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Terapias psicológicas para niños y adolescentes expuestos a traumas

Appendices

Appendix 1. Cochrane Specialised Register ‐ core MEDLINE search strategy

Core search strategy used to inform the Cochrane Common Mental Disorders Group's specialised register: OVID Medline
A weekly search alert based on condition + RCT filter only
1. [MeSH Headings]:
eating disorders/ or anorexia nervosa/ or binge‐eating disorder/ or bulimia nervosa/ or female athlete triad syndrome/ or pica/ or hyperphagia/ or bulimia/ or self‐injurious behavior/ or self mutilation/ or suicide/ or suicidal ideation/ or suicide, attempted/ or mood disorders/ or affective disorders, psychotic/ or bipolar disorder/ or cyclothymic disorder/ or depressive disorder/ or depression, postpartum/ or depressive disorder, major/ or depressive disorder, treatment‐resistant/ or dysthymic disorder/ or seasonal affective disorder/ or neurotic disorders/ or depression/ or adjustment disorders/ or exp antidepressive agents/ or anxiety disorders/ or agoraphobia/ or neurocirculatory asthenia/ or obsessive‐compulsive disorder/ or obsessive hoarding/ or panic disorder/ or phobic disorders/ or stress disorders, traumatic/ or combat disorders/ or stress disorders, post‐traumatic/ or stress disorders, traumatic, acute/ or anxiety/ or anxiety, castration/ or koro/ or anxiety, separation/ or panic/ or exp anti‐anxiety agents/ or somatoform disorders/ or body dysmorphic disorders/ or conversion disorder/ or hypochondriasis/ or neurasthenia/ or hysteria/ or munchausen syndrome by proxy/ or munchausen syndrome/ or fatigue syndrome, chronic/ or obsessive behavior/ or compulsive behavior/ or behavior, addictive/ or impulse control disorders/ or firesetting behavior/ or gambling/ or trichotillomania/ or stress, psychological/ or burnout, professional/ or sexual dysfunctions, psychological/ or vaginismus/ or Anhedonia/ or Affective Symptoms/ or *Mental Disorders/

2. [Title/ Author Keywords]:
(eating disorder* or anorexia nervosa or bulimi* or binge eat* or (self adj (injur* or mutilat*)) or suicide* or suicidal or parasuicid* or mood disorder* or affective disorder* or bipolar i or bipolar ii or (bipolar and (affective or disorder*)) or mania or manic or cyclothymic* or depression or depressive or dysthymi* or neurotic or neurosis or adjustment disorder* or antidepress* or anxiety disorder* or agoraphobia or obsess* or compulsi* or panic or phobi* or ptsd or posttrauma* or post trauma* or combat or somatoform or somati#ation or medical* unexplained or body dysmorphi* or conversion disorder or hypochondria* or neurastheni* or hysteria or munchausen or chronic fatigue* or gambling or trichotillomania or vaginismus or anhedoni* or affective symptoms or mental disorder* or mental health).ti,kf.

3. [RCT filter]:
(controlled clinical trial.pt. or randomized controlled trial.pt. or (randomi#ed or randomi#ation).ab,ti. or randomly.ab. or (random* adj3 (administ* or allocat* or assign* or class* or control* or determine* or divide* or distribut* or expose* or fashion or number* or place* or recruit* or subsitut* or treat*)).ab. or placebo*.ab,ti. or drug therapy.fs. or trial.ab,ti. or groups.ab. or (control* adj3 (trial* or study or studies)).ab,ti. or ((singl* or doubl* or tripl* or trebl*) adj3 (blind* or mask* or dummy*)).mp. or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or randomized controlled trial/ or pragmatic clinical trial/ or (quasi adj (experimental or random*)).ti,ab. or ((waitlist* or wait* list* or treatment as usual or TAU) adj3 (control or group)).ab.)

4. (1 and 2 and 3)

Records are screened for reports of RCTs within the scope of the Cochrane Common Mental Disorders Group. Secondary reports of RCTs are tagged to the appropriate study record.
Similar weekly search alerts are also conducted on OVID EMBASE and PsycINFO, using relevant subject headings (controlled vocabularies) and search syntax, appropriate to each resource.

PRISMA study flow diagram.
Figures and Tables -
Figure 1

PRISMA study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Funnel plot of comparison: 1 All psychotherapies versus control (short‐term), outcome: 1.2 PTSD total symptoms.
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Figure 4

Funnel plot of comparison: 1 All psychotherapies versus control (short‐term), outcome: 1.2 PTSD total symptoms.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 1 PTSD diagnosis.
Figures and Tables -
Analysis 1.1

Comparison 1 All psychotherapies versus control (short‐term), Outcome 1 PTSD diagnosis.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 2 PTSD total symptoms.
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Analysis 1.2

Comparison 1 All psychotherapies versus control (short‐term), Outcome 2 PTSD total symptoms.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 3 PTSD avoidance.
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Analysis 1.3

Comparison 1 All psychotherapies versus control (short‐term), Outcome 3 PTSD avoidance.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 4 PTSD hyperarousal.
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Analysis 1.4

Comparison 1 All psychotherapies versus control (short‐term), Outcome 4 PTSD hyperarousal.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 5 PTSD intrusion.
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Analysis 1.5

Comparison 1 All psychotherapies versus control (short‐term), Outcome 5 PTSD intrusion.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 6 Anxiety total symptoms.
Figures and Tables -
Analysis 1.6

Comparison 1 All psychotherapies versus control (short‐term), Outcome 6 Anxiety total symptoms.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 7 Anxiety ‐ state.
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Analysis 1.7

Comparison 1 All psychotherapies versus control (short‐term), Outcome 7 Anxiety ‐ state.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 8 Anxiety ‐ trait.
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Analysis 1.8

Comparison 1 All psychotherapies versus control (short‐term), Outcome 8 Anxiety ‐ trait.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 9 Depression.
Figures and Tables -
Analysis 1.9

Comparison 1 All psychotherapies versus control (short‐term), Outcome 9 Depression.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 10 Behaviour ‐ total.
Figures and Tables -
Analysis 1.10

Comparison 1 All psychotherapies versus control (short‐term), Outcome 10 Behaviour ‐ total.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 11 Behaviour ‐ internalising.
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Analysis 1.11

Comparison 1 All psychotherapies versus control (short‐term), Outcome 11 Behaviour ‐ internalising.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 12 Behaviour ‐ externalising.
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Analysis 1.12

Comparison 1 All psychotherapies versus control (short‐term), Outcome 12 Behaviour ‐ externalising.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 13 Functional impairment.
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Analysis 1.13

Comparison 1 All psychotherapies versus control (short‐term), Outcome 13 Functional impairment.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 14 Quality of life.
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Analysis 1.14

Comparison 1 All psychotherapies versus control (short‐term), Outcome 14 Quality of life.

