Risk Reduction for Substance Use and Trauma-Related Psychopathology in Adolescent Sexual Assault Victims: Findings From an Open Trial

Danielson, Carla Kmett; McCart, Michael R.; Arellano, Michael A. de; Macdonald, Alexandra; Doherty, Lauren Silcott; Resnick, Heidi S.

doi:10.1177/1077559510367939

Cited by 45 publications

(53 citation statements)

References 21 publications

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“…The five 526,533,621,673,678 studies examined family or multisystemic therapies. The Conran and Love 621 study was a case study, the Costa et al 678 study was an action research project, and the studies by Danielson et al 526 Tjersland et al 673 and Woodworth 533 were uncontrolled studies (see Table 17).…”

Section: Methodsmentioning

confidence: 99%

“…Five 526,533,621,673,678 very different studies addressed issues of the acceptability of systemic interventions. Details of these studies can be found in Table 17.…”

Section: Systemic Interventionsmentioning

confidence: 99%

“…Of the 73 included acceptability studies, the majority were set in the USA (42 studies 107,108,161,175,176,482,492,504,505,510,515,526,533,621, ). The remainder were in Canada (four studies 170,[658][659][660][661] ), the UK (14 studies 145,169,481,511,538,[662][663][664][665][666][667][668][669][670] ) and elsewhere in Europe: the Netherlands (three studies 497,671,672 ), Norway (three studies [673][674][675] ) and Sweden (one study 676 ), with one multisite review of services 145,146,640,[665][666][667][668][669]…”

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

“…Sexual abuse was the most commonly cited type of abuse across the acceptability studies (33 studies 161,[169][170][171]189,492,497,505,506,526,533,538,621,633,[636][637][638][640][641][642][643]645,647,648,653,657,660,662,664,668,673,[677][678][679][680] ) and some intervention categories reported data for only this population group [systemic interventions, 526,533,621,673,678 psychoeducational interventions, 161,538,647,664 peer mentoring 660 (note: there was only one study in this category)]. Three studies 510,639,65...…”

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

“…621,629 ) to a large national sample of n = 1085. 634 The majority of sample sizes were < 50 cases (40 studies 169,175,497,504,506,510,511,526,533,538,621,629,[636][637][638][639][641][642][643]645,646,648,651,652,658,[661][662][663]665,666,[668][669][670]675,677,678,680 ), between 50 and 100 cases (15 studies 107,170,176,481,482,492,505,644,647,…”

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

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The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Methodsmentioning

confidence: 99%

“…Five 526,533,621,673,678 very different studies addressed issues of the acceptability of systemic interventions. Details of these studies can be found in Table 17.…”

Section: Systemic Interventionsmentioning

confidence: 99%

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

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The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents

