The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis

Pfefferbaum, Betty; Nitiéma, Pascal; Newman, Elana

doi:10.1007/s40653-019-00266-0

Original Article
Published: 21 June 2019

The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis

Journal of Child & Adolescent Trauma volume 13, pages 127–140 (2020)Cite this article

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Abstract

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.

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References

Berger, R., & Gelkopf, M. (2009). School-based intervention for the treatment of tsunami-related distress in children: A quasi-randomized controlled trial. Psychotherapy and Psychosomatics, 78(6), 364–371. https://doi.org/10.1159/000235976.
Article PubMed Google Scholar
Berger, R., Pat-Horenczyk, R., & Gelkopf, M. (2007). School-based intervention for prevention and treatment of elementary-students’ terror-related distress in Israel: A quasi-randomized controlled trial. Journal of Traumatic Stress, 20(4), 541–551. https://doi.org/10.1002/jts.20225.
Article PubMed Google Scholar
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.
Article 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.
Article PubMed PubMed Central Google Scholar
Bland, J. M., & Altman, D. G. (1997). Statistics notes: Cronbach’s alpha. BMJ, 314(7080), 572. https://doi.org/10.1136/bmj.314.7080.572.
Article PubMed PubMed Central 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.
Article PubMed Google Scholar
Bonanno, G. A., Brewin, C. R., Kaniasty, K., & La Greca, A. M. (2010). Weighing the costs of disaster: Consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest, 11(1), 1–49. https://doi.org/10.1177/1529100610387086.
Article PubMed 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.
Article PubMed 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.
Article PubMed 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.
Article PubMed Google Scholar
Chrisman, A. K., & Dougherty, J. G. (2014). Mass trauma: Disasters, terrorism, and war. Child and Adolescent Psychiatric Clinics of North America, 23(2), 257–279. https://doi.org/10.1016/j.chc.2013.12.004.
Article PubMed Google Scholar
Cook, D. A., & Beckman, T. J. (2006). Current concepts in validity and reliability for psychometric instruments: Theory and application. American Journal of Medicine, 119(2), 166.e7–166.e16. https://doi.org/10.1016/j.amjmed.2005.10.036.
Article Google Scholar
Cronbach, L. J., & Meehl, P. E. (1955). Construct validity in psychological tests. Psychological Bulletin, 52(4), 281–302. https://doi.org/10.1037/h0040957.
Article PubMed Google Scholar
De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483–509. https://doi.org/10.1037/0033-2909.131.4.483.
Article PubMed 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.
Article PubMed PubMed Central 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.
Duval, S., & Tweedie, R. (2000). A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95(449), 89–98. https://doi.org/10.2307/2669529.
Article Google Scholar
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629.
Article PubMed PubMed Central Google Scholar
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.
Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., & Neuner, F. (2011). Community-implemented trauma therapy for former child soldiers in northern Uganda. A randomized control trial. JAMA, 306(5), 503–512. https://doi.org/10.1001/jama.2011.1060.
Article PubMed Google Scholar
Fu, C., & Underwood, C. (2015). A meta-review of school-based disaster interventions for child and adolescent survivors. Journal of Child and Adolescent Mental Health, 27(3), 161–171. https://doi.org/10.2989/17280583.2015.1117978.
Article PubMed Google Scholar
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.
Article PubMed Google Scholar
Hartung, J., & Knapp, G. (2001). On tests of the overall treatment effect in meta-analysis with normally distributed responses. Statistics in Medicine, 20(12), 1771–1782. https://doi.org/10.1002/sim.791.
Article PubMed Google Scholar
Hedges, L. V. (1981). Distribution theory for Glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6(2), 107–128. https://doi.org/10.3102/10769986006002107.
Article 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.
Article PubMed 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.
Article 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.65.3.207.20173
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.
Chapter 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.
Partlett, C., & Riley, R. D. (2016). Random effects meta-analysis: Coverage performance of 95% confidence and prediction intervals following REML estimation. Statistics in Medicine, 36(2), 301–317. https://doi.org/10.1002/sim.7140.
Article PubMed PubMed Central Google Scholar
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.
Article PubMed 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.
Article PubMed PubMed Central 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.
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.
Article PubMed Google Scholar
Ruf, M., Schauer, M., Neuner, F., Catana, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23(4), 437–445. https://doi.org/10.1002/jts.20548.
Article PubMed 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.
Book 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.
Article PubMed Google Scholar
Schwarzer, G. (2007). Meta: An R package for meta-analysis. R News, 7(3), 40–45.
Google Scholar
Tavakol, M., & Dennick, R. (2011). Making sense of Chronbach’s alpha. International Journal of Medical Education, 2, 53–55. https://doi.org/10.5116/ijme.4dfb.8dfd.
Article PubMed PubMed Central 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.
Article PubMed Google Scholar
Tol, W. A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T. S., Souz, R., et al. (2011). Mental health and psychosocial support in humanitarian settings: Linking practice and research. Lancet, 378(9802), 1581–1591. https://doi.org/10.1016/s0140-6736(11)61094-5.
Article PubMed PubMed Central 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.
Article PubMed PubMed Central 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.
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36(3), 1–48. https://doi.org/10.18637/jss.v036.i03.
Article Google Scholar
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.
Article Google Scholar

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Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP3217, Oklahoma City, OK, 73126-0901, USA
Betty Pfefferbaum
Department of Management Information Systems, Price College of Business, University of Oklahoma, Norman, OK, USA
Pascal Nitiéma
Department of Psychology, University of Tulsa, Tulsa, OK, USA
Elana Newman

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Betty Pfefferbaum
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Pascal Nitiéma
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Elana Newman
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Correspondence to Betty Pfefferbaum.

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Pfefferbaum, B., Nitiéma, P. & Newman, E. The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis. Journ Child Adol Trauma 13, 127–140 (2020). https://doi.org/10.1007/s40653-019-00266-0

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Published: 21 June 2019
Issue Date: June 2020
DOI: https://doi.org/10.1007/s40653-019-00266-0

Keywords

Children
Disaster
Functional impairment
Mass trauma
Psychological interventions
Terrorism
War
Youth