Comparison 1 All psychotherapies versus control (short‐term), Outcome 15 Loss to follow‐up.
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Analysis 1.15

Comparison 1 All psychotherapies versus control (short‐term), Outcome 15 Loss to follow‐up.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 1 PTSD diagnosis.
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Analysis 2.1

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 1 PTSD diagnosis.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 2 PTSD total symptoms.
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Analysis 2.2

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 2 PTSD total symptoms.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 3 PTSD ‐ avoidance.
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Analysis 2.3

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 3 PTSD ‐ avoidance.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 4 PTSD ‐ hyperarousal.
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Analysis 2.4

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 4 PTSD ‐ hyperarousal.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 5 PTSD ‐ intrusion.
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Analysis 2.5

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 5 PTSD ‐ intrusion.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 6 Anxiety total symptoms.
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Analysis 2.6

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 6 Anxiety total symptoms.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 7 Anxiety ‐ state.
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Analysis 2.7

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 7 Anxiety ‐ state.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 8 Anxiety ‐ trait.
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Analysis 2.8

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 8 Anxiety ‐ trait.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 9 Depression.
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Analysis 2.9

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 9 Depression.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 10 Behaviour ‐ total.
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Analysis 2.10

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 10 Behaviour ‐ total.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 11 Behaviour ‐ internalising.
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Analysis 2.11

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 11 Behaviour ‐ internalising.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 12 Behaviour ‐ externalising.
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Analysis 2.12

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 12 Behaviour ‐ externalising.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 13 Function.
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Analysis 2.13

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 13 Function.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 14 Quality of life.
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Analysis 2.14

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 14 Quality of life.

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 15 Loss to follow‐up.
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Analysis 2.15

Comparison 2 All psychotherapies versus control (medium‐term), Outcome 15 Loss to follow‐up.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 1 PTSD diagnosis.
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Analysis 3.1

Comparison 3 All psychotherapies versus control (long‐term), Outcome 1 PTSD diagnosis.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 2 PTSD total symptoms.
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Analysis 3.2

Comparison 3 All psychotherapies versus control (long‐term), Outcome 2 PTSD total symptoms.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 3 Anxiety.
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Analysis 3.3

Comparison 3 All psychotherapies versus control (long‐term), Outcome 3 Anxiety.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 4 Depression.
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Analysis 3.4

Comparison 3 All psychotherapies versus control (long‐term), Outcome 4 Depression.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 5 Behaviour ‐ total.
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Analysis 3.5

Comparison 3 All psychotherapies versus control (long‐term), Outcome 5 Behaviour ‐ total.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 6 Behaviour ‐ internalising.
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Analysis 3.6

Comparison 3 All psychotherapies versus control (long‐term), Outcome 6 Behaviour ‐ internalising.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 7 Behaviour ‐ externalising.
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Analysis 3.7

Comparison 3 All psychotherapies versus control (long‐term), Outcome 7 Behaviour ‐ externalising.

Comparison 3 All psychotherapies versus control (long‐term), Outcome 8 Loss to follow‐up.
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Analysis 3.8

Comparison 3 All psychotherapies versus control (long‐term), Outcome 8 Loss to follow‐up.

Comparison 4 CBT versus other therapies (short‐term), Outcome 1 PTSD diagnosis.
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Analysis 4.1

Comparison 4 CBT versus other therapies (short‐term), Outcome 1 PTSD diagnosis.

Comparison 4 CBT versus other therapies (short‐term), Outcome 2 PTSD total symptoms.
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Analysis 4.2

Comparison 4 CBT versus other therapies (short‐term), Outcome 2 PTSD total symptoms.

Comparison 4 CBT versus other therapies (short‐term), Outcome 3 PTSD avoidance.
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Analysis 4.3

Comparison 4 CBT versus other therapies (short‐term), Outcome 3 PTSD avoidance.

Comparison 4 CBT versus other therapies (short‐term), Outcome 4 PTSD hyperarousal.
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Analysis 4.4

Comparison 4 CBT versus other therapies (short‐term), Outcome 4 PTSD hyperarousal.

Comparison 4 CBT versus other therapies (short‐term), Outcome 5 PTSD intrusion.
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Analysis 4.5

Comparison 4 CBT versus other therapies (short‐term), Outcome 5 PTSD intrusion.

Comparison 4 CBT versus other therapies (short‐term), Outcome 6 Anxiety total symptoms.
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Analysis 4.6

Comparison 4 CBT versus other therapies (short‐term), Outcome 6 Anxiety total symptoms.

Comparison 4 CBT versus other therapies (short‐term), Outcome 7 Depression.
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Analysis 4.7

Comparison 4 CBT versus other therapies (short‐term), Outcome 7 Depression.

Comparison 4 CBT versus other therapies (short‐term), Outcome 8 Behaviour ‐ total.
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Analysis 4.8

Comparison 4 CBT versus other therapies (short‐term), Outcome 8 Behaviour ‐ total.

Comparison 4 CBT versus other therapies (short‐term), Outcome 9 Behaviour ‐ internalising.
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Analysis 4.9

Comparison 4 CBT versus other therapies (short‐term), Outcome 9 Behaviour ‐ internalising.

