叙事暴露疗法在儿童及青年创伤后应激障碍患者中应用效果的Meta分析

Effectiveness of narrative exposure therapy in children and adolescents with post-traumatic stress disorder ：A Meta-analysis

投稿时间：2023-02-22 修订日期：2024-03-02

DOI：

中文关键词: 叙事暴露疗法创伤后应激障碍儿童青年 Meta分析

英文关键词:narrative exposure therapy post-traumatic stress disorder children adolescents Meta-anal

基金项目:湖南省卫健委科研计划项目课题

作者	单位	地址
刘浚禹	中南大学湘雅护理学院	中南大学湘雅二医院精卫楼13楼
罗园	中南大学湘雅护理学院
汪健健^*	中南大学湘雅二医院
赵丽萍	中南大学湘雅二医院	中南大学湘雅二医院科教楼宣传办

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中文摘要:

【摘要】背景叙事暴露疗法（NET）已在研究中被证明可缓解PTSD症状，该方法结合叙事疗法和暴露疗法的优点，既保证患者对创伤有深入的认识，也保证了治疗的安全性。儿童和青少年是创伤后应激障碍（PTSD）的高发人群，但NET在该人群中效果存在差异。目的系统评价叙事暴露疗法（NET）对儿童及青少年PTSD患者的效果，为叙事暴露疗法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，收集叙事暴露疗法治疗儿童及青少年创伤后应激障碍的文献。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）对文献进行质量评价，采用RevMan5.4对纳入的随机对照试验进行Meta分析。结果纳入9篇文献，包括394例儿童及青少年PTSD患者。Meta分析结果显示，PTSD症状缓解程度比较中，叙事暴露疗法与放松疗法无显著性差异（干预后SMD=0.22，95% CI：-0.84~1.28，Z=0.41，P＞0.05；干预后6个月SMD=0.21，95% CI：-0.75~1.17，Z=0.43，P＞0.05），叙事暴露疗法效果优于常规治疗（干预后SMD=-0.66，95% CI：-1.04~-0.27，Z=3.34，P＜0.05；干预后6个月SMD=-0.77，95% CI：-1.36~-0.19，Z=2.58，P＜0.05）；共4篇文献比较抑郁缓解程度，叙事暴露疗法与常规治疗无显著性差异（SMD=-0.39，95% CI：-0.98~0.21，Z=1.26，P＞0.05），其中，2篇文献比较干预后6个月两组无统计学差异（SMD=-0.74，95% CI：-2.23~0.75，Z=0.97，P＞0.05）；2篇文献比较心理困扰缓解程度，叙事暴露疗法与常规治疗无显著性差异（SMD=-0.54，95% CI：-2.14~1.07，Z=0.65，P＞0.05）；共2篇文献比较食欲亢进缓解程度，叙事暴露疗法与常规治疗无显著性差异（SMD=-0.17，95% CI：-0.54~0.19，Z=0.93，P＞0.05）。结论叙事暴露疗法相较于常规治疗缓解儿童及青少年PTSD症状效果更佳，且具有中长期效果，但在抑郁和心理困扰治疗中无明显优势。

英文摘要:

【Abstract】 Background Narrative exposure therapy (NET) has been shown to alleviate symptoms of post-traumatic stress disorder (PTSD)in studies, and the approach combines the advantages of both narrative therapy and exposure therapy. It ensures that the patient has a comprehensive understanding of the trauma and that the treatment is safe. Children and adolescents have a high prevalence of PTSD, but there are differences in the effectiveness of NET in this population. Objective Explore effectiveness of narrative exposure therapy in children and adolescents with PTSD, in order to provide references for clinical practice and research in the future. Methods On August 1,2022, The Cochrane Library, PubMed, Web of Science, CINAHL, CNKI, SinoMed, VIP and Wanfang database were searched from?inception to June 2022. The method of combining subject words with free words is used to search the randomized controlled trials (RCTs)about effectiveness of narrative exposure therapy in children and adolescents with PTSD. The quality of the literature was evaluated by the Cochrane Collaboration’s tool for bias risk assessment of randomized controlled trials (2011), and Meta-analysis was performed on the included RCTs by RevMan5.4. Results There are 9 included literatures and a total of 394 samples with PTSD were included. Meta-analysis results showed that there was no significant difference between narrative exposure therapy and relaxation therapy in terms of PTSD symptom (post-intervention SMD=0.22,95% CI：-0.84~1.28,Z=0.41,P＞0.05; 6 months post-intervention SMD=0.21,95% CI：-0.75~1.17,Z=0.43,P＞0.05), and narrative exposure therapy was more effective than treatment as usual (post-intervention SMD=-0.66,95% CI：-1.04~-0.27,Z=3.34,P＜0.05; 6 months post-intervention SMD=-0.77,95% CI：-1.36~-0.19,Z=2.58,P＜0.05); a total of 4 literatures comparing depression, narrative exposure therapy was not significantly different from treatment as usual (SMD=-0.39,95% CI：-0.98~0.21,Z=1.26,P＞0.05),and a total of 4 literatures comparing depression after 6 mouths, narrative exposure therapy was not significantly different from treatment as usual(SMD=-0.74,95% CI：-2.23~0.75,Z=0.97,P＞0.05); A total of 2 papers comparing mental distress, narrative exposure therapy was not significantly different from treatment as usual (SMD=-0.54,95% CI：-2.14~1.07,Z=0.65,P＞0.05); A total of 2 papers comparing appetite aggression, narrative exposure therapy was not significantly different from treatment as usual (SMD=-0.17,95% CI：-0.54~0.19,Z=0.93,P＞0.05). Conclusion According to the Meta-analysis, narrative exposure therapy was more effective than treatment as usual for PTSD symptoms of children and adolescents with medium to long-term effects, but had no significant advantage in the treatment of depression and mental distress.

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