Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis
Background Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain.Objective We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and ad...
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BMJ Publishing Group
2021-11-01
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| Series: | BMJ Mental Health |
| Online Access: | https://mentalhealth.bmj.com/content/24/4/153.full |
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| author | Andrea Cipriani Pim Cuijpers Yuqing Zhang David Cohen Jürgen Barth Peng Xie Cinzia Del Giovane Xinyu Zhou Donna Gillies Teng Teng Xuemei Li Li Fan Yajie Xiang John R. Weisz Xueer Liu Yuanliang Jiang Kang Du Arun V. Ravindran |
| author_facet | Andrea Cipriani Pim Cuijpers Yuqing Zhang David Cohen Jürgen Barth Peng Xie Cinzia Del Giovane Xinyu Zhou Donna Gillies Teng Teng Xuemei Li Li Fan Yajie Xiang John R. Weisz Xueer Liu Yuanliang Jiang Kang Du Arun V. Ravindran |
| author_sort | Andrea Cipriani |
| collection | DOAJ |
| description | Background Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain.Objective We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents.Methods We searched eight databases and other international registers up to 31 December 2020. The pairwise meta-analyses and frequentist network meta-analyses estimated pooled standardised mean differences (SMDs) and ORs with random-effects model. Efficacy at post-treatment and follow-up, acceptability, depressive and anxiety symptoms were measured.Findings We included 56 randomised controlled trials with 5327 patients comparing 14 different types of psychotherapies and 3 control conditions. For efficacy, cognitive processing therapy (CPT), behavioural therapy (BT), individual trauma-focused cognitive–behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing, and group TF-CBT were significantly superior to all control conditions at post-treatment and follow-up (SMDs between −2.42 and −0.25). Moreover, CPT, BT and individual TF-CBT were more effective than supportive therapy (SMDs between −1.92 and −0.49). Results for depressive and anxiety symptoms were similar to the findings for the primary outcome. Most of the results were rated as ‘moderate’ to ‘very low’ in terms of confidence of evidence.Conclusions CPT, BT and individual TF-CBT appear to be the best choices of psychotherapy for PTSD in young patients. Other types and different ways of delivering psychological treatment can be alternative options. Clinicians should consider the importance of each outcome and the patients’ preferences in real clinical practice. |
| format | Article |
| id | doaj-art-4b85bfcadc41492aafbb057e1c327291 |
| institution | Kabale University |
| issn | 2755-9734 |
| language | English |
| publishDate | 2021-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj-art-4b85bfcadc41492aafbb057e1c3272912025-02-04T12:05:10ZengBMJ Publishing GroupBMJ Mental Health2755-97342021-11-0124410.1136/ebmental-2021-300346Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysisAndrea Cipriani0Pim Cuijpers1Yuqing Zhang2David Cohen3Jürgen Barth4Peng Xie5Cinzia Del Giovane6Xinyu Zhou7Donna Gillies8Teng Teng9Xuemei Li10Li Fan11Yajie Xiang12John R. Weisz13Xueer Liu14Yuanliang Jiang15Kang Du16Arun V. Ravindran171 Oxford Health NHS Foundation Trust, Oxford, UK3 Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands5 Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA12 Department of Child and Adolescent Psychiatry, Hôpital Pitié–Salpétrière, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, Franceprofessor & director of research2 NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland1 Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China8 NDIS Quality and Safeguards Commission, Penrith, New South Wales, Australia2 NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaGansu Provincial Key Laboratory of Environmental Oncology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China1Genmab, Princeton, NJ, USA1 Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China9 Department of Psychology, Harvard University, Cambridge, Massachusetts, USA2 NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China1 Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaCollege of Economics, Xi’an University of Finance and Economics, Xi`an, China14 Campbell Family Mental Health Research Centre, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaBackground Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain.Objective We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents.Methods We searched eight databases and other international registers up to 31 December 2020. The pairwise meta-analyses and frequentist network meta-analyses estimated pooled standardised mean differences (SMDs) and ORs with random-effects model. Efficacy at post-treatment and follow-up, acceptability, depressive and anxiety symptoms were measured.Findings We included 56 randomised controlled trials with 5327 patients comparing 14 different types of psychotherapies and 3 control conditions. For efficacy, cognitive processing therapy (CPT), behavioural therapy (BT), individual trauma-focused cognitive–behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing, and group TF-CBT were significantly superior to all control conditions at post-treatment and follow-up (SMDs between −2.42 and −0.25). Moreover, CPT, BT and individual TF-CBT were more effective than supportive therapy (SMDs between −1.92 and −0.49). Results for depressive and anxiety symptoms were similar to the findings for the primary outcome. Most of the results were rated as ‘moderate’ to ‘very low’ in terms of confidence of evidence.Conclusions CPT, BT and individual TF-CBT appear to be the best choices of psychotherapy for PTSD in young patients. Other types and different ways of delivering psychological treatment can be alternative options. Clinicians should consider the importance of each outcome and the patients’ preferences in real clinical practice.https://mentalhealth.bmj.com/content/24/4/153.full |
| spellingShingle | Andrea Cipriani Pim Cuijpers Yuqing Zhang David Cohen Jürgen Barth Peng Xie Cinzia Del Giovane Xinyu Zhou Donna Gillies Teng Teng Xuemei Li Li Fan Yajie Xiang John R. Weisz Xueer Liu Yuanliang Jiang Kang Du Arun V. Ravindran Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis BMJ Mental Health |
| title | Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis |
| title_full | Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis |
| title_fullStr | Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis |
| title_full_unstemmed | Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis |
| title_short | Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis |
| title_sort | comparative efficacy and acceptability of psychotherapies for post traumatic stress disorder in children and adolescents a systematic review and network meta analysis |
| url | https://mentalhealth.bmj.com/content/24/4/153.full |
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