Comparison 4 CBT versus other therapies (short‐term), Outcome 10 Behaviour ‐ externalising.
Figures and Tables -
Analysis 4.10

Comparison 4 CBT versus other therapies (short‐term), Outcome 10 Behaviour ‐ externalising.

Comparison 4 CBT versus other therapies (short‐term), Outcome 11 Function.
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Analysis 4.11

Comparison 4 CBT versus other therapies (short‐term), Outcome 11 Function.

Comparison 4 CBT versus other therapies (short‐term), Outcome 12 Loss to follow‐up.
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Analysis 4.12

Comparison 4 CBT versus other therapies (short‐term), Outcome 12 Loss to follow‐up.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 1 PTSD total symptoms.
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Analysis 5.1

Comparison 5 CBT versus other therapies (medium‐term), Outcome 1 PTSD total symptoms.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 2 Anxiety total symptoms.
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Analysis 5.2

Comparison 5 CBT versus other therapies (medium‐term), Outcome 2 Anxiety total symptoms.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 3 Depression.
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Analysis 5.3

Comparison 5 CBT versus other therapies (medium‐term), Outcome 3 Depression.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 4 Behaviour ‐ total.
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Analysis 5.4

Comparison 5 CBT versus other therapies (medium‐term), Outcome 4 Behaviour ‐ total.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 5 Behaviour ‐ internalising.
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Analysis 5.5

Comparison 5 CBT versus other therapies (medium‐term), Outcome 5 Behaviour ‐ internalising.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 6 Behaviour ‐ externalising.
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Analysis 5.6

Comparison 5 CBT versus other therapies (medium‐term), Outcome 6 Behaviour ‐ externalising.

Comparison 5 CBT versus other therapies (medium‐term), Outcome 7 Loss to follow‐up.
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Analysis 5.7

Comparison 5 CBT versus other therapies (medium‐term), Outcome 7 Loss to follow‐up.

Comparison 6 CBT versus other therapies (long‐term), Outcome 1 Behaviour ‐ internalising.
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Analysis 6.1

Comparison 6 CBT versus other therapies (long‐term), Outcome 1 Behaviour ‐ internalising.

Comparison 6 CBT versus other therapies (long‐term), Outcome 2 Behaviour ‐ externalising.
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Analysis 6.2

Comparison 6 CBT versus other therapies (long‐term), Outcome 2 Behaviour ‐ externalising.

Comparison 6 CBT versus other therapies (long‐term), Outcome 3 Loss to follow‐up.
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Analysis 6.3

Comparison 6 CBT versus other therapies (long‐term), Outcome 3 Loss to follow‐up.

Comparison 7 Subgroup analysis: Individual versus group therapy, Outcome 1 PTSD total symptoms.
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Analysis 7.1

Comparison 7 Subgroup analysis: Individual versus group therapy, Outcome 1 PTSD total symptoms.

Comparison 8 Subgroup analysis: Child versus mother and child therapy, Outcome 1 PTSD total symptoms.
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Analysis 8.1

Comparison 8 Subgroup analysis: Child versus mother and child therapy, Outcome 1 PTSD total symptoms.

Comparison 9 Subgroup analysis: type of trauma, Outcome 1 PTSD diagnosis.
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Analysis 9.1

Comparison 9 Subgroup analysis: type of trauma, Outcome 1 PTSD diagnosis.

Comparison 9 Subgroup analysis: type of trauma, Outcome 2 PTSD total symptoms.
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Analysis 9.2

Comparison 9 Subgroup analysis: type of trauma, Outcome 2 PTSD total symptoms.

Comparison 10 Subgroup analysis: symptomatic participants, Outcome 1 PTSD diagnosis.
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Analysis 10.1

Comparison 10 Subgroup analysis: symptomatic participants, Outcome 1 PTSD diagnosis.

Comparison 10 Subgroup analysis: symptomatic participants, Outcome 2 PTSD total symptoms.
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Analysis 10.2

Comparison 10 Subgroup analysis: symptomatic participants, Outcome 2 PTSD total symptoms.

Comparison 11 Sensitivity analysis: type of control, Outcome 1 PTSD diagnosis.
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Analysis 11.1

Comparison 11 Sensitivity analysis: type of control, Outcome 1 PTSD diagnosis.

Comparison 11 Sensitivity analysis: type of control, Outcome 2 PTSD total symptoms.
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Analysis 11.2

Comparison 11 Sensitivity analysis: type of control, Outcome 2 PTSD total symptoms.

Comparison 12 Sensitivity analysis: best‐/worst‐case analysis, Outcome 1 PTSD diagnosis.
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Analysis 12.1

Comparison 12 Sensitivity analysis: best‐/worst‐case analysis, Outcome 1 PTSD diagnosis.

Comparison 13 Sensitivity analysis: cluster‐randomisation, Outcome 1 PTSD diagnosis.
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Analysis 13.1

Comparison 13 Sensitivity analysis: cluster‐randomisation, Outcome 1 PTSD diagnosis.

Comparison 13 Sensitivity analysis: cluster‐randomisation, Outcome 2 PTSD total symptoms.
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Analysis 13.2

Comparison 13 Sensitivity analysis: cluster‐randomisation, Outcome 2 PTSD total symptoms.

Comparison 14 Sensitivity analysis: performance bias, Outcome 1 PTSD diagnosis.
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Analysis 14.1

Comparison 14 Sensitivity analysis: performance bias, Outcome 1 PTSD diagnosis.

Comparison 14 Sensitivity analysis: performance bias, Outcome 2 PTSD total symptoms.
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Analysis 14.2

Comparison 14 Sensitivity analysis: performance bias, Outcome 2 PTSD total symptoms.

Comparison 15 Sensitivity analysis: detection bias, Outcome 1 PTSD diagnosis.
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Analysis 15.1

Comparison 15 Sensitivity analysis: detection bias, Outcome 1 PTSD diagnosis.

Comparison 15 Sensitivity analysis: detection bias, Outcome 2 PTSD total symptoms.
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Analysis 15.2

Comparison 15 Sensitivity analysis: detection bias, Outcome 2 PTSD total symptoms.

