Background Available evidence on the comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder (PTSD) in children and adolescents remains uncertain. Objective We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents. Methods We searched eight databases and other international registers up to 31 December 2020. The pairwise meta-analyses and frequentist network meta-analyses estimated pooled standardised mean differences (SMDs) and ORs with random-effects model. Efficacy at post-treatment and follow-up, acceptability, depressive and anxiety symptoms were measured. Findings We included 56 randomised controlled trials with 5327 patients comparing 14 different types of psychotherapies and 3 control conditions. For efficacy, cognitive processing therapy (CPT), behavioural therapy (BT), individual trauma-focused cognitive–behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing, and group TF-CBT were significantly superior to all control conditions at post-treatment and follow-up (SMDs between −2.42 and −0.25). Moreover, CPT, BT and individual TF-CBT were more effective than supportive therapy (SMDs between −1.92 and −0.49). Results for depressive and anxiety symptoms were similar to the findings for the primary outcome. Most of the results were rated as ‘moderate’ to ‘very low’ in terms of confidence of evidence. Conclusions CPT, BT and individual TF-CBT appear to be the best choices of psychotherapy for PTSD in young patients. Other types and different ways of delivering psychological treatment can be alternative options. Clinicians should consider the importance of each outcome and the patients’ preferences in real clinical practice. Data are available in a public, open access repository.

中文翻译：

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儿童和青少年创伤后应激障碍心理治疗的比较疗效和可接受性：系统评价和网络荟萃分析

背景 关于心理疗法治疗儿童和青少年创伤后应激障碍（PTSD）的相对疗效和可接受性的现有证据仍不确定。目的 我们旨在对儿童和青少年 PTSD 的不同类型和形式的心理治疗进行比较和排名。方法 我们检索了截至 2020 年 12 月 31 日的八个数据库和其他国际登记册。配对荟萃分析和频率网络荟萃分析使用随机效应模型估计了汇总标准化均值差异 (SMD) 和 OR。测量治疗后和随访的疗效、可接受性、抑郁和焦虑症状。结果 我们纳入了 56 项随机对照试验，涉及 5327 名患者，比较了 14 种不同类型的心理治疗和 3 种对照条件。就疗效而言，认知加工疗法（CPT）、行为疗法（BT）、个体创伤聚焦认知行为疗法（TF-CBT）、眼动脱敏和再加工以及团体 TF-CBT 均显着优于术后所有对照条件。 -治疗和随访（SMD在-2.42和-0.25之间）。此外，CPT、BT 和个体 TF-CBT 比支持疗法更有效（SMD 介于 -1.92 和 -0.49 之间）。抑郁和焦虑症状的结果与主要结局的结果相似。就证据可信度而言，大多数结果被评为“中等”至“非常低”。结论 CPT、BT 和个体 TF-CBT 似乎是年轻患者 PTSD 心理治疗的最佳选择。其他类型和不同的心理治疗方式也可以作为替代选择。临床医生应考虑每个结果的重要性以及患者在实际临床实践中的偏好。数据可在公共、开放访问存储库中获取。