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Of the 57 eligible RCTs ( n = 4295), 51 RCTs were included in quantitative analyses
Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas.
We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the priple mean age
Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges’ g = 1.09; 95% CI 0.70–1.48; k = 8 trials) and multiple-trauma-related PTSD ( g = 1.11; 95% CI 0.74–1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSDparison with active control conditions regarding single-event PTSD was not possible owing to scarcity ( k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive–behavioural therapy only).
The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.
Keywords
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Post-traumatic stress disorder (PTSD) is a common disorder in children and adolescents. Reference Alisic, Zalta, van Wesel, Larsen, Hafstad and Hassanpour 1 Meta-analytic reviews of randomised controlled trials (RCTs) have concluded that psychological interventions for PTSD produce large and medium effect sizes compared with waiting-list and active control conditions respectively. Reference Hoppen and Morina 2, Reference Gutermann, Schreiber, Matulis, Schwartzkopff, Deppe and Steil 3 However, patients in these trials differed with respect to whether they had been exposed to single or multiple traumatic events. Research findings suggest that youth exposed to multiple traumatic events are more likely to develop PTSD and have more severe PTSD symptoms than those exposed to single traumatic events. Reference Copeland, Keeler, Angold and Costello 4– Reference Turner, Shattuck, Finkelhor and Hamby 6 Crucially, research further suggests that multiple exposure to traumatic events is associated with elevated lifetime adversity, greater likelihood of living in disordered communities and low levels of family support. Reference Turner, Shattuck, Finkelhor and Hamby 6 This suggests that youth exposed to multiple traumas may gain less from current psychological interventions than youth with exposure to a single trauma. Existing meta-analytic reviews have not yet addressed this relevant patient characteristic as a potential moderator of treatment efficacy. Potential differences in treatment outcome for youth exposed to single versus multiple traumas would make adjustment of current treatments necessary to better meet their needs. Against this background, we aimed to examine whether treatment efficacy is diminished when patients report multiple (versus single) traumas. To this end, we conducted a systematic review and meta-analysis of RCTs on the efficacy of psychological interventions for paediatric PTSD.
Method
The aims and methods of this meta-analysis were pre-registered with the PROSPERO database (registration number CRD42022338484) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines Reference Moher, Liberati, Tetzlaff and Altman 7 were followed. Two raters independently conducted the systematic literature search (title and abstract screening, full-text screening) and all following steps (data extractions, risk of bias assessment, categorisation of single versus multiple trauma trials). Disagreements were systematically analysed after each step and discussed among the authors until consensus was reached. We pre-registered the formulation of the main research question of the present work in terms of the Population, Intervention, Comparison, Outcome and Study (PICOS) framework as follows: in children and adolescents with full or partial PTSD (P), are psychological interventions (I), compared with passive control conditions, active control conditions or psychological interventions of another family of intervention (C), less effective when (most) participants survived multiple- versus single-event trauma (O), as studied in randomised controlled trials (S)?