Comparison 16 Sensitivity analysis: attrition bias, Outcome 1 PTSD diagnosis.
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Analysis 16.1

Comparison 16 Sensitivity analysis: attrition bias, Outcome 1 PTSD diagnosis.

Comparison 16 Sensitivity analysis: attrition bias, Outcome 2 PTSD total symptoms.
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Analysis 16.2

Comparison 16 Sensitivity analysis: attrition bias, Outcome 2 PTSD total symptoms.

Comparison 17 Sensitivity analysis: selection bias, Outcome 1 PTSD diagnosis.
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Analysis 17.1

Comparison 17 Sensitivity analysis: selection bias, Outcome 1 PTSD diagnosis.

Comparison 17 Sensitivity analysis: selection bias, Outcome 2 PTSD total symptoms.
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Analysis 17.2

Comparison 17 Sensitivity analysis: selection bias, Outcome 2 PTSD total symptoms.

Summary of findings for the main comparison. Psychological therapies versus wait list, treatment as usual or no treatment for children and adolescents exposed to trauma (short‐term)

Patient or population: children and adolescents exposed to trauma
Setting: three hospitals and fourteen community/outpatient settings (including eight schools, a trauma clinic, child support services, foster care and youth support services) in the US (6), Australia (2), Democratic Republic of Congo (2), Israel (2), the Palestinian territories (2), Bosnia(1), Canada (1), and Indonesia (1).
Intervention: all psychological therapies
Comparison: control (short‐term)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control (short‐term)

Risk with all psychotherapies

PTSD diagnosis

Study population

OR 0.51
(0.34 to 0.77)

874
(5 studies)

⊕⊝⊝⊝
Very lowa,b,c

367 per 1000

228 per 1000
(165 to 309)

Moderate

345 per 1000

212 per 1000
(152 to 288)

PTSD total symptoms

Mean PTSD total symptoms in the intervention group 0.42 standard deviations undefined fewer (0.61 fewer to 0.24 fewer)

Moderate effect size

2051
(15 studies)

⊕⊕⊝⊝
Lowd,e

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aParticipants are likely to have been aware of whether they received the active or inactive intervention in all studies, and diagnosis was based on self reported measures in 2 studies
bSignificant difference between the 2 psychological therapies included in this analysis (i.e. CBT and family therapy) (I2 = 69%)
cOnly 3 included studies with a relatively small overall sample number of 352

dParticipants were likely to have been aware of whether they received active or inactive intervention in all but one study, and scores were based on self reported measures in 10 studies

eSubstantial heterogeneity between different types of psychological therapy (I2 = 71%)

Figures and Tables -
Summary of findings for the main comparison. Psychological therapies versus wait list, treatment as usual or no treatment for children and adolescents exposed to trauma (short‐term)
Summary of findings 2. CBT versus other psychological therapies for children and adolescents exposed to trauma (short‐term)

Patient or population: children and adolescents exposed to trauma
Setting: All seven studies were done in community or outpatient settings including child trauma (2) or psychiatric (2) services, child support services (1), domestic violence service (1) and school (1) in the US (4), Netherlands (2), and Iran (1).
Intervention: CBT
Comparison: other psychological therapies (short‐term)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Numer of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with other therapies (short‐term)

Risk with CBT

PTSD diagnosis

Study population

OR 0.74
(0.29 to 1.91)

160
(2 studies)

⊕⊝⊝⊝
Very lowa,b

141 per 1000

108 per 1000
(45 to 239)

Moderate

111 per 1000

85 per 1000
(35 to 193)

PTSD total symptoms

Mean PTSD total symptoms in the intervention group 0.24 standard deviations undefined fewer (0.42 fewer to 0.05 fewer)

Small effect size

466
(7 studies)

⊕⊕⊕⊝
Moderatec

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aParticipants are likely to have been aware of whether they received active or inactive intervention in both studies, and diagnosis was based on self reported measures in both
bOnly 2 included studies with a relatively small overall sample number of 287

cParticipants are likely to have been aware of whether they received active or inactive intervention in all studies, and scores were based on self reported measures in 4 studies

Figures and Tables -
Summary of findings 2. CBT versus other psychological therapies for children and adolescents exposed to trauma (short‐term)
Table 1. Data from Church 2012

Outcome

Group

n

Mean

SD

PTSD symptoms

One month

Exposure therapy

8

3.38

2.60

Control

8

31.38

3.84

Avoidance

One month

Exposure therapy

8

2.88

2.62

Control

8

20.25

2.38

Intrusion

One month

Exposure therapy

8

0.50

0.50

Control

8

11.13

2.93

Figures and Tables -
Table 1. Data from Church 2012
Table 2. Data from Damra 2014

Outcome

Group

n

Mean

SD

PTSD symptoms

Post therapy

TF‐CBT

9

13.00

1.12

Control

9

24.20

1.54

PTSD symptoms

4 months

TF‐CBT

9

11.88

1.96

Control

9

23.98

1.47

Figures and Tables -
Table 2. Data from Damra 2014
Table 3. Data from McMullen 2013

Outcome

Group

n

Mean

SD

PTSD symptoms

Post therapy

TF‐CBT

24

10.6

4.5

Control

24

34.8

11.6

Conduct Problems

Post therapy

TF‐CBT

24

0.7

0.9

Control

24

7.1

7.0

Figures and Tables -
Table 3. Data from McMullen 2013
Comparison 1. All psychotherapies versus control (short‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

5

874

Odds Ratio (M‐H, Random, 95% CI)

0.51 [0.34, 0.77]

1.1 CBT

3

769

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.43, 0.80]

1.2 EMDR

1

40

Odds Ratio (M‐H, Random, 95% CI)

0.2 [0.01, 4.44]

1.3 Family therapy

1

65

Odds Ratio (M‐H, Random, 95% CI)

0.11 [0.02, 0.56]

2 PTSD total symptoms Show forest plot

15

2051

Std. Mean Difference (IV, Random, 95% CI)

