Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants / Marianna PURGATO in Journal of Child Psychology and Psychiatry, 61-5 (May 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.584-593 Titre : Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants Type de document : Texte imprimé et/ou numérique Auteurs : Marianna PURGATO, Auteur ; Federico TEDESCHI, Auteur ; Theresa S. BETANCOURT, Auteur ; Paul BOLTON, Auteur ; Chiara BONETTO, Auteur ; Chiara GASTALDON, Auteur ; James GORDON, Auteur ; Paul O'CALLAGHAN, Auteur ; Davide PAPOLA, Auteur ; Kirsi PELTONEN, Auteur ; Raija-Leena PUNAMAKI, Auteur ; Justin RICHARDS, Auteur ; Julie K. STAPLES, Auteur ; Johanna UNTERHITZENBERGER, Auteur ; Joop DE JONG, Auteur ; Mark J. D. JORDANS, Auteur ; Alden L. GROSS, Auteur ; Wietse A. TOL, Auteur ; Corrado BARBUI, Auteur Article en page(s) : p.584-593 Langues : Anglais (eng) Mots-clés : Mediation analysis  children  humanitarian setting  individual participant data  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways. METHODS: We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review. RESULTS: We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%. CONCLUSIONS: Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency. En ligne : http://dx.doi.org/10.1111/jcpp.13151 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422 [article] Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants [Texte imprimé et/ou numérique] / Marianna PURGATO, Auteur ; Federico TEDESCHI, Auteur ; Theresa S. BETANCOURT, Auteur ; Paul BOLTON, Auteur ; Chiara BONETTO, Auteur ; Chiara GASTALDON, Auteur ; James GORDON, Auteur ; Paul O'CALLAGHAN, Auteur ; Davide PAPOLA, Auteur ; Kirsi PELTONEN, Auteur ; Raija-Leena PUNAMAKI, Auteur ; Justin RICHARDS, Auteur ; Julie K. STAPLES, Auteur ; Johanna UNTERHITZENBERGER, Auteur ; Joop DE JONG, Auteur ; Mark J. D. JORDANS, Auteur ; Alden L. GROSS, Auteur ; Wietse A. TOL, Auteur ; Corrado BARBUI, Auteur . - p.584-593. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.584-593 Mots-clés : Mediation analysis  children  humanitarian setting  individual participant data  trauma Index. décimale : PER Périodiques Résumé : BACKGROUND: Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways. METHODS: We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review. RESULTS: We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%. CONCLUSIONS: Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency. En ligne : http://dx.doi.org/10.1111/jcpp.13151 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422

Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia / Jeremy C. KANE in Journal of Child Psychology and Psychiatry, 57-10 (October 2016)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 57-10 (October 2016) . - p.1194-1202 Titre : Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia Type de document : Texte imprimé et/ou numérique Auteurs : Jeremy C. KANE, Auteur ; Laura K. MURRAY, Auteur ; Judith A. COHEN, Auteur ; Shannon DORSEY, Auteur ; Stephanie SKAVENSKI VAN WYK, Auteur ; Jennica GALLOWAY HENDERSON, Auteur ; Mwiya IMASIKU, Auteur ; John MAYEYA, Auteur ; Paul BOLTON, Auteur Article en page(s) : p.1194-1202 Langues : Anglais (eng) Mots-clés : Posttraumatic stress disorder  orphans and vulnerable children  Zambia  trauma-focused cognitive behavioral therapy  moderation analysis Index. décimale : PER Périodiques Résumé : Background The effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia. Methods Data were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment. Results Treatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p < .05; functioning, p < .01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p < .01), and better functioning in those that identified their father as the primary caretaker (p < .05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p < .01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment. Conclusions This study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBT is warranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized trials of interventions in LMIC should power for moderation analyses in the study design phase when feasible. En ligne : http://dx.doi.org/10.1111/jcpp.12623 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=295 [article] Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia [Texte imprimé et/ou numérique] / Jeremy C. KANE, Auteur ; Laura K. MURRAY, Auteur ; Judith A. COHEN, Auteur ; Shannon DORSEY, Auteur ; Stephanie SKAVENSKI VAN WYK, Auteur ; Jennica GALLOWAY HENDERSON, Auteur ; Mwiya IMASIKU, Auteur ; John MAYEYA, Auteur ; Paul BOLTON, Auteur . - p.1194-1202. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 57-10 (October 2016) . - p.1194-1202 Mots-clés : Posttraumatic stress disorder  orphans and vulnerable children  Zambia  trauma-focused cognitive behavioral therapy  moderation analysis Index. décimale : PER Périodiques Résumé : Background The effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia. Methods Data were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment. Results Treatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p < .05; functioning, p < .01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p < .01), and better functioning in those that identified their father as the primary caretaker (p < .05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p < .01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment. Conclusions This study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBT is warranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized trials of interventions in LMIC should power for moderation analyses in the study design phase when feasible. En ligne : http://dx.doi.org/10.1111/jcpp.12623 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=295

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