Psychological interventions for post-traumatic stress disorder and depression in young survivors of mass violence in low- and middle-income countries: Meta-analysis

Abstract

BackgroundThe majority of survivors of mass violence live in low- and middle-income countries (LMICs).AimsTo synthesise empirical findings for psychological interventions for children and adolescents with post-traumatic stress disorder (PTSD) and/or depression in LMICs affected by mass violence.MethodRandomised controlled trials with children and adolescents with symptoms of PTSD and/or depression in LMICs were identified. Overall, 21812 records were found through July 2016 in the Medline, PsycINFO and PILOTS databases; 21 met the inclusion criteria and were reviewed according to recommended guidelines.ResultsTwenty-one studies were included. Active treatments for PTSD yielded large pre-treatment to post-treatment changes (g = 1.15) and a medium controlled effect size (g = 0.57). Effect sizes were similar at follow-up. Active treatments for depression produced small to medium effect sizes. Finally, after adjustment for publication bias, the imputed uncontrolled and controlled effect sizes for PTSD were medium and small respectively.ConclusionsPsychological interventions may be effective in treating paediatric PTSD in LMICs. It appears that more targeted approaches are needed for depressive responses.

Meta-analysis of interventions for posttraumatic stress disorder and depression in adult survivors of mass violence in low- and middle-income countries

“…This suggests that those treatments that have been shown to work effectively in developed countries also demonstrate efficacy when applied to treating the mental health needs in LMICs. Interestingly, similar results were also reported in a recently published meta‐analysis on the efficacy of psychological interventions for PTSD and depression in children and adolescents who had survived mass violence in LMICs (Morina, Malek, Nickerson, & Bryant, in press).…”

The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: systematic review and meta-analysis

“…Effect sizes in our sample were somewhat lower than effect sizes from the general population (Gillies et al, 2013: SMD = 1.34 compared to any control condition; Gutermann et al, 2016: SMC = 0.89 and SMD = 0.89 compared to untreated controls; Morina et al, 2016: SMD = 0.83 compared to waitlist controls), although they probably overestimated true treatment effects. They were also lower than those reported in children affected by war (Morina et al, 2017: SMC = 1.15). Part of the difference might be accounted by the small overlap between Morina et al and our study.…”

“…The mean pre-post effect size in our study cannot be meaningfully interpreted due to the high heterogeneity, which has also been reported in a number of other meta-analyses (e.g. Morina et al, 2017). In our view this shows how understudied this field of research is, as there are too few studies with obviously too different interventions available.…”

“…A recent meta-analysis on war-affected children and adolescents in low- and middle-income countries (Morina, Malek, Nickerson, & Bryant, 2017) identified 21 randomized controlled trials and reported pre-post effect sizes of g = 1.15 and a medium effect size of g = 0.53 compared to waitlist for posttraumatic stress symptoms. Effects on depressive symptoms were considerably lower, with g = 0.30 and g = 0.25, respectively.…”

New developments in the mental health of refugee children and adolescents

“…In recent years, an accumulating body of evidence has been established using cognitive behavioural psychotherapy, narrative exposure therapy and eye movement desensitisation and reprocessing for refugee children affected by war and displacement 63. For post-traumatic symptoms, one review that included children who experienced man-made and natural disasters found a moderate effect size for the intervention group compared with control groups, without a difference between the three interventions just mentioned 64.…”