‐0.42 [‐0.61, ‐0.24]

2.1 CBT

6

1329

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.55, ‐0.19]

2.2 EMDR

1

24

Std. Mean Difference (IV, Random, 95% CI)

‐0.77 [‐1.61, 0.06]

2.3 Family therapy

2

95

Std. Mean Difference (IV, Random, 95% CI)

‐0.53 [‐0.94, ‐0.12]

2.4 Narrative

1

64

Std. Mean Difference (IV, Random, 95% CI)

0.23 [‐0.26, 0.72]

2.5 Psychoeducation

2

215

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.69, 0.30]

2.6 Supportive therapy

2

272

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐0.95, 0.15]

2.7 CBT + narrative therapy

1

52

Std. Mean Difference (IV, Random, 95% CI)

‐1.96 [‐2.63, ‐1.29]

3 PTSD avoidance Show forest plot

2

205

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.29, 0.26]

3.1 Narrative

1

158

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.27, 0.36]

3.2 Psychoeducation

1

47

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.80, 0.35]

4 PTSD hyperarousal Show forest plot

2

205

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.22, 0.32]

4.1 Narrative

1

158

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.21, 0.41]

4.2 Psychoeducation

1

47

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.70, 0.45]

5 PTSD intrusion Show forest plot

2

205

Std. Mean Difference (IV, Random, 95% CI)

0.11 [‐0.16, 0.39]

5.1 Narrative

1

158

Std. Mean Difference (IV, Random, 95% CI)

0.15 [‐0.16, 0.46]

5.2 Psychoeducation

1

47

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.59, 0.55]

6 Anxiety total symptoms Show forest plot

7

959

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.26, 0.00]

6.1 CBT

2

557

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.30, 0.04]

6.2 Counselling

1

130

Std. Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.56, 0.16]

6.3 EMDR

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.66 [‐1.30, ‐0.03]

6.4 Exposure

1

65

Std. Mean Difference (IV, Random, 95% CI)

0.01 [‐0.48, 0.51]

6.5 Narrative

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.58, 0.17]

6.6 Psychoeducation

1

56

Std. Mean Difference (IV, Random, 95% CI)

0.32 [‐0.21, 0.85]

7 Anxiety ‐ state Show forest plot

2

70

Std. Mean Difference (IV, Random, 95% CI)

‐0.64 [‐1.12, ‐0.16]

7.1 CBT

1

46

Std. Mean Difference (IV, Random, 95% CI)

‐0.71 [‐1.31, ‐0.12]

7.2 EMDR

1

24

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.33, 0.31]

8 Anxiety ‐ trait Show forest plot

2

70

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.81, 0.14]

8.1 CBT

1

46

Std. Mean Difference (IV, Random, 95% CI)

‐0.36 [‐0.94, 0.22]

8.2 EMDR

1

24

Std. Mean Difference (IV, Random, 95% CI)

‐0.29 [‐1.10, 0.51]

9 Depression Show forest plot

13

1569

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.30, 0.04]

9.1 CBT

6

1191

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.42, ‐0.00]

9.2 EMDR

2

64

Std. Mean Difference (IV, Random, 95% CI)

‐0.39 [‐1.41, 0.64]

9.3 Exposure

1

52

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.45, 0.65]

9.4 Family therapy

1

30

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.66, 0.77]

9.5 Narrative

2

176

Std. Mean Difference (IV, Random, 95% CI)

0.13 [‐0.52, 0.77]

9.6 Psychoeducation

1

56

Std. Mean Difference (IV, Random, 95% CI)

0.09 [‐0.43, 0.62]

10 Behaviour ‐ total Show forest plot

3

166

Std. Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.51, 0.42]

10.1 EMDR

1

24

Std. Mean Difference (IV, Random, 95% CI)

‐0.44 [‐1.25, 0.37]

10.2 Exposure

1

77

Std. Mean Difference (IV, Random, 95% CI)

0.34 [‐0.11, 0.80]

10.3 Family therapy

1

65

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.72, 0.26]

11 Behaviour ‐ internalising Show forest plot

10

719

Std. Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.20, 0.13]

11.1 CBT

2

162

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.44, 0.18]

11.2 EMDR

2

64

Std. Mean Difference (IV, Random, 95% CI)

‐0.57 [‐1.07, ‐0.07]

11.3 Exposure

1

77

Std. Mean Difference (IV, Random, 95% CI)

0.38 [‐0.08, 0.84]

11.4 Family therapy

1

30

Std. Mean Difference (IV, Random, 95% CI)

0.32 [‐0.40, 1.04]

11.5 Narrative

2

180

Std. Mean Difference (IV, Random, 95% CI)

0.12 [‐0.18, 0.41]

11.6 Psychoeducation

2

206

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.38, 0.17]

12 Behaviour ‐ externalising Show forest plot

12

1174

Std. Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.33, 0.14]

12.1 CBT

3

565

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.28, 0.06]

12.2 EMDR

2

64

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐1.19, 0.10]

12.3 Exposure

1

77

Std. Mean Difference (IV, Random, 95% CI)

0.49 [0.03, 0.95]

12.4 Family therapy

1

30

Std. Mean Difference (IV, Random, 95% CI)

0.23 [‐0.49, 0.95]

12.5 Narrative

2

180

Std. Mean Difference (IV, Random, 95% CI)

0.20 [‐0.41, 0.81]

12.6 Psychoeducation

2

206

Std. Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.52, 0.46]

12.7 CBT + narrative therapy

1

52

Std. Mean Difference (IV, Random, 95% CI)

‐1.06 [‐1.64, ‐0.47]

13 Functional impairment Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

13.1 CBT

2

557

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.59, ‐0.24]

14 Quality of life Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

14.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Loss to follow‐up Show forest plot

26

3872

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.69, 1.39]

15.1 CBT

14

2913

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.47, 1.62]

15.2 Counselling

1

164

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.30, 1.03]

15.3 EMDR

2

92

Risk Ratio (M‐H, Random, 95% CI)

