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Cochrane Database of Systematic Reviews

Les psychothérapies pour les enfants et les adolescents exposés à un traumatisme

Información

DOI:
https://doi.org/10.1002/14651858.CD012371Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 11 octubre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Trastornos mentales comunes

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Donna Gillies

    Correspondencia a: Western Sydney Local Health District ‐ Mental Health, Parramatta, Australia

    [email protected]

  • Licia Maiocchi

    Wattle Grove, Australia

  • Abhishta P Bhandari

    James Cook University, Townsville, Australia

  • Fiona Taylor

    Prevention, Early Intervention and Recovery Service, Sydney West Area Mental Health Service, Parramatta, Australia

  • Carl Gray

    Department of Child and Adolescent Psychiatry, Western Sydney Local Health Network, New South Wales Health Service, Westmead, Australia

  • Louise O'Brien

    School of Nursing and Midwifery, University of Newcastle and Greater Western Area Health Service, New South Wales Health Service, Orange, Australia

Contributions of authors

Donna Gillies ‐ review co‐ordination, study selection, data extraction, data entry and analysis, writing of the review.

Licia Maiocchi ‐ data extraction, data analysis.

Abhishta P. Bhandari ‐ study selection, data extraction.

Fiona Taylor ‐ study selection, data extraction.

Carl Gray ‐ data extraction.

Louise O'Brien ‐ data extraction.

Sources of support

Internal sources

  • Sydney West Area Health Service, Australia.

  • The University of Western Sydney, Australia.

External sources

  • No sources of support supplied

Declarations of interest

None known.

Acknowledgements

Pam Withey (Rogers) and Charles Meekings, co‐authors of the protocol for the original review (Gillies 2007).

CRG Funding Acknowledgement:
The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Common Mental Disorders Group.

Disclaimer:
The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the NIHR, the NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2016 Oct 11

Psychological therapies for children and adolescents exposed to trauma

Review

Donna Gillies, Licia Maiocchi, Abhishta P Bhandari, Fiona Taylor, Carl Gray, Louise O'Brien

https://doi.org/10.1002/14651858.CD012371

Differences between protocol and review

Trauma exposure

It was proposed for prevention studies that we include only trials in which children or adolescents had been exposed to a traumatic event within a year before initiation of therapy. However, as time since exposure to trauma was not an inclusion/exclusion criterion in any included trials, the review authors decided to include all studies that met all other inclusion criteria.

Quality criteria

We stated in the protocol the intention to collect the following quality criteria. We collected these, but we updated the headings for quality criteria for consistency with quality criteria headings provided in the 'Risk of bias' table.

  • Adequate allocation concealment and sequence generation.

  • Clear inclusion and exclusion criteria.

  • No potential confounding variables.

  • Intention‐to‐treat analysis.

  • < 25% loss to follow‐up.

  • Blinded outcome assessment.

Skewed data

In the protocol, it was stated that "if the standard deviation multiplied by two was greater than the mean it will not be added to the meta‐analysis", but this was updated to comply with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2008) (i.e. for a scale that starts from zero, a standard deviation greater than half the mean suggests skew, but a standard deviation greater than the mean is considered strong evidence of a skewed distribution). Therefore, if the standard deviation was greater than the mean for both groups, these data were not included in a meta‐analysis.

Best‐case/Worst‐case analyses

It was initially proposed that in best‐case and worst‐case analyses of primary binary outcomes, early departure of people from the study was considered to have had a negative effect in the treatment group and no negative effect in the control group (worst‐case scenario), or no negative effect in the treatment group and a negative effect in the control group (best‐case scenario). However, we considered it more appropriate that people from both groups would have left for the same reason; therefore, for worst‐case, we have considered that all people lost to follow‐up had the negative outcome (i.e. a diagnosis of PTSD), and for best‐case analysis, all those lost to follow‐up were considered not diagnosed with PTSD.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

PRISMA study flow diagram.
Figuras y tablas -
Figure 1

PRISMA study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
Analysis 10.1

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

Comparison 10 Subgroup analysis: symptomatic participants, Outcome 2 PTSD total symptoms.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
Analysis 13.1

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

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

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

Comparison 14 Sensitivity analysis: performance bias, Outcome 1 PTSD diagnosis.
Figuras y tablas -
Analysis 14.1

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

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

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

Comparison 15 Sensitivity analysis: detection bias, Outcome 1 PTSD diagnosis.
Figuras y tablas -
Analysis 15.1

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

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

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

Comparison 16 Sensitivity analysis: attrition bias, Outcome 1 PTSD diagnosis.
Figuras y tablas -
Analysis 16.1

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

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

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

Comparison 17 Sensitivity analysis: selection bias, Outcome 1 PTSD diagnosis.
Figuras y tablas -
Analysis 17.1

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

Comparison 17 Sensitivity analysis: selection bias, Outcome 2 PTSD total symptoms.
Figuras y tablas -
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%)

Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
Comparison 17. Sensitivity analysis: selection bias