numbers of children and adolescents. This meta-analysis sought to establish whether such an approach is an effective method for targeting PTSD symptoms and to identify potential moderators of effectiveness.Method: PubMed, PsycNET, and PTSDPubs were searched for randomized controlled trials that used a group-based PTSD intervention with children and adolescents aged 6 to 18 years. Data were extracted for PTSD symptoms and depression symptoms. A random-effects meta-analysis was conducted to obtain between-group pooled effect size estimates. This study was registered on PROSPERO (CRD42020187214).Results: The initial search identified 9,650 studies, of which 42 were eligible for inclusion (N = 5,998). Children randomized to a group-based intervention had significantly lower PTSD symptoms after treatment compared with a control group, with a medium pooled effect (g = −0.55, 95% CI [−0.76, −0.35]). Group interventions were superior when compared with either active or passive controls, at follow-up, and for depression symptoms. There was a large amount of heterogeneity, but no evidence that this was explained by whether the intervention was delivered in a low- and middle-income or high-income country, included caregivers, or was universal or targeted.Conclusion: Group PTSD interventions, particularly cognitive-behavioral therapy–based interventions, are effective at targeting posttrauma distress in children and adolescents. There was evidence of effectiveness when delivered in highly complex and resource-scarce settings and to a range of trauma-exposed groups, including groups exposed to war/conflict, natural disasters, and abuse.

AB - Objective: Trauma exposure in childhood is common and can lead to a range of negative mental health outcomes, including posttraumatic stress disorder (PTSD). In many settings, resources to address this distress are scarce. Group-based interventions require minimal resources and training, can be delivered by non–mental health specialists, and target larger numbers of children and adolescents. This meta-analysis sought to establish whether such an approach is an effective method for targeting PTSD symptoms and to identify potential moderators of effectiveness.Method: PubMed, PsycNET, and PTSDPubs were searched for randomized controlled trials that used a group-based PTSD intervention with children and adolescents aged 6 to 18 years. Data were extracted for PTSD symptoms and depression symptoms. A random-effects meta-analysis was conducted to obtain between-group pooled effect size estimates. This study was registered on PROSPERO (CRD42020187214).Results: The initial search identified 9,650 studies, of which 42 were eligible for inclusion (N = 5,998). Children randomized to a group-based intervention had significantly lower PTSD symptoms after treatment compared with a control group, with a medium pooled effect (g = −0.55, 95% CI [−0.76, −0.35]). Group interventions were superior when compared with either active or passive controls, at follow-up, and for depression symptoms. There was a large amount of heterogeneity, but no evidence that this was explained by whether the intervention was delivered in a low- and middle-income or high-income country, included caregivers, or was universal or targeted.Conclusion: Group PTSD interventions, particularly cognitive-behavioral therapy–based interventions, are effective at targeting posttrauma distress in children and adolescents. There was evidence of effectiveness when delivered in highly complex and resource-scarce settings and to a range of trauma-exposed groups, including groups exposed to war/conflict, natural disasters, and abuse.

KW - PTSD

KW - trauma

KW - children

KW - treatment

KW - group

UR - https://www.sciencedirect.com/journal/journal-of-the-american-academy-of-child-and-adolescent-psychiatry

U2 - 10.1016/j.jaac.2023.02.013

DO - 10.1016/j.jaac.2023.02.013

M3 - Article

SN - 0890-8567

VL - 62

SP - 1217

EP - 1232

JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

IS - 11

ER -

Meta-analytic review: Group-based interventions for treating post-traumatic stress symptoms in children and adolescents

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