1.64 [0.48, 5.59]

15.4 Exposure

1

16

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

15.5 Family therapy

2

105

Risk Ratio (M‐H, Random, 95% CI)

1.44 [0.48, 4.30]

15.6 Narrative

2

280

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.32, 2.39]

15.7 Psychoeducation

3

274

Risk Ratio (M‐H, Random, 95% CI)

1.21 [0.75, 1.96]

15.8 Psychodrama

1

28

Risk Ratio (M‐H, Random, 95% CI)

1.5 [0.29, 7.65]

Figures and Tables -
Comparison 1. All psychotherapies versus control (short‐term)
Comparison 2. All psychotherapies versus control (medium‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

4

742

Odds Ratio (M‐H, Random, 95% CI)

0.66 [0.26, 1.69]

1.1 CBT

2

570

Odds Ratio (M‐H, Random, 95% CI)

0.49 [0.09, 2.61]

1.2 Debriefing

1

132

Odds Ratio (M‐H, Random, 95% CI)

1.31 [0.47, 3.68]

1.3 EMDR

1

40

Odds Ratio (M‐H, Random, 95% CI)

0.35 [0.01, 9.13]

2 PTSD total symptoms Show forest plot

12

2337

Std. Mean Difference (IV, Random, 95% CI)

‐0.17 [‐0.38, 0.05]

2.1 CBT

5

1701

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.72, 0.03]

2.2 Debriefing

2

231

Std. Mean Difference (IV, Random, 95% CI)

0.04 [‐0.22, 0.30]

2.3 Family therapy

2

141

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.39, 0.27]

2.4 Narrative

1

64

Std. Mean Difference (IV, Random, 95% CI)

0.23 [‐0.26, 0.73]

2.5 Psychoeducation

1

56

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.65, 0.40]

2.6 Supportive therapy

1

144

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.54, 0.12]

3 PTSD ‐ avoidance Show forest plot

2

243

Std. Mean Difference (IV, Fixed, 95% CI)

0.04 [‐0.22, 0.29]

3.1 Debriefing

1

132

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐0.42, 0.26]

3.2 Family therapy

1

111

Std. Mean Difference (IV, Fixed, 95% CI)

0.18 [‐0.20, 0.55]

4 PTSD ‐ hyperarousal Show forest plot

2

243

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.43, 0.17]

4.1 Debriefing

1

132

Std. Mean Difference (IV, Random, 95% CI)

0.01 [‐0.33, 0.35]

4.2 Family therapy

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.67, 0.09]

5 PTSD ‐ intrusion Show forest plot

2

243

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.29, 0.21]

5.1 Debriefing

1

132

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.39, 0.29]

5.2 Family therapy

1

111

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.40, 0.35]

6 Anxiety total symptoms Show forest plot

7

1470

Std. Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.20, 0.00]

6.1 CBT

3

1131

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.19, 0.04]

6.2 Debriefing

1

132

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.42, 0.27]

6.3 EMDR

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.72 [‐1.36, ‐0.07]

6.4 Psychoeducation

1

56

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.73, 0.32]

6.5 Narrative

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.17 [‐0.54, 0.21]

7 Anxiety ‐ state Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 CBT

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Anxiety ‐ trait Show forest plot

2

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 CBT

2

101

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.45 [‐0.85, ‐0.05]

9 Depression Show forest plot

13

2191

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.22, 0.07]

9.1 CBT

8

1810

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.31, 0.07]

9.2 Debriefing

2

231

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.38, 0.14]

9.3 Family therapy

1

30

Std. Mean Difference (IV, Random, 95% CI)

0.34 [‐0.38, 1.06]

9.4 Narrative

1

64

Std. Mean Difference (IV, Random, 95% CI)

0.34 [‐0.15, 0.84]

9.5 Psychoeducation

1

56

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.67, 0.38]

10 Behaviour ‐ total Show forest plot

3

281

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.43, 0.04]

10.1 Debriefing

1

132

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.28 [‐0.62, 0.06]

10.2 Family therapy

1

50

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.37 [‐0.93, 0.19]

10.3 Narrative

1

99

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.39, 0.39]

11 Behaviour ‐ internalising Show forest plot

4

291

Std. Mean Difference (IV, Random, 95% CI)

0.01 [‐0.25, 0.28]

11.1 EMDR

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐1.13, 0.14]

11.2 Family therapy

1

30

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.72, 0.72]

11.3 Narrative

2

221

Std. Mean Difference (IV, Random, 95% CI)

0.13 [‐0.13, 0.40]

12 Behaviour ‐ externalising Show forest plot

5

694

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.32, 0.35]

12.1 CBT

1

403

Std. Mean Difference (IV, Random, 95% CI)

0.07 [‐0.13, 0.27]

12.2 EMDR

1

40

Std. Mean Difference (IV, Random, 95% CI)

1.00 [‐1.66, ‐0.33]

12.3 Family therapy

1

30

Std. Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.72, 0.71]

12.4 Narrative

2

221

Std. Mean Difference (IV, Random, 95% CI)

0.31 [0.05, 0.58]

13 Function Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

13.1 CBT

3

814

Std. Mean Difference (IV, Random, 95% CI)

‐0.46 [‐0.88, ‐0.05]

14 Quality of life Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

14.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

15 Loss to follow‐up Show forest plot

20

3663

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.82, 1.21]

15.1 CBT

11

2856

Odds Ratio (M‐H, Fixed, 95% CI)

1.01 [0.81, 1.27]

15.2 Counselling

1

23

Odds Ratio (M‐H, Fixed, 95% CI)

7.0 [0.32, 152.95]

15.3 Debriefing

1

158

Odds Ratio (M‐H, Fixed, 95% CI)

0.76 [0.33, 1.76]

15.4 EMDR

1

65

Odds Ratio (M‐H, Fixed, 95% CI)

1.41 [0.52, 3.84]

15.5 Family therapy

1

75

Odds Ratio (M‐H, Fixed, 95% CI)

1.28 [0.48, 3.39]

