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Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence
Journal of the American Academy of Child and Adolescent Psychiatry ( IF 13.3 ) Pub Date : 2022-05-09 , DOI: 10.1016/j.jaac.2022.05.002
Tommaso Boldrini 1 , Viola Ghiandoni 2 , Elisa Mancinelli 1 , Silvia Salcuni 1 , Marco Solmi 3
Affiliation  

Objective

Disruptive behavior disorders (DBDs) represent a common motive for referral among youths. This meta-analysis aimed at estimating the efficacy of psychosocial interventions for adolescents with DBDs.

Method

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)−compliant systematic review of MEDLINE/PubMED/PsycINFO/Cochrane Central Register of Controlled Trials was conducted. Eligible studies were randomized controlled trials (RCTs) administering psychosocial interventions to adolescents with DBD, published before April 5, 2020. From the initial set of 6,006 records, 17 RCTs involving 18 cohorts (16 publications) were subjected to a random-effect meta-analysis (involving sensitivity, subgroup, and meta-regression analyses). Primary and secondary outcomes were externalizing symptoms at RCT endpoint (ie, standardized mean difference [SMD]) and acceptability (drop-out odds ratio [OR]), respectively. Risk of bias was assessed using the Risk of Bias 2 tool.

Results

A total of 17 RCTs, involving 1,954 adolescents, were included. The mean age was 14.09 (SD 1.33) years; 61% were male. The mean RCT duration was 12 weeks, with a mean follow-up of 8 (SD 3.98) months. Concern over risk of bias emerged in 12 studies, with high concern in 6. Psychosocial interventions had a large effect size at RCT endpoint (SMD = 0.98, 95% CI = −0.55 to −1.38, k = 18) and were acceptable (drop-out OR = 1.29, 95% CI = 0.62-2.70, k = 13). However, this beneficial effect did not persist at follow-up (SMD = −0.36, 95% CI = 0.06 to −0.78, k = 10). Family format was the most effective variable. No other clinically significant moderator was found.

Conclusion

Psychosocial interventions involving the families of DBD adolescents are effective and acceptable in the short term. Future studies should focus on strategies to achieve their long-term efficacy.



中文翻译:

系统回顾和荟萃分析:青春期破坏性行为症状和障碍的社会心理治疗

客观的

破坏性行为障碍(DBD) 是青少年转诊的常见动机。这项荟萃分析旨在评估社会心理干预对患有 DBD 的青少年的疗效。

方法

对 MEDLINE/PubMED/PsycINFO/Cochrane 对照试验中央登记册进行了符合系统评价和元分析 (PRISMA) 的首选报告项目。符合条件的研究是在 2020 年 4 月 5 日之前发表的对患有 DBD 的青少年进行社会心理干预的随机对照试验 (RCT)。从最初的 6,006 条记录中,涉及 18 个队列(16 篇出版物)的 17 项随机对照试验接受了随机效应元-分析(涉及敏感性、亚组和元回归分析)。主要和次要结果分别是 RCT 终点的外化症状(即标准化平均差 [S​​MD])和可接受性(退出比值比 [OR])。使用偏倚风险 2 工具评估偏倚风险。

结果

共纳入 17 项随机对照试验,涉及 1,954 名青少年。平均年龄为 14.09 (SD 1.33) 岁;61% 是男性。平均 RCT 持续时间为 12 周,平均随访时间为 8 (SD 3.98) 个月。12 项研究出现了对偏倚风险的担忧,其中 6 项研究高度关注。社会心理干预在 RCT 终点具有较大的效应量(SMD = 0.98,95% CI = -0.55 至 -1.38,k = 18)并且是可以接受的(下降-输出 OR = 1.29,95% CI = 0.62-2.70,k = 13)。然而,这种有益效果在随访中并未持续存在(SMD = −0.36,95% CI = 0.06 至 −0.78,k = 10)。家庭形式是最有效的变量。没有发现其他有临床意义的调节剂。

结论

涉及 DBD 青少年家庭的社会心理干预在短期内是有效且可接受的。未来的研究应侧重于实现其长期疗效的策略。

更新日期:2022-05-09
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