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

Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis / Matthew D. BURKEY in Journal of Child Psychology and Psychiatry, 59-9 (September 2018)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 59-9 (September 2018) . - p.982-993 Titre : Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis Type de document : Texte imprimé et/ou numérique Auteurs : Matthew D. BURKEY, Auteur ; Megan HOSEIN, Auteur ; Isabella MORTON, Auteur ; Marianna PURGATO, Auteur ; Ahmad ADI, Auteur ; Mark KURZROK, Auteur ; Brandon A. KOHRT, Auteur ; Wietse A. TOL, Auteur Article en page(s) : p.982-993 Langues : Anglais (eng) Mots-clés : Child behaviour  disruptive behaviour disorders  psychosocial interventions  low-income countries  meta-analysis Index. décimale : PER Périodiques Résumé : Background Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was ?0.25 (95% confidence interval (CI): ?0.41 to ?0.09; I2: 78%) and of treatment studies was ?0.56 (95% CI: ?0.51 to ?0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: ?0.35; 95% CI: ?0.57 to ?0.14) and behavioural parenting interventions (SMD: ?0.43; 95% CI: ?0.66 to ?0.20), and that interventions were effective across age ranges. Conclusions Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings. En ligne : https://doi.org/10.1111/jcpp.12894 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=368 [article] Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis [Texte imprimé et/ou numérique] / Matthew D. BURKEY, Auteur ; Megan HOSEIN, Auteur ; Isabella MORTON, Auteur ; Marianna PURGATO, Auteur ; Ahmad ADI, Auteur ; Mark KURZROK, Auteur ; Brandon A. KOHRT, Auteur ; Wietse A. TOL, Auteur . - p.982-993. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 59-9 (September 2018) . - p.982-993 Mots-clés : Child behaviour  disruptive behaviour disorders  psychosocial interventions  low-income countries  meta-analysis Index. décimale : PER Périodiques Résumé : Background Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was ?0.25 (95% confidence interval (CI): ?0.41 to ?0.09; I2: 78%) and of treatment studies was ?0.56 (95% CI: ?0.51 to ?0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: ?0.35; 95% CI: ?0.57 to ?0.14) and behavioural parenting interventions (SMD: ?0.43; 95% CI: ?0.66 to ?0.20), and that interventions were effective across age ranges. Conclusions Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings. En ligne : https://doi.org/10.1111/jcpp.12894 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=368

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