15.6 Narrative

2

171

Odds Ratio (M‐H, Fixed, 95% CI)

0.70 [0.16, 2.99]

15.7 Psychoeducation

2

244

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.40, 1.47]

15.8 Other

1

71

Odds Ratio (M‐H, Fixed, 95% CI)

0.90 [0.29, 2.73]

Figures and Tables -
Comparison 2. All psychotherapies versus control (medium‐term)
Comparison 3. All psychotherapies versus control (long‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Narrative

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 PTSD total symptoms Show forest plot

2

141

Std. Mean Difference (IV, Random, 95% CI)

0.17 [‐0.28, 0.62]

2.1 Exposure

1

77

Std. Mean Difference (IV, Random, 95% CI)

0.39 [‐0.07, 0.85]

2.2 Narrative

1

64

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.56, 0.42]

3 Anxiety Show forest plot

2

176

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.41, 0.18]

3.1 Exposure

1

65

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.80, 0.19]

3.2 Narrative

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.39, 0.36]

4 Depression Show forest plot

3

152

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.24 [‐0.56, 0.08]

4.1 CBT

1

36

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.59 [‐1.27, 0.09]

4.2 Exposure

1

52

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.84, 0.26]

4.3 Narrative

1

64

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.51, 0.47]

5 Behaviour ‐ total Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Exposure

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Behaviour ‐ internalising Show forest plot

2

141

Std. Mean Difference (IV, Random, 95% CI)

0.04 [‐0.51, 0.59]

6.1 Exposure

1

77

Std. Mean Difference (IV, Random, 95% CI)

0.31 [‐0.15, 0.77]

6.2 Narrative

1

64

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.75, 0.24]

7 Behaviour ‐ externalising Show forest plot

3

298

Std. Mean Difference (IV, Random, 95% CI)

0.28 [‐0.05, 0.60]

7.1 Exposure

1

77

Std. Mean Difference (IV, Random, 95% CI)

0.51 [0.04, 0.97]

7.2 Narrative

2

221

Std. Mean Difference (IV, Random, 95% CI)

0.17 [‐0.30, 0.64]

8 Loss to follow‐up Show forest plot

2

120

Odds Ratio (M‐H, Random, 95% CI)

0.45 [0.15, 1.32]

8.1 CBT

1

50

Odds Ratio (M‐H, Random, 95% CI)

0.29 [0.08, 1.09]

8.2 Narrative

1

70

Odds Ratio (M‐H, Random, 95% CI)

0.88 [0.17, 4.71]

Figures and Tables -
Comparison 3. All psychotherapies versus control (long‐term)
Comparison 4. CBT versus other therapies (short‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

2

160

Odds Ratio (M‐H, Random, 95% CI)

0.74 [0.29, 1.91]

1.1 EMDR

1

36

Odds Ratio (M‐H, Random, 95% CI)

1.0 [0.06, 17.33]

1.2 Supportive therapy

1

124

Odds Ratio (M‐H, Random, 95% CI)

0.71 [0.26, 1.95]

2 PTSD total symptoms Show forest plot

7

466

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.42, ‐0.05]

2.1 EMDR

2

62

Std. Mean Difference (IV, Random, 95% CI)

0.06 [‐0.44, 0.56]

2.2 Play therapy

1

26

Std. Mean Difference (IV, Random, 95% CI)

0.21 [‐0.56, 0.98]

2.3 Supportive therapies

4

378

Std. Mean Difference (IV, Random, 95% CI)

‐0.32 [‐0.53, ‐0.12]

3 PTSD avoidance Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 PTSD hyperarousal Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 PTSD intrusion Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Anxiety total symptoms Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Supportive therapy

2

230

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐0.74, ‐0.22]

7 Depression Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Supportive therapy

2

237

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.42, 0.14]

8 Behaviour ‐ total Show forest plot

3

182

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.27, 0.31]

8.1 EMDR

1

14

Std. Mean Difference (IV, Random, 95% CI)

‐0.44 [‐1.50, 0.63]

8.2 Supportive therapy

2

168

Std. Mean Difference (IV, Random, 95% CI)

0.05 [‐0.25, 0.36]

9 Behaviour ‐ internalising Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 Supportive therapy

3

235

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.79, 0.28]

10 Behaviour ‐ externalising Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 Supportive therapy

3

235

Std. Mean Difference (IV, Random, 95% CI)

‐0.31 [‐0.58, ‐0.05]

11 Function Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

11.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

12 Loss to follow‐up Show forest plot

8

544

Odds Ratio (M‐H, Random, 95% CI)

0.69 [0.41, 1.18]

12.1 EMDR

2

64

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.23, 2.52]

12.2 Play therapy

1

31

Odds Ratio (M‐H, Random, 95% CI)

0.08 [0.00, 1.56]

12.3 Supportive therapy

5

449

Odds Ratio (M‐H, Random, 95% CI)

0.74 [0.38, 1.43]

Figures and Tables -
Comparison 4. CBT versus other therapies (short‐term)
Comparison 5. CBT versus other therapies (medium‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD total symptoms Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Supportive therapy

2

223

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.43, 0.11]

2 Anxiety total symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Depression Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Behaviour ‐ total Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Behaviour ‐ internalising Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Supportive therapy

2

178

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.36, 0.26]

6 Behaviour ‐ externalising Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Supportive therapy

2

178

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.37, 0.25]

7 Loss to follow‐up Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

7.1 Supportive therapy

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 5. CBT versus other therapies (medium‐term)
Comparison 6. CBT versus other therapies (long‐term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Behaviour ‐ internalising Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Behaviour ‐ externalising Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Supportive therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Loss to follow‐up Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Supportive therapy

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 6. CBT versus other therapies (long‐term)
Comparison 7. Subgroup analysis: Individual versus group therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD total symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Short‐term

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 7. Subgroup analysis: Individual versus group therapy
Comparison 8. Subgroup analysis: Child versus mother and child therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD total symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Short‐term

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Medium‐term

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Long‐term

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 8. Subgroup analysis: Child versus mother and child therapy
Comparison 9. Subgroup analysis: type of trauma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

