The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis
- 25 Downloads
This study examined the benefit of psychosocial interventions on functional impairment in youth exposed to mass trauma. A random effects meta-analysis was used to estimate the overall effect in 15 intervention trials identified through a literature review. The moderator analysis examined how the effect of intervention differed across types of populations receiving the intervention (targeted or non-targeted samples), characteristics of intervention delivery (individual or group application and number of sessions), and the context of intervention administration (country income level). The results revealed a significant small effect on functional impairment (Hedges’ g = 0.33; 95%CI = (0.16; 0.50); p = 0.0011). None of the moderators explained the heterogeneity in intervention effect, perhaps due to the small number of trials. The effect of the interventions on functional impairment and on posttraumatic stress were positively correlated. The current analysis provides preliminary evidence that interventions can improve functioning in youth exposed to mass trauma, but the mechanisms, moderators, and duration of benefit are yet unknown.
KeywordsChildren Disaster Functional impairment Mass trauma Psychological interventions Terrorism War Youth
Compliance with Ethical Standards
Disclosure of Interest
All authors declare that they have no conflicts to report.
Ethical Standards and Informed Consent
Formal consent was not required for this literature review and analysis.
- Berger, R., Gelkopf, M., & Heineberg, Y. (2012). A teacher-delivered intervention for adolescents exposed to ongoing and intense traumatic war-related stress: A quasi-randomized controlled study. Journal of Adolescent Health, 51(5), 453–461. https://doi.org/10.1016/j.jadohealth.2012.02.011.Google Scholar
- Betancourt, T. S., McBain, R., Newnham, E. A., Akinsulure-Smith, A. M., Brennan, R. T., Weisz, J. R., & Hansen, N. B. (2014). A behavioral intervention for war-affected youth in Sierre Leone: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(12), 1288–1297. https://doi.org/10.1016/j.jaac.2014.09.011.Google Scholar
- Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K. F., Neugebauer, R., Murray, L., & Verdeli, H. (2007). Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda. A randomized controlled trial. Journal of the American Medical Association, 298(5), 519–527. https://doi.org/10.1001/jama.298.5.519.Google Scholar
- Brown, E. J., McQuaid, J., Farina, L., Ali, R., & Winnick-Gelles, A. (2006). Matching interventions to children’s mental health needs: Feasibility and acceptability of a pilot school-based trauma intervention program. Education and Treatment of Children, 29(2), 257–286.Google Scholar
- Brown, F. L., de Graaff, A. M., Annan, J., & Betancourt, T. S. (2017a). Annual research review: Breaking cycles of violence – A systematic review and common practice elements analysis of psychosocial interventions for children and youth affected by armed conflict. Journal of Child Psychology and Psychiatry, 58(4), 507–524. https://doi.org/10.1111/jcpp.12671.Google Scholar
- Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017b). Psychosocial interventions for children and adolescents after man-made and natural disasters: A meta-analysis and systematic review. Psychological Medicine, 47(11), 1893–1905. https://doi.org/10.1017/s0033291717000496.Google Scholar
- Cerdá, M., Bordelois, P. M., Galea, S., Norris, F., Tracy, M., & Koenen, K. C. (2013). The course of posttraumatic stress symptoms and functional impairment following a disaster: What is the lasting influence of acute versus ongoing traumatic events and stressors? Social Psychiatry and Psychiatric Epidemiology, 48(3), 385–395. https://doi.org/10.1007/s00127-012-0560-3.Google Scholar
- De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A. G., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900. https://doi.org/10.1037/a0038498.Google Scholar
- Del Re, A. C. (2013). Compute.Es: Compute effect sizes (R package version 0.2-2). Computer Software Retrieved from http://cran.r-project.org/web/packages/compute.es.
- Ertl, V., & Neuner, F. (2014). Are school-based mental health interventions for war-affected children effective and harmless? BMC Medicine, 12(1). [Online.] Retrieved from https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-12-84. https://doi.org/10.1186/1741-7015-12-84.
- Gelkopf, M., & Berger, R. (2009). A school-based, teacher-mediated prevention program (ERASE-stress) for reducing terror-related traumatic reactions in Israeli youth: A quasi-randomized controlled trial. Journal of Child Psychology and Psychiatry, 50(8), 962–971. https://doi.org/10.1111/j.1469-7610.2008.02021.x.Google Scholar
- Jordans, M. J. D., Komproe, I. H., Tol, W. A., Kohrt, B. A., Luitel, N. P., Macy, R. D., & de Jong, J. T. V. M. (2010). Evaluation of a classroom-based psychosocial intervention in conflict-affected Nepal: A cluster randomized controlled trial. Journal of Child Psychology and Psychiatry, 51(7), 818–826. https://doi.org/10.1111/j.1469-7610.2010.02209.x.Google Scholar
- Jordans, M.J.D., Pigott, H., & Tol, W.A. (2016). Interventions for children affected by armed conflict: A systematic review of mental health and psychosocial support in low-and middle-income countries. Current Psychiatry Reports, 18(1), 1–15. [Online]. Retrieved from https://link.springer.com/article/10.1007%2Fs11920-015-0648-z. https://doi.org/10.1007/s11920-015-0648-z.
