Background:

Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions.

Aim/Methods:

We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions.

Results:

From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness.

Conclusion:

Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial’s that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).

中文翻译：

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监狱环境中以创伤为中心的干预措施的有效性：系统回顾和荟萃分析

背景：

相对于社区人口，创伤后应激障碍 (PTSD) 在监狱中的比例过高，并且在可能固有地加剧创伤相关症状的环境中可能难以管理。人们对监狱中以创伤为中心的干预措施的有效性知之甚少，对缓和这些干预措施有效性的因素也知之甚少。

目的/方法：

我们使用元分析技术检查了监狱中以创伤为中心的干预措施相对于监狱控制措施的有效性。我们进一步使用元回归分析来检查治疗、方法和参与者级别的调节因素，以确定提高这些干预措施有效性的因素。

结果：

从符合荟萃分析条件的 16 项研究中，我们发现以创伤为中心的干预措施的效果虽小但意义重大。第 2 阶段的创伤处理干预和单独实施的干预导致 PTSD 症状明显减少。使用主动治疗控制的研究比使用候补名单或无接触控制的研究产生的效果更小。治疗时间、研究质量、结果类型和性别不是治疗效果的重要调节因素。

结论：

本次审查的结果令人鼓舞，但应谨慎解读。结果表明，创伤处理疗法和以创伤为中心的个体干预方式可以有效并在监狱中成功实施。然而，不充分的比较组并不能得出明确的结论。需要高质量的随机对照试验来额外测量复杂的 PTSD，利用模块化治疗方法，并包括国家健康和护理卓越研究所 (NICE) 指南中推荐的治疗方法，例如以创伤为中心的 CBT 和眼动脱敏再处理（EMDR）。