6

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Community violence

3

769

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.43, 0.80]

1.2 Interpersonal violence

1

65

Odds Ratio (M‐H, Random, 95% CI)

0.11 [0.02, 0.56]

1.3 Natural disaster

1

166

Odds Ratio (M‐H, Random, 95% CI)

0.16 [0.06, 0.45]

1.4 Physical trauma

1

132

Odds Ratio (M‐H, Random, 95% CI)

1.31 [0.47, 3.68]

2 PTSD total symptoms Show forest plot

18

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Community violence

8

2170

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.41, ‐0.06]

2.2 Interpersonal violence

1

65

Std. Mean Difference (IV, Random, 95% CI)

‐0.61 [‐1.11, ‐0.11]

2.3 Life‐threatening illness

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.50, 0.26]

2.4 Maltreatment

1

142

Std. Mean Difference (IV, Random, 95% CI)

‐0.12 [‐0.45, 0.21]

2.5 Natural disaster

1

166

Std. Mean Difference (IV, Random, 95% CI)

‐1.27 [‐1.60, ‐0.94]

2.6 Physical trauma

4

311

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.29, 0.26]

2.7 Sexual abuse

2

76

Std. Mean Difference (IV, Random, 95% CI)

‐0.67 [‐1.18, ‐0.16]

Figures and Tables -
Comparison 9. Subgroup analysis: type of trauma
Comparison 10. Subgroup analysis: symptomatic participants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Symptoms not stated

5

999

Odds Ratio (M‐H, Random, 95% CI)

0.41 [0.20, 0.83]

1.2 Symptomatic

2

197

Odds Ratio (M‐H, Random, 95% CI)

0.64 [0.32, 1.25]

2 PTSD total symptoms Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Symptoms not stated

12

1648

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.68, ‐0.13]

2.2 Symptomatic

9

1639

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.53, ‐0.06]

Figures and Tables -
Comparison 10. Subgroup analysis: symptomatic participants
Comparison 11. Sensitivity analysis: type of control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Inactive control

5

1067

Odds Ratio (M‐H, Random, 95% CI)

0.53 [0.32, 0.88]

1.2 Active control

2

129

Odds Ratio (M‐H, Random, 95% CI)

0.23 [0.05, 1.14]

2 PTSD total symptoms Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Inactive control

15

2856

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐0.61, ‐0.19]

2.2 Active control

6

431

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.58, 0.09]

Figures and Tables -
Comparison 11. Sensitivity analysis: type of control
Comparison 12. Sensitivity analysis: best‐/worst‐case analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Best case

7

1282

Odds Ratio (M‐H, Random, 95% CI)

0.52 [0.28, 0.99]

1.2 Worst case

7

1252

Odds Ratio (M‐H, Random, 95% CI)

0.64 [0.42, 0.98]

Figures and Tables -
Comparison 12. Sensitivity analysis: best‐/worst‐case analysis
Comparison 13. Sensitivity analysis: cluster‐randomisation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Cluster‐randomised

4

935

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.27, 0.76]

1.2 Individuals randomised

3

261

Odds Ratio (M‐H, Random, 95% CI)

0.47 [0.10, 2.19]

2 PTSD total symptoms Show forest plot

20

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Cluster‐randomised

7

2063

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐0.71, ‐0.10]

2.2 Individuals randomised

13

1172

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.38, ‐0.06]

Figures and Tables -
Comparison 13. Sensitivity analysis: cluster‐randomisation
Comparison 14. Sensitivity analysis: performance bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Unclear risk

1

64

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.09, 3.62]

1.2 High risk

6

1132

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.27, 0.79]

2 PTSD total symptoms Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Unclear risk

1

64

Std. Mean Difference (IV, Random, 95% CI)

0.23 [‐0.26, 0.72]

2.2 High risk

20

3223

Std. Mean Difference (IV, Random, 95% CI)

‐0.39 [‐0.57, ‐0.20]

Figures and Tables -
Comparison 14. Sensitivity analysis: performance bias
Comparison 15. Sensitivity analysis: detection bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Low risk

2

197

Odds Ratio (M‐H, Random, 95% CI)

0.41 [0.04, 4.68]

1.2 Unclear risk

1

64

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.09, 3.62]

1.3 High risk

4

935

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.27, 0.76]

2 PTSD total symptoms Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Low risk

1

132

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.39, 0.30]

2.2 Unclear risk

2

191

Std. Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.46, 0.40]

2.3 High risk

18

2964

Std. Mean Difference (IV, Random, 95% CI)

‐0.42 [‐0.62, ‐0.22]

Figures and Tables -
Comparison 15. Sensitivity analysis: detection bias
Comparison 16. Sensitivity analysis: attrition bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Low risk

2

320

Odds Ratio (M‐H, Random, 95% CI)

0.27 [0.11, 0.65]

1.2 Unclear risk

3

329

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.45, 1.38]

1.3 High risk

2

547

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.06, 1.60]

2 PTSD total symptoms Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Low risk

7

1410

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.75, ‐0.01]

2.2 Unclear risk

9

1046

Std. Mean Difference (IV, Random, 95% CI)

‐0.36 [‐0.67, ‐0.05]

2.3 High risk

5

831

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.53, ‐0.06]

Figures and Tables -
Comparison 16. Sensitivity analysis: attrition bias
Comparison 17. Sensitivity analysis: selection bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PTSD diagnosis Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Low risk

4

516

Odds Ratio (M‐H, Random, 95% CI)

0.46 [0.18, 1.15]

1.2 Unclear risk

2

547

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.06, 1.60]

1.3 High risk

1

133

Odds Ratio (M‐H, Random, 95% CI)

0.65 [0.32, 1.33]

2 PTSD total symptoms Show forest plot

21

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Low risk

8

874

Std. Mean Difference (IV, Random, 95% CI)

‐0.57 [‐0.97, ‐0.17]

2.2 Unclear risk

13

2413

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.39, ‐0.06]

Figures and Tables -
Comparison 17. Sensitivity analysis: selection bias