| 刘浚禹,汪健健,罗园,赵丽萍,刘芷静.叙事暴露疗法在儿童和青少年创伤后应激障碍患者中应用效果的Meta分析[J].四川精神卫生杂志,2024,37(2):179-186.Liu Junyu,Wang Jianjian,Luo Yuan,Zhao Liping,Liu Zhijing,Effectiveness of narrative exposure therapy for post-traumatic stress disorder in children and adolescents： a Meta-analysis[J].SICHUAN MENTAL HEALTH,2024,37(2):179-186 |
| 叙事暴露疗法在儿童和青少年创伤后应激障碍患者中应用效果的Meta分析 |
| Effectiveness of narrative exposure therapy for post-traumatic stress disorder in children and adolescents： a Meta-analysis |
| 投稿时间：2023-02-22 |
| DOI：10.11886/scjsws20230222007 |
| 中文关键词: 叙事暴露疗法 创伤后应激障碍 儿童 青少年 Meta分析 |
| 英文关键词:Narrative exposure therapy Post-traumatic stress disorder Children Adolescents Meta-analysis |
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| 中文摘要: |
| 背景 叙事暴露疗法（NET）结合叙事疗法和暴露疗法的优点，对缓解创伤后应激障碍（PTSD）症状有效，有助于患者对创伤进行深入的认识，也具有较好的安全性。儿童和青少年是PTSD的高发人群，但NET对该人群干预效果的研究结果存在差异。目的 系统评价NET对儿童和青少年PTSD患者的干预效果，为NET的临床应用提供参考。方法 于2022年8月1日，计算机检索Cochrane Library、PubMed、Web of Science、CINAHL、中国知网（CNKI）、中国生物医学文献数据库（SinoMed）、维普数据库和万方数据库，检索时限为建库至2022年6月。采用主题词与自由词相结合的方式进行检索，收集NET治疗儿童和青少年PTSD的文献。根据Cochrane协作网更新的偏倚风险评估手册中对随机对照试验的真实性评价标准（2011），评价文献质量。采用RevMan 5.4对纳入的随机对照试验进行Meta分析。结果 纳入9篇文献，共包括394例儿童和青少年PTSD患者。Meta分析结果显示，在PTSD症状缓解程度方面，干预后1~3个月（SMD=0.22，95% CI：-0.84~1.28）以及干预后6个月（SMD=0.21，95% CI：-0.75~1.17），NET与放松疗法的效果比较，差异无统计学意义；干预后1~3个月（SMD=-0.66，95% CI：-1.04~-0.27）以及干预后6个月（SMD=-0.77，95% CI：-1.36~-0.19），NET的效果均优于常规治疗，差异均有统计学意义。在抑郁症状缓解程度方面，治疗后1~3个月，NET与常规治疗的效果比较，差异无统计学意义（SMD=-0.39，95% CI：-0.98~0.21）；干预后6个月，NET与常规治疗的效果比较，差异无统计学意义（SMD=-0.74，95% CI：-2.23~0.75）。在心理困扰缓解程度方面，干预后1~3个月，NET与常规治疗的效果比较，差异无统计学意义（SMD=-0.54，95% CI：-2.14~1.07）。在食欲亢进缓解程度方面，NET与常规治疗的效果比较，差异无统计学意义（SMD=-0.17，95% CI：-0.54~0.19）。结论 与常规治疗相比，NET对缓解儿童和青少年PTSD症状的效果更佳，且具有中长期效果，但在改善抑郁症状、心理困扰以及食欲亢进方面无明显优势。 |
| 英文摘要: |
| Background Narrative exposure therapy （NET）， an integration of narrative therapy and exposure therapy， has been shown to be effective in relieving the symptoms of post-traumatic stress disorder （PTSD）， which can help patients gain a deeper understanding of their trauma and is also considered to be quite safe. PTSD is highly prevalent in children and adolescents， while the effectiveness of NET intervention varies among the subjects.Objective To systematically evaluate the effectiveness of NET for PTSD in children and adolescents， so as to provide references for the clinical application of NET.Methods On August 1， 2022， the Cochrane Library， PubMed， Web of Science， CINAHL， China National Knowledge Infrastructure （CNKI）， SinoMed， VIP and Wanfang database were searched from their inception to June 2022. Search was conducted with the use of a combination of medical subject heading and free text terms， and randomized controlled trials relevant to NET for PTSD in children and adolescents were collected. Then the quality of the controlled trials was evaluated according to the Cochrane Collaboration's tool for assessing risk of bias （2011）， and Meta-analysis was performed using RevMan 5.4 software.Results Nine randomized controlled trials involving 394 children and adolescents with PTSD were included. Meta-analysis showed that NET and relaxation therapy reported comparable symptom relief in PTSD patients within 1 to 3 months after intervention （SMD=0.22， 95% CI： -0.84~1.28） and at 6 months after intervention （SMD=0.21， 95% CI： -0.75~1.17）， while NET provided greater PTSD symptom relief than routine therapy both within 1 to 3 months after intervention （SMD=-0.66， 95% CI： -1.04~-0.27） and at 6 months after intervention （SMD=-0.77， 95% CI： -1.36~-0.19）， with statistically significant differences. Regarding the alleviation of depressive symptoms， the effect was similar between NET and routine therapy within 1 to 3 months after intervention （SMD=-0.39， 95% CI： -0.98~0.21） and at 6 months after intervention （SMD=-0.74， 95% CI： -2.23~0.75）. No statistical difference was demonstrated between NET and routine therapy in relieving psychological distress （SMD=-0.54， 95% CI： -2.14~1.07） and suppressing hyperorexia （SMD=-0.17， 95% CI： -0.54~0.19） 1 to 3 months after intervention.Conclusion NET yields a better outcome and a medium- and long-term effectiveness in alleviating symptoms of PTSD in children and adolescents compared with routine therapy， while it does not offer any significant advantages in improving depression symptoms， psychological distress and hyperorexia. |
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