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de Haan, Anke, Meiser-Stedman, Richard 
ORCID: https://orcid.org/0000-0002-0262-623X, Landolt, Markus A., Kuhn, Isla, Black, Melissa J., Klaus, Kristel, Patel, Shivam D., Fisher, David J., Haag, Christina, Ukoumunne, Obioha C., Jones, Benjamin G., Flaiyah, Ashraf Muwafaq, Catani, Claudia, Dawson, Katie, Bryant, Richard A., de Roos, Carlijn, Ertl, Verena, Foa, Edna B., Ford, Julian D., Gilboa-Schechtman, Eva, Tutus, Dunja, Hermenau, Katharin, Hecker, Tobias, Hultmann, Ole, Axberg, Ulf, Jaberghaderi, Nasrin, Jensen, Tine K., Ormhaug, Silje M., Kenardy, Justin, Lindauer, Ramon J. L., Diehle, Julia, Murray, Laura K., Kane, Jeremy C., Peltonen, Kirsi, Kangaslampi, Samuli, Robjant, Katy, Koebach, Anke, Rosner, Rita, Rossouw, Jaco, Smith, Patrick, Tonge, Bruce J., Hitchcock, Caitlin and Dalgleish, Tim
(2024)
Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials.
The Lancet Child & Adolescent Health, 8 (1).
pp. 28-39.
ISSN 2352-4642
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Abstract
Background: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. Methods: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6−18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. Findings: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=−13·17, 95% CI −17·84 to −8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=−0·15, 95% CI −0·29 to −0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. Interpretation: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress.
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| Additional Information: | Funding Information: This work was supported by a Swiss National Science Foundation grant awarded to AdH (grant reference P2ZHP1_187612). RM-S was supported by the UK National Institute for Health Research (NIHR; Career Development Fellowship CDF-2015-08-073 and the Research for Patient Benefit Programme NIHR200586) and by the UK Medical Research Council (MRC) Developmental Pathway Funding Scheme. DJF was supported by the MRC (grant reference MC_UU_00004/06). OCU was supported by the NIHR Applied Research Collaboration South West Peninsula. JDF was supported by the US Department of Health and Human Services (SAMHSA 1H79SM085111-01). KP was supported by the Academy of Finland (grant number 275804). PS was supported by a Kraupl Taylor Fellowship, Psychiatry Research Trust, King's College London (London, UK), and received funding from the MRC. CHi was supported by an UK Economic and Social Research Council New Investigator Award and an Australian Research Council Discovery Early Career Award. TD was supported by the MRC (grant reference MC_UU_00030/5). The NIHR had no role in the study design, collection, management, analysis or interpretation of data, writing of the report, or the decision to submit the report for publication. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health and Social Care. Funding Information: We thank Ian R White (MRC Clinical Trials Unit, University College London, London, UK) for his statistical advice. Moreover, we thank everyone involved in the individual studies included in this IPD-MA. This work was supported by a Swiss National Science Foundation grant awarded to AdH (grant reference P2ZHP1_187612). RM-S was supported by the UK National Institute for Health Research (NIHR; Career Development Fellowship CDF-2015-08-073 and the Research for Patient Benefit Programme NIHR200586) and by the UK Medical Research Council (MRC) Developmental Pathway Funding Scheme. DJF was supported by the MRC (grant reference MC_UU_00004/06). OCU was supported by the NIHR Applied Research Collaboration South West Peninsula. JDF was supported by the US Department of Health and Human Services (SAMHSA 1H79SM085111-01). KP was supported by the Academy of Finland (grant number 275804). PS was supported by a Kraupl Taylor Fellowship, Psychiatry Research Trust, King's College London (London, UK), and received funding from the MRC. CHi was supported by an UK Economic and Social Research Council New Investigator Award and an Australian Research Council Discovery Early Career Award. TD was supported by the MRC (grant reference MC_UU_00030/5). The NIHR had no role in the study design, collection, management, analysis or interpretation of data, writing of the report, or the decision to submit the report for publication. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health and Social Care. Publisher Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Mental Health Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health |
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| Depositing User: | LivePure Connector |
| Date Deposited: | 10 Nov 2023 03:23 |
| Last Modified: | 14 Dec 2023 03:37 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/93620 |
| DOI: | 10.1016/S2352-4642(23)00253-5 |
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