A systematic review and meta-analysis published in the Journal of the American Academy of Child & Adolescent Psychiatry found that group-based posttraumatic stress disorder (PTSD) interventions, particularly with cognitive behavioral therapy (CBT)-based components, were effective at addressing posttrauma distress in children.
Investigators from the University of Bath in the United Kingdom searched publication databases through June 2021 for studies evaluating the efficacy of group-based PTSD interventions in the pediatric setting. A total of 42 studies were included in this analysis.
The pooled population comprised of 5998 pediatric patients with a mean age of 12.4 (range, 6 to 19) years and 52.9% were girls or women. Most studies (n=25) were conducted in the school setting, followed by in community (n=9), during mental health services (n=4), during social care (n=3), and in youth offending (n=1) settings. Most studies recruited patients exposed to interpersonal trauma (n=32), such as war (n=14), or nonpersonal traumas, such as natural disasters (n=7).
The studies mostly used targeted treatment approaches (n=32) and CBT-based interventions were most common (n=37). Interventions were delivered by mental health professionals (n=14), school staff (n=11), social care professionals (n=7), or community members (n=4). The most common comparator condition was waitlist (n=24), followed by treatment as usual (n=6), a different group-based intervention (n=6), individual trauma-focused intervention (n=4), or another trauma-focused group intervention (n=1).
The pooled effect of the interventions on PTSD symptoms posttreatment compared with controls had a median effect size (g, -0.55; 95% CI, -0.76 to -0.35; I2, 92%). Stratified by comparator treatment, the effect sizes were medium to large when the comparator was a passive control (g, -0.71; 95% CI, -0.97 to -0.45) and small to medium effect when the comparator was an active control (g, -0.25; 95% CI, -0.47 to -0.03).
Of note, the study that used an individual psychologic treatment intervention as comparator had an effect size in the opposite direction (g, 0.69; 95% CI, 0.17-1.22), favoring individualized treatment.
Excluding the study with the individual intervention, group treatment was favored over comparator at follow-up (g, -0.28; 95% CI, -0.43 to -0.12; I2, 65%).
In a moderation analysis, significant effects were observed for the type of comparator (Q, 4.55; P =.03), in which, effects were larger in passive (g, -0.71) rather than active (g, -0.25) comparator studies. No other significant moderators were observed.
For the specific outcome of depression, the group-based PTSD interventions were associated with improved symptoms (g, -0.30; 95% CI, -0.48 to -0.12; I2, 82%). However, the effect was no longer significant at follow-up (g, -0.11; 95% CI, -0.25 to -0.02).
The major limitation of this study was the high heterogeneity between studies observed and the fact that most studies were at a high risk for bias.
Analysis authors concluded, “Overall, findings from this meta-analysis provide support for the use of group (particularly CBT-based) interventions for treating PTSD symptoms in trauma-exposed children and young people, with potential for related reductions in depression symptoms. This has important implications for contexts in which group [programs] may be the most or only viable option, including communities exposed to conflict or natural disaster, through to poorly resourced services.”
Davis RS, Meiser-Stedman R, Afzal N, et al. Meta-analytic review: group-based interventions for treating posttraumatic stress symptoms in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2023;S0890-8567(23)00129-6. doi:10.1016/j.jaac.2023.02.013