BACKGROUND Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways. METHODS We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review. RESULTS We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%. CONCLUSIONS Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency.

中文翻译：

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在资源匮乏的人道主义环境中为儿童提供有针对性的社会心理支持干预措施的调解人：来自 3,143 名参与者的个人参与者数据集的分析。

背景社会心理干预的研究一直集中在心理社会干预对心理健康结果的有效性上，而没有探索干预如何取得有益效果。通过强调与此类途径相关的特定组成部分，确定干预工作的潜在途径可能会进一步加强干预。方法 我们使用来自 11 个随机对照试验 (RCT) 的数据集中的个体参与者数据进行了预先计划的调解分析，这些数据比较了受人道主义危机影响的中低收入国家 (LMIC) 儿童的重点心理社会支持干预与对照条件。基于生态恢复力框架，我们假设（a）应对，（b）希望，（c）社会支持，(d) 功能障碍介导干预和结果 PTSD 症状之间的关系。截至 2018 年 8 月，对 Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE、PubMed、PyscARTICLES、Web of Science 和主要的本地 LMIC 数据库进行了系统搜索。 使用从研究中获得的个体参与者数据对假设进行了测试系统评价中所有研究的作者。结果 我们纳入了来自 11 项研究的 3,143 名儿童（100% 来自纳入研究的数据），其中来自六项研究的 1,877 名儿童参与了中介分析。功能障碍是针对 PTSD 进行重点心理社会干预的最强中介因素（中介系数 -0.087，标准误 0.040）。由功能障碍介导的估计影响比例，并针对混杂因素进行了调整，为 31%。结论 结果不支持提议的应对、希望和社会支持的中介假设。通过功能障碍进行的调解可能代表未测量的代理措施或指向影响自我效能和代理的更广泛机制。