et al. 2020

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IMPORTANCE No empirically supported treatments have been evaluated to address co-occurring substance use problems (SUP) and posttraumatic stress disorder (PTSD) symptoms among adolescents in an integrative fashion. This lack is partially owing to untested clinical lore suggesting that delivery of exposure-based PTSD treatments to youth with SUP might be iatrogenic.OBJECTIVE To determine whether an exposure-based, integrative intervention for adolescents with SUP and PTSD symptoms-risk reduction through family therapy (RRFT)-resulted in improved outcomes relative to a treatment-as-usual (TAU) control condition consisting primarily of trauma-focused cognitive behavioral therapy. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial enrolled 124 participants who were recruited from November 1, 2012, through January 30, 2017. Adolescents (aged 13-18 years) who engaged in nontobacco substance use at least once during the past 90 days, experienced at least 1 interpersonal traumatic event, and reported 5 or more PTSD symptoms were enrolled. Blinded assessments were collected at baseline and at 3, 6, 12, and 18 months after baseline. Recruitment and treatment took place in community-based child advocacy centers in the Southeastern United States. Data were analyzed from August 2 through October 4, 2018, and were based on intention to treat. INTERVENTIONS Participants were randomized to receive RRFT (n = 61) or TAU (n = 63). MAIN OUTCOMES AND MEASURESPrimary outcomes focused on number of nontobacco substance-using days measured with the timeline follow-back method and PTSD symptom severity using the UCLA (University of California, Los Angeles) PTSD Reaction Index for DSM-IV completed by adolescents and caregivers. Secondary outcomes focused on marijuana, alcohol, and polysubstance use and PTSD criterion standard (re-experiencing, avoidance, and hyperarousal) symptom severity.RESULTS In all, 124 adolescents (mean [SD] age, 15.4 [1.3] years; 108 female [87.1%]) were randomized. For primary outcomes relative to TAU, RRFT yielded significantly greater reductions in substance-using days from baseline to month 12 (event rate [ER], 0.28; 95% CI, 0.12-0.65) and month 18 (ER, 0.10; 95% CI, 0.04-0.24). Significant reductions in PTSD symptoms were observed within groups for RRFT from baseline to months 3 (β = −9.25; 95% CI, −12.95 to −5.55), 6 (β = −16.63; 95% CI = −20.40 to −12.87), 12 (β = −17.51; 95% CI, −21.62 to −13.40), and 18 (β = −19.02; 95% CI, −23.07 to −14.96) and for TAU from baseline to months 3 (β = −9.62; 95% CI, −13.16 to −6.08), 6 (β = −13.73; 95% CI, −17.43 to −10.03), 12 (β = −15.53; 95% CI, −19.52 to −11.55), and 18 (β = −13.88; 95% CI, −17.69 to −10.09); however, between-group differences were not observed.CONCLUSIONS AND RELEVANCE In this study, RRFT and TAU demonstrated within-group improvements in SUP and PTSD symptoms, with greater improvement for substance use and PTSD avoidance and hyperarousal symptoms among adolescents randomized to RRFT compared with TAU. No evidence of the worsening of SUP wa...

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Is being a victim of bullying or cyberbullying in secondary school associated with subsequent risk‐taking behavior in adolescence? A longitudinal study in secondary schools

Shah

Dodd

Allen

et al. 2022

Journal of Adolescence

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Introduction Neurobiological and social changes in adolescence can make victims of bullying more susceptible to subsequent impulsive behavior. With the high prevalence of bullying in schools and rise in cyberbullying in the United Kingdom, it is important that the health impacts of bullying victimization, including on risk‐taking, are understood. Our study aims to investigate whether bullying/cyberbullying victimization is associated with subsequent health risk‐taking behavior in adolescence. Risk‐taking behavior includes electronic cigarette and cigarette smoking, alcohol consumption, illicit drug use, early sexual debut, weapon carrying, damaging property, and setting fire. Methods A secondary quantitative analysis of data from 3337, English, secondary school students in the control arm of the INCLUSIVE trial, constituting an observational cohort. Bullying victimization was measured at baseline (age 11/12 years) using the gatehouse bullying scale and a separate question on cyberbullying victimization. Logistic regression was used to test for an association between bullying/cyberbullying victimization at baseline and risk‐taking behavior at 36 months, adjusting for baseline risk‐taking behavior and other potential confounders, and accounting for school clustering. Results There was strong evidence (p ≤ .02) for a positive dose‐responsive association between being bullied at baseline and nearly all risk‐taking behavior at follow‐up. Although there was no evidence for an association between being bullied at baseline and weapon carrying (p = .102), there was evidence for a positive association between being cyberbullied at baseline and weapon carrying (p = .036). Conclusions It is plausible that bullying/cyberbullying victimization increases the likelihood of subsequent risk‐taking behavior in adolescence. Policy options should focus on implementing evidence‐based antibullying school interventions.

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Risk Reduction for Substance Use and Trauma-Related Psychopathology in Adolescent Sexual Assault Victims: Findings From an Open Trial

Cited by 45 publications

References 21 publications

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents

Is being a victim of bullying or cyberbullying in secondary school associated with subsequent risk‐taking behavior in adolescence? A longitudinal study in secondary schools

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