- Morina, N., Malek, M., Nickerson, A., & Bryant, R. A. (2017). Psychological interventions for post-traumatic stress disorder and depression in young survivors of mass violence in low- and middle-income countries: Meta-analysis. British Journal of Psychiatry, 210(4), 247–254. https://doi.org/10.1192/bjp.bp.115.180265.Google Scholar
- Newman, E., Pfefferbaum, B., Kirlic, N., Tett, R., Nelson, S., & Liles, B. (2014). Meta-analytic review of psychological interventions for children survivors of natural and man-made disasters. Current Psychiatry Reports, 16(9), 1–10. [Online] Retrieved from https://link.springer.com/article/10.1007%2Fs11920-014-0462-z. https://doi.org/10.1007/s11920-014-0462-z.
- Norris, F.H., Friedman, M.J., Watson, P.J., Byrne, C.M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry, 65(3), 207–239. https://doi.org/10.1521/psyc.18.104.22.16873
- O’Connor, D., Green, S., & Higgins, J. P. T. (2008). Defining the review question and developing criteria for including studies. In J. P. T. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions (pp. 91–94). West Sussex, UK: Wiley-Blackwell, Ltd). https://doi.org/10.1002/9780470712184.ch5.Google Scholar
- Ooi, C.S., Rooney, R.M., Roberts, C., Kane, R.T., Wright, B., & Chatzisarantis, N. (2016). The efficacy of a group cognitive behavioral therapy for war-affected young migrants living in Australia: A cluster randomized controlled trial. Frontiers in Psychology, 7. [Online]. Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2016.01641/full. https://doi.org/10.3389/fpsyg.2016.01641.
- Pfefferbaum, B., Shaw, J. A., & the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). (2013). Practice parameter on disaster preparedness. Journal of the American Academy of Child and Adolescent Psychiatry, 52(11), 1224–1238. https://doi.org/10.1016/j.jaac.2013.08.014.Google Scholar
- Pfefferbaum, B., Sweeton, J. L., Newman, E., Varma, V., Noffsinger, M. A., Shaw, J. A., et al. (2014). Child disaster mental health interventions, part II. Timing of implementation, delivery settings and providers, and therapeutic approaches. Disaster Health, 2(1), 58–67. https://doi.org/10.4161/dish.27535.Google Scholar
- Pfefferbaum, B., Nitiéma, P., & Newman, E. (2019 online). A meta-analysis of intervention effects on depression and/or anxiety in youth exposed to political violence or natural disasters. Child and Youth Care Forum. https://doi.org/10.1007/s10566-019-09494-9
- Pfefferbaum, B., Nitiéma, P., & Newman, E., & Patel, A. (in press). The benefit of interventions to reduce posttraumatic stress in youth exposed to mass trauma: A review and Meta-analysis. Prehospital and Disaster Medicine.Google Scholar
- Purgato, M., Gross, A. L., Betancourt, T., Bolton, P., Bonetto, C., Gastaldon, C., Gordon, J., O'Callaghan, P., Papola, D., Peltonen, K., Punamaki, R. L., Richards, J., Staples, J. K., Unterhitzenberger, J., van Ommeren, M., de Jong, J., Jordans, M. J. D., Tol, W. A., & Barbui, C. (2018). Focused psychosocial interventions for children in low-resource humanitarian settings: A systematic review and individual participant data meta-analysis. The Lancet Global Health, 6(4), e390–e400. https://doi.org/10.1016/s2214-109x(18)30046-9.Google Scholar
- Schmidt, F. L., & Hunter, J. E. (2015). Methods of meta-analysis. Correcting error and bias in research findings (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
- Schmidt, F. L., Le, H., & Ilies, R. (2003). Beyond alpha: An empirical examination of the effects of different sources of measurement error on reliability estimates for measures of individual-differences constructs. Psychological Methods, 8(2), 206–224. https://doi.org/10.1037/1082-989x.8.2.206.Google Scholar
- Schwarzer, G. (2007). Meta: An R package for meta-analysis. R News, 7(3), 40–45.Google Scholar
- The World Bank. (2018) Data. Retrieved from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.
- Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Macy, R. D., & de Jong, J. T. V. M. (2008). School-based mental health intervention for children affected by political violence in Indonesia. A cluster randomized trial. Journal of the American Medical Association, 300(6), 655–662. https://doi.org/10.1001/jama.300.6.655.Google Scholar
- Tol, W. A., Komproe, I. H., Jordans, M. J. D., Vallipuram, V., Sipsma, H., Sivayokan, S., et al. (2012). Outcomes and moderators of a preventive school-based mental health intervention for children affected by war in Sri Lanka: A cluster randomized trial. World Psychiatry, 11(2), 114–122. https://doi.org/10.1016/j.wpsyc.2012.05.008.Google Scholar
- Tol, W.A., Komproe, I.H., Jordans, M.J.D., Ngayisaba, A., Ntamutumba, P., Sipsma, H., … & de Jong, J.T.V.M. (2014). School-based mental health intervention for children in war-affected Burundi: A cluster randomized trial. BMC Medicine, 12(1), 56. [Online]. Retrieved from https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-12-56. https://doi.org/10.1186/1741-7015-12-56.
- Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., et al. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72(2), 79–117. https://doi.org/10.1037/a0040.Google Scholar